Would targeting mental illness stop more mass shootings?
It's an idea that is mentioned frequently in the wake of tragedies, including the recent shooting at Marjory Stoneman Douglas High School in Parkland, Florida that left 17 people dead.
What is currently known about the mental health of the 19 year-old shooter is murky at best. Some of his behavior distressed classmates and worried teachers. His actions were reported to both therapists and law enforcement. He was seen by crisis health workers and released. Diagnosis of a severe mental illness has not been made public.
People often think that a severe mental illness refers to a spectrum of how bad any diagnosable mental illness might be. But, Dr. Amy Barnhorst, vice chairwoman of community psychiatry at the University of California-Davis, said to MPR News that health professionals use the term in a specific way. "If you considered everything in there [Diagnostic and Statistical Manual of Mental Disorders] a mental illness you would be including things like caffeine intoxication and certain sleep problems. When we talk about severe mental illness we're talking about things like schizophrenia, bipolar disorder...severe depression."
However, even if a diagnosis of a severe mental illness is released in the coming days, it would put the alleged shooter in the minority when compared to his peers. A study of mass 235 mass murders conducted by Dr. Michael Stone of Columbia University found that only 22 percent could be considered mentally ill.
A separate study found that the risk of violence associated with mental illness alone is only about four percent.
The fact so many conversations on mental illness come in the wake of violence is a point of frustration for John Snook, executive director of the Treatment Advocacy Center.
"When these tragedies happen the discussion is often focused on how didn't this person get care. And I think it's important that we try to flip that discussion and think about the fact that these sorts of incidents are rare. But, even these sorts of situations where we have folks who are really sick and really in need of care... even then the system is not working. And, so for everybody else who is trying to get care, they're struggling even more."
Access is one of the major barriers to people getting the care that they need.
Since the John F Kennedy Community Mental Health Act of 1963 about 90 percent of beds reserved for the mentally ill in state hospitals have been eliminated.
Costs, limited access to care and stigma have contributed to a triage approach to treating people with mental illness. One major factor in determining whether or not a patient gets care is by assessing if they are in danger of harming themselves or others.
Snook points out that waiting for patients to reach dangerous levels is not how we treat any other illness.
In his work, he fields calls from all over the country. "Families say I knew my loved one was sick. This has happened over and over again. He stopped taking his medication. He stopped showering. He was talking to himself. If we could have gotten him care a month ago, we know that we could have gotten him back on track. But everyone we called, said, 'Well, he doesn't sound dangerous." Snook understands the frustration that causes families.
"Who cares if he is dangerous or not?" Snook said. "He is sick."
Use the audio player above to hear the full discussion.