Can better mental health care prevent mass killings like the Sandy Hook school shootings?

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In the wake of the Sandy Hook elementary school shootings, an online essay written by the mother of a mentally ill son has gone viral, shifting a portion of the post-tragedy conversation away from the familiar debate on gun control and toward a conversation about untreated mental illness and its link to violence.

In the essay, “I am Adam Lanza’s Mother,” Liza Long of Boise, Idaho offers a poignant and personal tale of her struggles with her violent 13-year-old son who, she says, has long suffered from mental illness.

She tells  of incidents in which her son pulled a knife and threatened to kill her and himself.  

The article struck a chord in a nation numb from the Dec. 14 mass killing at Sandy Hook Elementary School in Newtown, Conn.  Authorities have identified Adam Lanza, 20, as the shooter who, they say,  killed his mother Nancy, along with 20 children and six adults at the school, before turning his gun on himself. 

“This problem is too big for me to handle on my own,” Long writes. “Sometimes there are no good options. So you just pray for grace and trust that in hindsight, it will all make sense.”

“We hear stories like this all too often from families who are desperate and who are saying, 'How do I keep my child safe? How do I keep myself safe?'” says Doris A. Fuller, executive director of the non-profit Treatment Advocacy Center  (TAC). Her organization focuses on  how best to treat those who are severely mentally ill. “I have one mother who routinely sends me emails, ‘I’m locked in my room, he’s threatening to kill me,’" says Fuller. "And what is just heart wrenching is we are not doing anything to fix the system that allows that to happen.”

Widespread elimination of psychiatric hospital beds in California and throughout the nation, Fuller says, has resulted in a mental health system that “completely fails individuals with mental health illness, and the communities they live in.”

As an example, she cites the lack of psychiatric hospital beds nationwide, which are at levels last seen in 1850, according to a  study TAC issued in July, “No Room at the Inn.” 

Nationwide, the study indicates there are about 14 hospital beds for every 100,000 persons, far lower than the 50 beds per 100,000 persons that’s “generally considered by people in the field to be minimally adequate,” Fuller says.

The consequences of too few public psychiatric beds include: “increased homelessness; the incarceration of severely mentally ill individuals in jails and prisons; emergency rooms being overrun with patients waiting for a psychiatric bed; and an increase in violent behavior, including homicides, in communities across the nation,” says a 2008 TAC study, “The Shortage of Public Hospital Beds for Mentally Ill Persons.”

That’s prompted many in the mental health community to fight for mandatory outpatient treatment for a small subset of the mentally ill -  the untreated severely mentally ill  who suffer from a lack of awareness about their illness and their need for help. 

Called, Anosognosia,  this lack of awareness is a neurological condition that mandatory outpatient treatment laws are designed to address.  With such laws in place, family members can ask a court to order their mentally ill loved one to undergo outpatient treatment.

In California, Laura’s Law is a state law that allows counties to adopt mandated outpatient care in certain cases. It applies only to patients with severe mental illness and a history of multiple hospitalizations or jail time.

 The law lets a judge order such patients into “assisted outpatient treatment” that enables them to maintain jobs and live in their communities.

Nevada County, the only one of California’s 58 counties to adopt the law, issued a grand jury report last June that says Laura’s Law saves money and lives. 

So far, Nevada county officials say every dollar they’ve spent on Laura’s Law has saved them $1.81, as fewer people end up in jail or locked down on emergency psychiatric holds.

But not everyone agrees court-mandated psychiatric care is a good idea.

“If somebody in fact is involuntarily treated, often they will avoid mental health services in the future. For a lot of reasons I don’t think it’s the panacea it’s made out to be,” says Jim Preis, an attorney with Mental Health Advocacy Services in Los Angeles, a non-profit organization that represents clients with mental illnesses.

“Nevada County is small and I’m not saying they weren’t helped," says Preis, "but it’s not clear to me that if they were provided intensive services without the court, without the judge ordering them, that they wouldn’t have been helped equally well.”  Preis advocates for “intensive” community mental health services, such as 24-hour clinic assistance, social support for patients and help in obtaining food and shelter. He says patients, not judges, should be the ones to choose  such treatments. 

But some families of the sickest of the sick counter that while that sounds good, it won’t work for their children, among them Orange County resident Jennifer Hoff.

Hoff raised a mentally ill son. She fears that patients-rights laws that proved valuable in protecting the mentally ill against abuses uncovered in the former overcrowded state psychiatric hospital model need revamping. Under today's system, such laws that emphasize patients' rights put the most severely mentally ill patients at risk, along with their families and neighbors.

Hoff says that beginning at age five, her son displayed episodes of violence and mental instability.  She ultimately sent him to an out-of-state, locked residential treatment program to protect her two younger sons from him and to get him help.  But when he turned 18 and was released to Orange County, she discovered she was no longer able help him as a parent.

“I would call the social workers who said I need to support his decision-making,” Hoff says. “They'd say things like, ‘we find that our ‘clients’ respond better when they’re allowed to learn from their own mistakes. I’m like, ‘clients?’ He’s a patient. But when he turns 18 he’s no longer a patient, he’s now a client of mental health services.” 

In the 18 months since his return, Hoff’s son – now 19 – has been off his meds and in jail several times. Now, she says, he’s facing prison time for walking into a bank and handing the teller a note that said he’d blow it up if the teller didn’t give him $1,000.

“He’s going to jail for 11 to 17 years and there’s nothing we can do," says Hoff.

A 2010 TAC study says he won’t be alone.  “There are now three times more seriously mentally ill persons in jails and prisons than in hospitals,” according to the report, “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States.”

“We don’t really know what Adam Lanza’s diagnosis was and we don’t know his psychiatric history at all," says TAC's Fuller. "But we know the histories of enough people in these mass murders to know he wasn’t stable and treatment very likely was an option for him.”

Fuller says it’s her hope that the Sandy Hook tragedy will bring greater recognition that such mass killings can be prevented.

Severe mental illness, she says “is a real disease, it can be treated. There are humane, proven, legal ways to intervene before we get to this point and those who receive time and effective treatment are no more dangerous than anyone else."

 

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