A few years ago, the police brought a 21-year-old man into the emergency unit where I work as a disaster psychiatrist. His parents had called the police after seeing postings on his Facebook page that praised the Columbine shooters, referred to imminent death and destruction at his community college and promised his own “Day of Retribution.” His brother reported to the police that he had recently bought a gun.
When I interviewed the patient, he denied all of this. He had no history of mental illness and mentioned he didn’t wish or require any remedy. My job was to evaluate whether he met the criteria to be involuntarily admitted to a psychiatric hospital.
Each mass shooting reignites a discussion about what originates this form of violence and how it could be prevented. Those who oppose further limitations on gun ownership often set their sights on the mental health care system. Shouldn’t psychiatrists be able to recognize as prejudicial someone like Nikolas Cruz, the youthful man charged in the school shooting last week in Florida, who scared his classmates, damage animals and left menacing online posts?
Mr. Cruz had suffered from depression and was getting counseling at one thing. He was in addition evaluated by disaster mental health employees in 2016, but they resolved not to hospitalize him. Why a couple of critics are nerve-racking, didn’t he receive proper treatment? And can’t we just stop angry, unstable youthful men like him from purchasing firearms?
It’s much harder than it sounds.
The mental health system doesn’t recognize most of these people for the reason that they don’t come in to get care. And although they do, laws created to preserve the civil liberties of people with mental illness place limits on what treatments could be imposed contrary a person’s will. Here in California, as in many states, patients must be a danger to themselves or others due to mental illness before they could be involuntarily admitted to a psychiatric hospital. This is a mechanism for getting people into remedy when they are too deep in the throes of their illness to comprehend that they require it. It approved me to hospitalize a woman who attempted to choke her mother for the reason that she was satisfied her family had been substituted with impostors and a man who had sent threatening letters to his boss for the reason that he believed she had implanted a microchip in his brain.
But the youthful man who had written about shooting his classmates was calm, cooperative and well mannered. The posts, he insisted, were nothing more than online braggadocio. He denied being suicidal or homicidal; he had never heard voices or gotten strange messages from the television. He admitted to having been bullied and was resentful of classmates who seemed to have more thriving social and romantic lives. But he adamantly denied he would be violent toward them.
What choices did I have? It was clear to me that he didn’t have a psychiatric illness that would justify an involuntary hospitalization, but I was reluctant to release this man whose story echoed that of so multiple mass shooters.
I could fudge it a small, claiming to require more time for observation, and admit him to the hospital anyway. But within the week he would go before a hearing officer to contest being held contrary his will. The hearing officer would probably make the same conclusion I had, that he was not prejudicial because of a mental illness, and he would be free to go. The only virtue of this version of happenings would be that the order to release the man who could be the next mass shooter would not be signed with my pen.
Maybe the hearing officer would share my trepidation and commit him out of fear of the substitute. Then the hospital would have 14 more days to treat him.
The psychiatrist liable for his care would know how to treat delusions, paranoia, mania, suicidal impulses, self-injurious routines, auditory hallucinations, and catatonia. But there are no reputable cures for insecurity, resentment, entitlement, and hatred.
The one concrete benefit of officially committing him would be that he might be prohibited from purchasing a gun from any federally certified retailer. needless to say, this would do nothing about any guns and ammunition he may previously have gathered. Nor would it deter him from getting guns from private-party sales, which are exempt from environment checks in multiple states.
I finished up admitting this patient, and he was released by the hearing officer two days later.
He never took any prescription, never reached the threshold for a federal firearm prohibition and left the hospital in the same state he arrived in. Like so multiple of his peers, he won’t seek out therapy for the longstanding personality traits that seem to predispose him to violence and rage, and there is no alternative to impose remedy upon him.The circumstance the mental health system fails to prevent mass shootings is that mental illness is rarely the cause of such violence. although all potential mass shooters did get psychiatric care, there is no reputable cure for angry youthful men who harbor violent fantasies. And the laws intended to stop the mentally ill from purchasing guns are too narrow and simply sidestepped; people like Nikolas Cruz and my patient are unlikely to qualify.
Instead of hoping that imposing mental health remedy on everyone who shows “red flags” will terminate mass shootings, we should focus on alternatives to put a couple of distance between these youthful men and their guns.