Let’s connect the dots on mental illness before the violence occurs

Petula Dvorak
Columnist September 19, 2013

We’ve been here before, of course.

Anyone who shoots up a military base, an elementary school or a movie theater, or walks up to a member of Congress and pulls the trigger, is deeply disturbed. Before he fatally shot 12 people Monday at the Washington Navy Yard, Aaron Alexis, 34, spoke of insomnia and hallucinations. He told police that he heard voices and that people were chasing him and microwaving him through the walls of a Newport, R.I., hotel.

Petula is a columnist for The Washington Post's local team who writes about homeless shelters, gun control, high heels, high school choirs, the politics of parenting, jails, abortion clinics, mayors, modern families, strip clubs and gas prices, among other things. View Archive

And? What exactly were police supposed to do with that information? You can’t lock someone up just because the person is hearing voices. Or as one Newport police officer told The Washington Post, “People make a complaint like that to us all the time.” A sergeant called military police at the local naval station and faxed them the report, but it’s not clear whether anyone there followed up.

“No one connects the dots. People live and work in silos,” said Carolyn Wolf, senior partner at the Abrams Fensterman law firm in New York and director of its mental-health law practice. She specializes in getting people the care they need and in setting up systems to recognize mental-health issues that could lead to workplace or campus violence.

When one of these mass shootings happens in America — yet again — the people who knew the shooter often nod their heads. “Nobody’s surprised when they find out who it was,” Wolf said.

But the tragedy, of course, is that those dots are connected after a blood bath. Our challenge is to find a way to make those connections before that quiet rage and anguish become a lethal burst of gunfire.

It won’t be easy. Not everyone who hears voices is dangerous.

Spend some time at a downtown park. You’ll see the man in pressed Bermuda shorts and a fine Panama hat talking to himself and his skim latte. You’ll see the woman with the shopping cart screaming obscenities into the night air. You’ll see the woman who smiled at me and then spit in my face.

Do all of these people pose a threat? Probably not. But we have no mechanisms to know.

Years ago, our babysitter occasionally had her son pick her up. He was adorable — he played with the kids, got down on the floor and crawled around with my baby. Then, one night, he attacked someone with a knife at a 7-Eleven. In my silo, I never saw his dark side. Neither did his mother. But at the 7-Eleven and his former workplace, they knew.

He was bipolar and had a hard time getting his medication. We tried to help the sitter navigate the health-care system to get her son help; it was a nightmare.

The people who knew Seung Hui Cho at Virginia Tech; Jared Lee Loughner in Tucson; James Holmes in Aurora, Colo; or Adam Lanza in Newtown, Conn., all saw pieces of mental-health problems. Teachers saw scary essays. Families saw erratic behavior. All of those bits and pieces of dysfunction raised little red flags, not one big epiphany.

Wolf believes that the key to connecting these dots is building oversight teams that can discern the big picture.

“It’s a mechanism like we do with terrorism: ‘If you see something, say something,’ ” she said.

This works well on college campuses. There, something akin to a threat-assessment team can connect one student’s report that a roommate is growing despondent with a teacher’s concern about a violent essay and with a friend’s freakout about a visit to a gun store, and respond in an appropriate way.

“To do this, we need resources to do early intervention, supportive services, to triage this information and categorize it,” she said.

Wouldn’t a system like that cost a fortune?

“So much money goes to so many things that aren’t really a question of life or death,” she said. “This is a question of life or death.”

Good point. The massacre at Virginia Tech — besides taking 32 lives and permanently scarring hundreds more — cost taxpayers about $48.2 million. That’s according to the Center for American Progress, a liberal D.C. think tank that analyzed Cho’s April 16, 2007, attack by sifting through the legal bills, university staffing costs, police costs, hospital bills and autopsy receipts.

Cho needed mental-health care. Would have been cheaper to make sure he got it, right?

Health and Human Services Secretary Kathleen Sebelius blogged in April about the need for better access to mental-heath care and pointed to a $205 million investment, in programs to help identify mental-health concerns early, in the administration’s fiscal 2014 budget.

That includes “$30 million in tools and research that will expand our understanding of gun violence prevention, including key mental health issues,” she said.

But money isn’t the only obstacle to a better mental-health system. Privacy laws also thwart efforts to connect the dots, Wolf said. Parents who have been tending to children their entire lives legally can’t get any real information once the children are adults.

“When in good faith, people want to intervene and be helpful, these walls go up,” she said.

And try getting all of America’s corporations to sign off on those assessment teams.

To tackle mental illness in America, then, we’ll have to get funding for lots of support staff, spread public awareness and change centuries of stigma, and we need to demolish some of the privacy laws that prohibit real cooperation when it comes to helping people with mental illness.

Easy peasy, right?

And you thought requiring background checks for gun purchases was hard.

For previous columns, go to washingtonpost.com/dvorak.

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