Dr. Keith: Tragedy of Mental Illness

[Reprint] The story of alleged gunman Jared Loughner’s murderous rampage, which took the lives of six innocent victims and critically wounded Arizona Rep. Gabrielle Gifford’s, will ultimately prove to be a story about how severe mental illness—including that linked to violence—routinely goes untreated.

By all accounts, Loughner was psychiatrically ill long before he shot anyone. He was described by a high school classmate as a drug user and loner whose thoughts made little sense. Ultimately, he dropped out. He apparently tried to complete a high school equivalency while enrolled in the Aztec Middle Community College, a program offered by Pima Community College that caters to those who have no high school diploma. He couldn’t finish up there, either. In fact, police were reportedly called to campus five separate times because Loughner was behaving erratically. A teacher has been quoted as saying that he worried frequently whether Loughner had a gun. Students say he was prone to nonsensical outbursts. He was sent home with the instructions that he not return until it could be proven that he was not a danger to himself or others.

I have no idea whether what should have happened at that point (or much earlier) actually did happen. If he seemed to be a danger to himself or others, Loughner should have been admitted to a locked psychiatric unit. There, a firm diagnosis of his condition should have been arrived at, and appropriate treatment rendered. This would likely have included psychotherapy and medication.

Only once Loughner seemed to be a threat to no one should he have been eligible for discharge, and then it may well have made sense that he be monitored in a cohesive outpatient psychiatry setting in which participating in counseling and/or taking medications was mandatory, with failure to do so resulting in another hospitalization. If that had occurred (which I doubt) it is hard to imagine how Loughner’s case manager (who would have been appointed by the relevant department of mental health) would have missed his Internet ravings about how illiteracy, government conspiracy, “the rarest bird on earth, with no feathers,” and his “shot . . .” being “ready for aim,” would have escaped notice.

No, I would bet almost none of that happened, despite repeated and consistent evidence that would suggest Loughner may have been psychotic and having violent thoughts connected to his mental disorder. If that sounds a lot like the story of Seung-Hui Cho, the Virginia Polytechnic Institute shooter who killed 32 people, that’s because it is.

While polarized political parties may not be the best way to govern, I believe they will turn out to have absolutely nothing to do with Loughner turning into a killer. His murderousness will have nothing to do with the availability of firearms. His violence will be understood as a result of a severe, untreated or under-treated mental illness -- the kind that afflicts millions of young people in this country.

As a forensic psychiatrist who also has run community mental health centers, hospitals and clinics, I can tell you for sure, without any question, that the mental health care delivery system in this country is shoddy and shattered and without any hope at present of dealing effectively with sick individuals like Jared Loughner. There are slim resources and no strategy, whatsoever.

That’s the very, very worrisome story behind this tragedy.