The recent mass shooting at Marjory Stoneman Douglas School in Parkland, Florida, has brought the issue of mental health and its relationship to gun violence into the forefront of public attention. The shooter, a 19-year-old young man with a history of psychological and behavioral problems, was apprehended by police and will eventually be brought to trial.
Media sources report that the Parkland shooter was being treated for mental health issues, but as many individuals in the country have discovered, access to effective management of psychiatric issues can be difficult. The Parkland shooting wasn’t the first incident in which unresolved psychological problems played a part, and there are many reasons why providing adequate mental health care continues to be a difficulty that American society has yet to overcome.
An Inadequate System for Mental Health Care
After learning the facts about the recent tragedy, many people wonder why the young man involved in the Parkland shooting didn’t receive emergency psychiatric treatment when responsible parties clearly suspected his problems were getting worse. The fact is that emergency psychiatric treatment is absent in many areas of the United States, and individuals routinely fall through the cracks of a system that hasn’t been improved in 40 years, even in response to today’s growing need for care.
In the United States, mental health care is still not considered a part of the normal health care system. Attempts to ensure mental health care is provided as regularly as traditional health care have, for the most part, been ineffective. In 1996, the Mental Health Parity Act forbade health care plans provided by large corporations from discriminating between coverage for psychiatric care and coverage for ordinary medical care. However, health insurance plans continued to limit the number of visits or impose coverage limits for treatment of mental health problems.
With the 2010 passage of the Affordable Care Act, popularly known as Obamacare, many hoped it would close the gap between medical care and psychiatric care. Unfortunately, though, patients still saw gaps in coverage, and changes in the system were still not adequately addressed.
What Constitutes a Psychiatric Emergency?
The public has learned that law enforcement and the FBI were notified of concerns about Nicholas Cruz before the Parkland shooting. However, it’s important to note that these agencies, as well as the general public, are often unclear about what constitutes a mental health crisis. The University of Hawaii offers some reasonable guidelines on these issues.
During a psychiatric “emergency,” individuals may become violent against others or try to harm themselves. These individuals, who may also be severely impaired by drugs or alcohol, may also act out in an unusual or unpredictable manner. They may be clearly unable to care for themselves and pose a threat to their own health.
During a psychiatric “crisis,” individuals may talk about suicide. They may threaten to harm others and engage in self-harming behavior, but not to an extent that requires medical attention. Moreover, many people dealing with a psychiatric crisis are extremely depressed and anxious, and they often display manic or erratic behavior. Many also abuse alcohol or drugs or refuse to take their prescribed medication. Anyone who exhibits any of these behaviors should get psychiatric treatment to prevent their condition from progressing into a full-blown emergency.
Calling the Police During a Psychiatric Emergency
State laws vary widely on what law enforcement can do when someone is in a psychiatric emergency. Generally, police are unable to take someone into custody unless a crime has been committed or a public disturbance is involved. In many places, police can legally intervene when an individual is a danger to themselves or others.
In these cases, the person is typically taken to the emergency room for an evaluation. The individual may speak briefly with a social worker, but they are unlikely to receive treatment in an emergency situation. More commonly, the person is released to go home, sometimes with a referral to a mental health clinic or psychiatric service for later diagnosis and treatment. In severe psychiatric emergencies, the individual may be taken to a nearby psychiatric hospital or treatment center, but these are not available in all communities, and waiting lists for admission are common.
Police Are Not Trained to Recognize Psychiatric Emergencies
A number of problems can arise when individuals in a mental health crisis call 9-1-1 for help. The primary problem is that most law enforcement personnel do not receive psychiatric crisis intervention training. Officers employed in large urban areas may be required to receive crisis education, but in smaller communities throughout the United States, this additional training is absent.
As a result, most officers do not know how to recognize a mental health problem, much less how to manage someone in a psychiatric emergency. They may view the behavior of someone dealing with a mental breakdown through the lens of the average behavior they encounter. An officer may not understand that an individual is unable to respond to commands in a normal manner.
In some cases, officers may interpret the person’s behavior as hostility or aggression, and many individuals in a mental health emergency are tasered, beaten, or even shot when the police are called in to manage a disturbance. In addition, people of color who deal with law enforcement during a mental health emergency are particularly at risk of injury or death while in police custody.
Going to the Hospital for Psychiatric Care
Individuals in a psychiatric crisis may recognize that they need help, so they go to the emergency room to get it. Although this seems like a reasonable strategy, busy hospitals are unlikely to provide the on-the-spot emergency treatment these individuals need. Psychiatric units in most hospitals are small and generally cannot accommodate the number of people who need immediate professional help. In many cases, the individual may simply be examined and released to find himself or herself back at home untreated and waiting for an appointment with a counselor who must slog through the often-lengthy task of determining the correct diagnosis and treatment.
The Marshall Project notes that, in some states, individuals in crisis are handed over to the police and put in jail on a “mental health hold” for 24 hours or more with no provision for treatment. Individuals may be put in jail to wait until a bed in a psychiatric facility is available. In other situations, an individual’s behavior is interpreted as a problem related to drug or alcohol abuse. All of these issues lead to a failure in getting individuals the help they need. The issues also continue the cycle of crisis and imprisonment that plague the criminal justice system.
Mental Health Clinics for Emergency Psychiatric Treatment
Contacting a clinic that specializes in psychological care can often provide the best opportunity for help during a psychiatric emergency. These clinics, however, are not always available in small communities, and if they are, they typically only operate during business hours. Some clinics are associated with large hospitals that have psychiatric departments, and they may provide 24-hour services to help those who are dealing with a mental health crisis or emergency.
When a person visits an emergency clinic, the staff will typically contact his or her regular psychiatric professional to receive background information and get advice on how to best provide treatment for the current situation. The clinic’s efforts to understand the symptoms of various psychological problems increase the odds that the person will receive the right treatment for their emergency issue.
Why the System Fails
The adults around the Parkland shooter attempted to get care for him. Reportedly, he had a number of psychological issues in addition to having to deal with the deaths of his adoptive parents. Even today, mental health care is not a precise science. Diagnoses can be hit or miss, with many years passing before the right diagnosis is determined. Incorrect diagnoses are also common, and so are incomplete ones. Once properly diagnosed, the individual must then begin the search for the right treatment.
Today, psychiatric professionals have a wide range of medications for treating conditions. However, finding the right medication can be time-consuming and lead to problems with side effects and delays in delivering the appropriate treatment for a particular individual. The delays can result in worsening symptoms, suicide, and violent behavior. Individuals stopping medication on their own because of side effects creates another problem due to the fact that some of the drugs cause psychiatric issues when a person suddenly stops taking them.
Guns and Psychiatric Issues
The Parkland shooting has also opened up many questions about gun access for those with mental health problems. In Florida, where the shooter lived and the incident took place, you can purchase an AR-15 at the age of 18. Numerous gun-law loopholes exist in Florida, where gun shows occur each weekend and there are many private sales of weapons. Additionally, the state requires no license or permit to own guns, which often do not need to be registered. Individuals can only be denied a gun if they have committed a crime or have had their gun rights restricted by a court of law because of severe psychiatric problems.
Data show that only a small percentage, about 4 percent, of individuals with psychological issues ever become violent. Indeed, many times, individuals with these problems become the targets of violence themselves and may feel they need to own a gun for self-protection. Finding a way to ascertain who might be a threat to society if they have access to a gun is challenging due to procedural and legal issues relating to privacy and biases about psychological disorders. Perhaps, in the future, the psychiatric profession will help provide a way to make fair and accurate determinations about who should be allowed to have a gun and when to withhold this most basic right of American citizenship.
The United States has now experienced a number of mass shootings, many involving weapons with the ability to kill large numbers of people. The need to balance the Constitutional right to own a gun and still maintain a safe society has become more pressing. Adjustments relating to the idea of the right to bear arms are likely to occur as our society becomes progressively more complex, congested, and diverse. The problems of mental health add another layer of difficulty in sorting out the problem of guns in society.
At the same time, substance abuse, depression, and suicide are increasing, which indicates that the country will be forced to deal with the issue of psychological problems in a more humane and scientific manner than it has in the past. Unless society finds better ways to provide prompt and effective treatment for psychiatric issues, the problem of widespread access to guns could lead to more tragedies in the future.