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Gabrielle Giffords, Jared Loughner and Mental Illness

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The shooter of Representative Giffords, Jared Lee Loughner, is likely to be mentally ill.

The hints are in his writings. Like Ted Kaczynski, the Unabomber who sent 16 mail bombs in the 1980s and 1990s and wrote a rambling manifesto of incomprehensible philosophy, Jared Lee Loughner also had psychotic fueled rantings. Only reflecting the times, Mr. Loughners ramblings were posted on YouTube rather than mailed. He killed with a gun, rather than parcel post. More like Russell Weston, another mentally ill man who shot and killed two police officers in the Capital in 1998.

Politicized Pundits and Politicians (PPPs) are on the air now analyzing the ramblings of Loughner, as if they are worthy of analysis. They are already starting to use him as a poster child for gun control or against the Tea Party, or for a Rodney King-style "can't we all be friends" approach to political civility.

But the PPPs are failing to address the reforms that could prevent these incidents.

What's needed is reform of our involuntary commitment and treatment laws.

Families face a deadly Catch-22. If their family member is so mentally ill they can't even recognize they are ill, they can't be helped until after they become "danger to self or others". Rather than preventing violence, the law in many states requires it. Families are the most frequent victims.

The AP says: "He was obviously disturbed... He disrupted class frequently with nonsensical outbursts," said Lynda Sorenson, who took a math class with Loughner last summer"

Involuntary commitment laws did begin to change twelve years ago at the state level when 32-year-old Kendra Webdale was pushed to her death in front of an oncoming New York City subway train by Andrew Goldstein, a young man with untreated serious mental illness.

In reaction to this incident and similar ones across the country, state leaders started passing Assisted Outpatient Treatment (AOT) laws which allow courts to courts to order mentally ill individuals who have a past history of violence and non-compliance with treatment -- to stay in violence-preventing treatment as a condition of living in the community. Case managers and the specter of rehospitalization work in tandem to ensure medication compliance and a richer, fuller life for those experiencing serious mental illness. These laws save money, save lives, and improve care for the seriously ill.

Is Anyone Listening?

But only after Ms. Webdale was pushed, did the New York State legislature pass the eponymously named Kendra's Law. It was after the shooting of 19-year-old Laura Wilcox (10 years ago today) that California passed Laura's law. Similarly, AOT laws were enacted in Maine after mentally ill William Bruce killed his mother with a hatchet; in Florida, after deputy sheriff Eugene Gregory was shot by mentally ill Alan Singletary; and in New Jersey after the stabbing of 11-year-old Gregory Katsnelson.

None of the mental health commissioners make sufficient use of the laws that were put on the books. Maryland, Connecticut, Massachusetts, New Mexico, Nevada and Tennessee still don't have a law in spite of pressure from advocates for the mentally ill to pass one as a way to deliver more humane care.

While mental health commissioners may not have a plan to improve care for the mentally ill, they do have a plan to avoid responsibility when events like the shooting of Representative Gabrielle Giffords takes place.

The National Association of State Mental Health Directors recently issued a 98-page Toolkit for State Mental Health Commissioners: Responding to a High-Profile Tragic Incident Involving a Person with a Serious Mental Illness. As the toolkit explains:

No one wants to think about such an event happening on his or her watch"

And therein lies the problem.

Mental Health Commissioners won't 'think about such an event' or take steps to minimize the possibility of one. The 98-page document doesn't contain a single proposal on how to improve care for the seriously mentally ill; only 98 pages of information on how to spin the media into thinking no action is needed.

And I have not heard any of the PPPs on TV addressing this issue. States that have AOT should force their mental health departments to make greater use of it. Those that don't have AOT should get it. Washington should force states to stop spending the mental health dollars on the worried-well and force them to spend on the most seriously ill. And Washington based government agencies like the Substance Abuse and Mental Health Agency that stand in the way of reform should lose their funding.

Something has to change.

It shouldn't take another Loughner shooting another Giffords to get Washington and states to act.

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