01/11/2011 08:06 am ET | Updated May 25, 2011

Arizona Shooting: Treating Mental Illness Before it Kills

In the mass shooting in Arizona Saturday there were heroes who prevented even more bloodshed. We need heroes to intervene before lives are lost.

The three people who wrestled Jared Loughner to the ground and disarmed him outside a supermarket in Tucson are being hailed as heroes, and rightly so. They prevented further loss of life at the hands of the 22-year-old, who had, in little more than an instant, killed six people and wounded more than a dozen others, including Rep. Gabrielle Giffords. These two men and a 61-year-old woman saw a chance to intercede, and they made the most of it.

But there are others in this story who could have, and I believe would have, been heroes if they had the knowledge and tools they needed to stop Jared Loughner's descent into mental illness before it cost the lives of his victims, not to speak of his own life.

It's heartbreaking to read the accounts of college students and professors who noticed Loughner's bizarre and frightening behavior, shared their fears with others, but didn't see a way to get Loughner effective help when his downward slide could have been stopped.

On the first day of class one student wrote to a friend that another student in the class was so disruptive he scared her. "Hopefully he will be out of class very soon, and not come back with an automatic weapon." A week later she wrote, "We have a seriously disturbed student in the class. They are trying to figure out how to get rid of him before he does something bad, but on the other hand, until he does something bad, you can't do anything about him. Needless to say, I sit by the door."

It's terrible to imagine a student actually sitting by the door of her classroom because she was so afraid of another obviously mentally ill student--and outrageous that it took more than a single day to resolve the situation. In fact, it took three or four weeks before her concerned professor, and others who had Loughner in their classes, were able to have him removed. But they weren't able to get him help. Pima Community College required that Loughner undergo an evaluation if he wanted to reenroll; he refused.

What his professors didn't do is acknowledge that he was a risk to both himself and others, and call the police. College administrators, or neighbors, or friends, for that matter, wouldn't look the other way if a young man they knew was bleeding, or going into a diabetic coma. They would immediately dial 911. And the kind of psychotic breakdown Loughner was demonstrating is no less severe, no less demanding of immediate treatment. And it gives no shortage of warning, either. Schizophrenia, if that's what this is--or any of the other psychiatric disorders that can lead to psychosis--doesn't develop overnight. There are warning signs, and those signs didn't prompt the intervention they should have.

Why? Because people have little understanding and a lot of fear when it comes to psychiatric disorders. If you're on a subway car and someone faints, or has a seizure, half the people on the car will come to his aid, or call 911, or pull the emergency cord. But if someone is acting delusional or disturbing on a subway car, people will look away, move to the other end of the car, or change to the next car as soon as they can.

And mentally ill people, especially those with paranoid delusions, are also at risk of slipping into the alternative universe of the Internet, where all kinds of extreme rants seem to offer evidence for their fantasies. For Loughner this included a radical right-winger who argues that the government uses grammar to control people, and only an alternate "truth language" can offer escape. It wouldn't be that surprising if he also gave literal credence to the violent rhetoric that permeates politics these days--especially in Arizona.

How many times does this have to happen--think Virginia Tech--before we recognize how pervasive mental illness is in the college-aged population, and cut through legal and emotional barriers to getting treatment as soon as symptoms develop? The first signs of 75 percent of all psychiatric disorders appear by the age of 24.

We need a plan for giving mental health care parity with other medical care in terms of access, in terms of quality, and in terms of moral responsibility.

Part of what needs to be addressed is stigma--the general fear and unease surrounding psychiatric illness, particularly disorders like schizophrenia. Take, for instance, Steve Kornacki's conclusion on Salon, after evaluating Loughner's political musings: "My hunch is that Lougnher is just basically crazy, and that his political thinking isn't particularly coherent or organized."

While I can't disagree that his political thinking appears incoherent, what this sentiment misses is that there is no such thing as "basically crazy." If Loughner is indeed afflicted with schizophrenia that does not mean that this tragedy had to happen. While the vast majority of people who suffer with schizophrenia are not violent, the disorder can lead to the sort of disastrous violence we saw on Saturday if left untreated.

We don't know exactly why this happened, but the truth is that early intervention improves the outlook for anyone with a psychiatric disorder. So what can we do? Reduce stigma through improved education, so both those with a mental illness and the people around them will not hesitate to seek or facilitate treatment. Improve access to the best evidence-based interventions. Praise those who would be heroes by helping someone get the psychiatric care he needs before it becomes a tragedy.

Harold S. Koplewicz, M.D. is a leading child and adolescent psychiatrist and the president of the Child Mind Institute. For more on schizophrenia, trauma, and the perils of untreated mental illness, go to our website, which offers parenting advice and a wealth of information on childhood psychiatric and learning disorders.