Why can’t America have a debate about mental health?

In the wake of this week’s tragedy in Charleston, SC we’re hearing the usual calls for tightening America’s gun control laws. I’m not at all opposed to such a discussion, but like the Daily Show’s Jon Stewart and others, I don’t hold out much hope of one given the failure to do anything after the 2012 Sandy Hook killings in Newtown, CT. It seems to me, though, that once again guns are the bright shiny object and we’re missing an opportunity to do good following this senselessness.

While something’s clearly not right in your head if you have racist impulses that lead you to murder nine people in a church, it’s still unclear if Dylan Roof suffered from severe mental illness. However, there’s no shortage of examples of mass murderers in America with mental health problems and we never seem to have a serious debate about it, let alone pass any legislation to address the problems faced by the families of the mentally ill.

Before commenting further on the mental health aspect of mass murders, it’s worth correcting some of the handwringing about why we can’t do anything about gun control. For example, the Economist’s “Lexington” column wrote this week about the debate following Sandy Hook:

Various marginal tweaks to gun laws were tried and failed to gain traction in Congress.

Of course, that completely misrepresents what happened. The measures were hardly marginal. Democrats spent months putting together a comprehensive bill, including bans on certain guns and additional background checks. Rather than try pass something with strong bipartisan support, Democratic leaders attempted to pass their wish-list of reforms. Although Democrats were in the majority in the senate, members of their own party balked and it couldn’t pass. In other words, it was rejected on a bipartisan basis and poisoned the well for any chance of gun law reform. Sadly, those conservatives who were favorable to some tighter gun control, like Peggy Noonan, predicted that might happen. Shortly after the Newtown tragedy, Noonan wrote:

What I fear is that the Democrats will overreach and put together some big, comprehensive gun bill that will bog down in useless disagreement, debate and acrimony. But they can get extended ammunition clips banned tomorrow with a brief and limited bill, and they can use that victory to gain momentum and launch a bigger debate on gun violence. A quick victory now would be good for the country.

So while the political well for gun control reform is still poisoned, no such issue exists for mental health system reform, which is seldom seriously debated after these tragedies. And that’s a shame, because unstable people don’t need guns to do serious harm. Indeed people forget that in last year’s Isla Vista killings by Elliot Rodger, his first three victims were all stabbed to death. Tighter gun laws won’t provide their families with any solace.

Rodger had been seeing therapists since he was 8 years old, but when he turned 18 he rejected the mental health care his family was urging on him. This sort of situation is all too typical for families of the mentally ill. I remember reading a heartbreaking blog post following the Sandy Hook massacre. It was entitled “I am Adam Lanza’s Mother” and the author wrote about her multi-year struggles with her 13 year old son Michael’s illness. He was having increasingly violent outbursts and was approaching the point when he would be stronger than her. She wrote:

“When I asked my son’s social worker about my options, he said that the only thing I could do was to get Michael charged with a crime… No one wants to send a 13-year old genius who loves Harry Potter and his snuggle animal collection to jail. But our society, with its stigma on mental illness and its broken healthcare system, does not provide us with other options.”

Not only does America provide families like hers few options, but various laws and reforms have made it even more difficult for families to even be involved in their loved one’s care. As Rep Tim Murphy, one of the few politicians who has tried to do something about our broken mental health system, has said:

“If you had a loved one who had a heart attack or was in an auto accident or unconscious, that doctor would talk to you about that person. If you have someone who is seriously mentally ill in the other room, that doctor won’t tell you anything. Nor will that doctor ask history from you.”

Years ago, doctors had vast powers to commit patients involuntarily and the various horrors that resulted from that have been well documented. However, the pendulum seems to have swung much too far in the opposite direction. Lloyd Sederer summed up today’s situation well:

“An individual with a mental illness that interferes with his judgment, self-interest, self-preservation and safety represents a profound challenge for families and clinicians. Doctors have remarked that when patient rights exceed truly necessary protections, individuals with mental illness can ‘die with their rights on.’ Sometimes they may harm others along the way.”

Indeed, James Holmes, who is pleading insanity in his trial for the movie theater shootings in Aurora, Colorado, is reported to have told a court-appointed examiner, “I kind of regret that [my doctor] didn’t lock me up so that everything could have been avoided.”

For any meaningful change in our mental health system to happen, however, our representatives need to hear calls from more than just the mothers of Adam Lanzas. Tim Murphy’s bill that would, amongst other things, enable specialists to share some information with families, failed in 2013 and was recently introduced. According to GovTrack.us, it has little chance of succeeding, which is a tragedy in itself.