The Tucson shooting and mental illness

When reports arrived that accused gunman Jared Lee Loughner had opened fire in Tucson, Arizona on January 7, journalistic first responders linked the incident to the fierceness of political rhetoric in the United States. Upon reflection, some of the discussion has turned to questions about mental illness, guns, and violence.

And plenty of reflection is required, because the connections are not at all simple. To get a sense of just how complicated they are, we invite you to read the lead article in this month’s Harvard Mental Health Letter entitled, “Mental Illness and Violence.” Strangely (for us) it was prepared for publication a month before the tragedy in Tucson. In light of the shooting, we are making the article available to non-subscribers.

I am not surprised at the outrage expressed in the news or at the impulse to blame. A quick scan of the news, however, shows there is not much agreement about whom to blame. In addition to the alleged perpetrator, one can find explicit and implicit criticisms of politicians for playing to our baser instincts; of media figures, various men and women of zeal, for their disingenuous or manipulative partisanship; of the various community bystanders (police, teachers, doctors, family members, neighbors, friends), whom we imagine could have intervened to prevent tragedy.

The political debate flowing from this incident will continue, as will the endless cycle of blame and defensiveness. But I caution all of us — and especially mental health professionals — not to make clinical judgments about Mr. Loughner. Very few people will or should have access to the kind of information that would allow such judgments.

From a public health perspective, however, we should make careful judgments about policies that could reduce risk.

Guns

What should we do about guns? Public health experts experts are gravely concerned about gun policy in the United States. I wrote about the issue in June 2008, as the Supreme Court case, District of Columbia v. Heller, was being decided. You can read that piece here.

Also see Gail Collins’ article in The New York Times, which alludes to the changes in technology that allow an assassin to kill more people faster. She advocates a pragmatic approach to balancing the costs and benefits of gun ownership, much as Representative Giffords did. So do I.

Access to Mental Health Care

We also need to make reasonable judgments, as a society, about the value of mental health care. Whatever mental processes are at the root of the shooting in Arizona, it is a good moment to note that access to good mental health treatment may well be worth the cost.

We can’t predict or prevent specific acts of violence, as was fictionally portrayed by Philip K. Dick 55 years ago in his story, “Minority Report,” later made into a movie. But good treatment aimed at chronic mental illness and substance use reduces the risk of violence (and suicide), so communities that provide such services improve their chances of avoiding harm.

Please take a look at other recent articles from our archive on related topics — stigma and mental health parity.

Other resources

You may also want to give a listen to my colleague in Baltimore, Lisa Dixon, MD, a Professor of Psychiatry at the University of Maryland, who is an expert on services research. She describes what experts have learned about how to engage people who have chronic illnesses. It turns out that psychosocial interventions are at least as important, if not more important, than medications for improving quality of life and reducing harm.

Dr. Dixon appeared on the Diane Rehm radio show with Dr. Ken Duckworth (medical director for the National Alliance on Mental Illness) and Dr. E. Fuller Torrey (president of the Treatment Advocacy Center). You can also read our article that refers to research done by Dr. Dixon and her colleagues.

Links to our articles mentioned in this post:

• Mental Illness and Violence
• Handguns and Health
• The Evolving Understanding of Stigma
• How Does the Healthcare Reform Act Affect Mental Health Parity
• Schizophrenia Treatment Recommendations Updated

Links to other sources mentioned in this post:

• Gail Collins, “A Right to Bear Glocks,” New York Times, January 9, 2011
• Diane Rehm Show, “The Serious Psychiatric Disorders Among Young Adults,” January 11, 2011
• Dixon LB, et al. “The 2009 Schizophrenia PORT Psychosocial Treatment Recommendations and Summary Statements,” Schizophrenia Bulletin (Jan. 2010): Vol. 36, No. 1, pp. 48–70.