It has not yet been confirmed whether Adam Lanza had been diagnosed with mental illness, but the 20-year-old who murdered his mother, then drove to a Newtown, Conn., elementary school and gunned down 20 first-graders and six adults has again shined the spotlight on care for the mentally ill in the United States, and has many asking whether yet another mass shooting could have been prevented.
Despite four shooting rampages since President Obama took office in 2009, mental health care continues to be hampered by budget cuts, closures, battles with insurers and stigma, doctors said.
"We have very good treatments for mental illness that are highly effective," said Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association. "But they're not widely available. People don't have ready access to them."
Since the recession forced budget cuts in 2009, state general funding for mental health care has decreased by an estimated $4.35 billion nationwide, according to the National Association of State Mental Health Program Directors, which serves 6.8 million patients a year.
Since 2009 alone, 3,222 psychiatric hospital beds are no longer available to patients, and another 1,249 may disappear soon because of proposed closures, according to the association. That's about 10 percent of all state psychiatric hospital beds gone in about three years, said Dr. Robert Glover, the association's executive director, who said he'd never been more worried.
"This is the worst I've seen it," Glover, who's worked in mental health for almost five decades, said about the cuts. "They are painful, and unbelievably tough. I am incredibly worried about future cuts with the fiscal cliff and state budgets not getting better."
One in five American adults reported suffering from mental illness within the past year, with one in 20 reporting serious mental illness that resulted in "functional impairment," according to the Substance Abuse and Mental Health Services Administration's latest annual National Survey on Drug Use and Health Report.
Despite its prevalence, mental illness is something patients and those around them have tried to ignore dating as far back as World War I, when soldiers were called cowards for showing signs of what we now know was post traumatic stress disorder, Lieberman said.
Today, the largest mental health facilities are for inmates at the Los Angeles County Jail in California, Cook County Jail in Illinois and Rikers Island in New York, Lieberman said.
According to the Bureau for Justice Statistics, 56 percent of state prisoners, 45 percent of federal prisoners and 64 percent of jail inmates had mental health problems in 2006. Between 10 percent and 20 percent of those with mental health problems had symptoms of psychosis, such as delusions or hallucinations.
Jared Lougher was diagnosed with schizophrenia six months after he went on a shooting spree outside an Arizona shopping center in 2011, killing six people and wounding 13 others, including Rep. Gabrielle Giffords. A judge declared Virgina Tech shooter Seung-Hui Cho "mentally ill" two years before he killed 32 people and then turned the gun on himself in 2007. A child psychologist wrote a book 10 years after the Columbine High School massacre that said shooters Eric Harris and Dylan Klebold weren't just bullied before they gunned down 12 classmates and a teacher in 1999; they were mentally ill, too.
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