Violence and Mental Illness: Is Loughner a Case for Involuntary Commitment?

Loughner never received mental health counseling despite friends' concerns.

January 11, 2011, 4:47 PM

Jan. 12, 2011— -- In the aftermath of Saturday's shooting rampage in Tucson, Ariz., that left six dead and 14 wounded, recent reports that alleged shooter Jared Lee Loughner, 22, refused a mental health evaluation after his friends and college administrators expressed worry over the state of his mental health loom large.

Many who interacted with Loughner at Pima Community College believed he was mentally unwell and potentially dangerous. Loughner was suspended after several run-ins with the campus police and the discovery of a disturbing YouTube video, the school said in a statement. He was told his return was contingent on receiving clearance from a mental health professional, but Loughner apparently did not seek help and school officials could not force him to do so.

Like the acts of mass violence perpetrated by schizophrenic unabomber Ted Kaczynski, Loughner's shooting rampage may spur debate over what should be done about people with undiagnosed, untreated mental illness who might pose a danger to society.

Mental health professionals worry that incidents like the Tucson massacre may only spur further stigma against the mentally ill, falsely bolstering an association between violence and mental illness.

"People who are mentally ill are already exposed to a certain amount of stigma. These instances only extenuate that," says Dr. Anthony Lehman, professor and chairman of psychology at the University of Maryland.

"And the stigma often stands in the way of people receiving care," adds Dr. Carolyn Robinowitz, past president of the American Psychiatric Association. "Someone can be told to seek care, and they or their families don't follow up because they are fearful of being labeled. This [incident] can be an opportunity to educate people because we know that the best prevention of violence for those with mental illness is proper treatment."

Mentally Ill Does Not Mean Violent

The mentally ill are slightly more likely to become aggressive or violent, but research has shown that this is almost exclusively in cases where the mental illness goes untreated, or the patient is abusing drugs and alcohol.

"It is true that certain people with mental illness commit violent acts -- partly people who are acutely psychotic or who are using drugs or alcohol. But the vast majority of people with mental illness do not commit violent acts," says Lehman.

Seena Fazel is an Oxford University psychiatrist who has studied the link between mental illness and violence extensively. In a 2009 analysis of past studies on the topic, he found that the relationship between schizophrenia and violence is almost completely determined by drug and alcohol abuse.

Those who do not have severe mental illness but do abuse drugs or alcohol are responsible for a much larger proportion of the violent crimes committed in any given country, Fazel says.

"From a public health and policy perspective, if you want to reduce violence, those to target would be those with drug and alcohol problems," he says.

To put it simply, Lehman says, "Most people with mental illness are not violent, and most violent people are not mentally ill."

Ensuring Proper Treatment

For that minority of people with untreated mental illness that may drive them to violence, identifying them and getting them into treatment can be formidable tasks psychiatrists note.

"You can't be involuntarily treated unless you're an imminent danger to yourself or others," says Lehman. "Just because someone speaks loudly and scares other people doesn't mean they're an imminent threat to others. I think that's the dilemma here. [For Loughner] was scary, but he wasn't directly threatening anybody."

In Arizona, courts would have required that two clinicians evaluate Loughner and conclude that he was a danger to himself or others or both to initiate committing him involuntarily to a mental health facility, but that would have involved forcing him to be evaluated.

Some have questioned whether the Tucson massacre makes a case for more lenient requirements on involuntary commitment, but Robinowitz warns that "there's a tendency to overreact" following violent incidents.

"It becomes an issue of balancing public health and individual civil rights," she says. "The pendulum has gone from a time [in the 1940s and 1950s], when it was relatively easy to force people to have treatment against their will," to now, when there is much more emphasis on protecting the rights of individuals.

Using Tucson as an Opportunity for Growth

Psychiatrists agree that at least one positive thing that can come out of the tragedy in Tucson is a better awareness of the need for mental health services, especially within schools and colleges.

"It's an opportunity to put the message to the public at large that mental illness does not equal violence," Robinowitz says. "If we treat it as something secret and dark and awful, that makes it less likely that people are going to seek care. We also need to make sure that people have access to some degree of mental health services and that we fund these services, because so often they are the first to get cut for financial reasons."

A part of ensuring that those in need get help, psychiatrists say, is alerting the proper authorities to worrisome behavior in a peer or family member.

"If it's someone that they know, like a fellow student, talking to school authorities would be a good idea. If it's a friend or they know the family, let the parents know. If they are making direct threats, it can be reported to the police," Lehman says.

ABC News' Katie Moisse contributed on this report.

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