Dinah Miller M.D.


Laws to Force Treatment Are Not the Answer to Mass Murder

Can we prevent mass murders like the Fort Lauderdale shooting?

Posted Jan 18, 2017

In his op-ed column in the Sun-Sentinel, "System Failure: Not Treating the Mentally Ill has Consequences," U.S. Rep. Timothy Murphy (R-PA) makes some excellent points. Our mental health system is a disaster: There is a shortage of psychiatric beds in this country, it is difficult to access outpatient care, and there are too few clinicians. While psychiatric treatment can alleviate or moderate the psychic torment that illnesses cause, I'd like to suggest that many of the points Murphy made in his article are either conjecture or simply inaccurate. We don't yet know what happened with the man who killed innocent people in the Fort Lauderdale airport, and we certainly don't know that it was a preventable tragedy. 

Murphy states that the family had no insight into the shooter's mental illness or how to handle it, that he "sailed" through an evaluation and was released, while his family and the police were powerless to force him into treatment. Yet we don't actually know that any of that was true: Murphy presents an adversarial account that implies that everyone wanted this man to remain hospitalized, but that the laws prevented that from happening, and he insinuates that if legislation were different and psychiatry could have forced his care, then a mass murder would have been prevented. 

We don't know what insights the family had, or if the patient resisted treatment. We don't know that doctors wanted to keep him in the hospital, or what outpatient care (if any) was readily available. The sad truth in our country is that insurers, not psychiatrists, often make decisions about psychiatric treatment, and even if a distressed patient wants to get care in a hospital, it is often not an option. This situation is likely to get worse, and not better, as the GOP rushes to dismantle the ACA. 

Finally, it's simply not true that to be involuntarily hospitalized, "a person must be waving a gun and vow murder." It seems that Murphy believes psychiatrists can identify potential mass murderers and prevent these acts if only they could force those with psychosis to get treatment, indefinitely. For all we know (and as a curious psychiatrist interested in involuntary care, I have no inside information on this case), the shooter may have accepted voluntary treatment, been discharged from the hospital without issue, and left with nowhere to get followup care or medications (presuming they were prescribed). If he left in a better state than he entered, it's possible that he stopped the medications, or that he became ill again despite taking medicines. 

Violence has little to do with mental illness, and plugging treatment as a cure for the very rare event of mass murder is stigmatizing to patients. Mental illness accounts for only 4 percent of violent acts in this country, and substance abuse, anger, and past violent behaviors are far better predictors of future violence. Psychiatric disorders are common—one in five people suffers from an episode in any given year; half of us will meet criteria for a mental disorder over the course of a lifetime, and roughly 5 million people suffer from chronic, severe mental illness, only half of whom get treatment. Yet so few of these patients become mass murderers that it's not like looking for a needle in a haystack, it's like looking for a specific piece of hay in that haystack.

Providing easy access to high-quality, affordable psychiatric care needs to be a priority to alleviate suffering and prevent suicide and needless incarceration for nuisance crimes. Psychiatric treatment can be invaluable in helping people to live more productive, less tormented lives. But laws to allow more forced care are not the answer, as Murphy insists, to preventing mass murder.

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