Mental health policy is wild card in gun safety

(courtesy image/used under Creative Commons license)

 

On his way home to Chicago, University of Michigan student Kevin Heisinger stepped off Indian Trails bus no. 4560 and walked into the restroom of a Kalamazoo bus station. There he was beaten to death by a paranoid schizophrenic man who was not taking his medication.

Heisinger’s death in 2000 led to a new state law – Kevin’s Law – four years later allowing judges to order those diagnosed with serious mental illness and deemed a threat to themselves and others to receive outpatient treatment. In the nine years since then, the law has been sporadically enforced -- partly because it is extremely difficult to identify those most likely to become violent.

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It is “almost impossible to predict” who the next mass murderer will be, said Mark Reinstein, president of the Mental Health Association in Michigan. “We need to do a better job of identifying people who are severely mentally ill and who, in the absence of treatment, one could reasonably predict are likely to become a threat to themselves or others.”

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The vast majority of people suffering mental illness are not violent, said Reinstein, who has a doctoral degree in psychological studies. Those diagnosed with severe depression, bipolar disorder or schizophrenia are slightly more prone to violence, he said. Add in alcohol and drugs, and the risk increases. If a person was a victim of abuse, the risk further increases. The danger of violence rises more if that person has a history of violence.

Yet, “if you tried to make a prediction on those four criteria, you’d be wrong the vast majority of times,” Reinstein said. “There is no test you can subject people to with a reasonable degree of reliability and say, ‘Ah ha! We’ve got a potential mass murderer here.’”

Policy shifts from state hospitals to local communities

Michigan’s approach to treating the mentally ill has changed drastically in recent decades. In the past, hospitalization, often against the patient’s will, was the preferred course. Until the mid-1980s, Michigan operated 17 psychiatric hospitals with about 3,500 beds. Between 1987 and 2003, the state closed 12 of those hospitals, paring the number of beds to 893.

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The assumption behind deinstitutionalization was that most mentally ill patients could be treated more cheaply and effectively as outpatients in their own hometowns through community mental health agencies. While the idea might have been sound, in practice too many mentally ill patients are going without proper treatment, Reinstein said.

“We have nothing that filled in the gap,” he said. “We have far too many people left to their own resources. They’re part of a revolving door. They don’t recognize their own situation, or, if they do, they don’t care.”

The amount of money Michigan spends treating mental illness (an average of $5,200 for each mentally ill adult and $3,850 for each mentally ill youth) is not nearly enough, he said, though he was unable to put a cost figure on policy changes preferred by his group. Michigan ranked 21^st among the 50 states in per capita spending on mental health in fiscal year 2010, according to the Henry J. Kaiser Family Foundation’s State Health Facts, appropriating about $119 a year for each person in the state, slightly below the national average.

In February, Gov. Rick Snyder issued an executive order creating a six-member Mental Health and Wellness Commission to study and recommend ways to strengthen the state’s mental health system. The report is due on or before Dec. 20.

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Nine years ago, former Gov. Jennifer Granholm created a similar commission that issued 71 recommendations, centered on more education and so-called mental health “parity” in insurance coverage. Most of the ideas were not implemented.

“We welcome any attention given to mental health,” Reinstein said, “but do we need another commission nine years after Granholm’s?”

State panel will study mental treatment reform

This time will be different, said Lt. Gov. Brian Calley, named by Snyder to head the commission. The killing of 20 children and six adults in Sandy Hook Elementary School “really did elevate the discussion of how well we’re doing delivering mental health services,” Calley said. “Now we feel like people across the political spectrum are talking about how can we prevent things like this from happening? It would be a real shame not to take a lesson out of that. We felt like it was an opportunity to move forward with an unusually high awareness and determination.”

Pushing gun control as the solution is “focusing on symptoms, rather than root causes,” he said. “How many failures were there earlier in the process when we had an opportunity to intervene and prevent that?”

The new commission will begin by reviewing the recommendations from Granholm’s commission and then will work toward its own, Calley said. It starts with the premise that the state’s current mental health system is not doing enough to identify and treat those in need of care.

“Basically in our system today a person needs to, A, know they need services, and, B, know how to get them,” Calley said. “We can do better. We have a long way to go.”

Some doubt, however, that improving mental health care alone will do much to prevent the kind of violence that happened in Newtown. More than 20 leaders in gun policy and violence who convened at Johns Hopkins University in January for a Summit on Reducing Gun Violence in America developed several recommendations to reduce the bloodshed. Improving mental health care was not among them.

The summit did recommend that those who are seriously mentally ill and deemed dangerous should be barred from buying guns. It also urged the federal government to fund incentives for the states to provide information about such mentally ill patients to the FBI’s National Instant Check System for gun buyers.

Michigan was more conscientious than most states in submitting mental health records to NICS, according to Mayors Against Illegal Guns. In 2011, Michigan sent in 99,268 records, the third-highest rate of all 50 states.

“The idea of the mentally ill committing gun violence is in the zeitgeist right now,” said April Zeoli, a Michigan State University assistant professor of criminal justice who participated in the summit. “But most people who are mentally ill are not violent.”

Instead, research suggests other characteristics of those most likely to commit gun crimes, she said, including:

* A history of domestic violence.

* Violent crimes as a juvenile.

* Two or more crimes involving drugs or alcohol.

* Drug trafficking.

* Gang membership.

* Convictions for stalking.

“There seems to be more political will now than there has been in the past to make changes,” Zeoli said. “That didn’t happen after Aurora. Newtown was something different. If there’s any time we’re going to make progress on this issue it’s now.”

Pat Shellenbarger is a freelance writer based in West Michigan. He previously was a reporter and editor at the Detroit News, the St. Petersburg Times and the Grand Rapids Press.