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Guns and mental health— Experts note issues separate

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This is the sixth in our series “Guns and the Village.”
Click here to see all the articles in the series.

Local resident T (who preferred to be anonymous to protect her family’s privacy) knew something was happening with her son when at 15 he was suddenly having trouble sleeping and began spending much time alone. The eccentric behavior quickly intensified, she said, and soon R began knocking on people’s doors singing Christmas carols and dressing in a suit to look for a job. That year R began home schooling and taking medication for depression and psychosis.
Around that time, R found an antique rifle his father had kept in the house. He began asking about it, T said, curious about its age and how his father had come to own it. Though her son was a gentle person and had never exhibited violent behavior, T was concerned about the gun.

“I didn’t want him having any access to it, or even him remembering it was around,” she said. “So I gave it to my friend, a part-time policewoman, who said they could melt it down.”

R lived peacefully with his mother for many years, finally diagnosed in his mid-20s with schizophrenia. Then one day an emotional incident caused him to become very agitated, and after a series of attempted interventions, he attacked someone with an improvised weapon.
R’s story represents what many believe is the mental health piece of the solution to help reduce violence, particularly the number of random shooting events that have been perpetrated by people with a known mental illness. While current laws limit access to firearms for those diagnosed with a mental illness, many states, including Ohio, are considering adopting tighter gun ownership restrictions and mandating better information sharing about the mentally ill.

However, according to several local professionals who know something about the patients they treat every day, the gun violence issue is more complicated than a few laws on gun access are going to solve. First, the propensity of the mentally ill to commit a violent act is only slightly higher than the average person, and most violence is not perpetrated by the mentally ill.

Second, according to local psychologist Tim Callahan, society needs to realize that it’s partly responsible for the current state of affairs. In order to really make a change, the mainstream culture must stop stigmatizing the mentally ill, which exacerbates the symptoms, and get better at including those who think differently. And of course  better treatment, including earlier intervention and broader, more community-based management options, would do a world of good for society in general, both Callahan and private therapist Bob Barcus said.

But relying on practitioners to diagnose which patients will become violent and then sharing those names with law enforcement authorities is neither possible nor would it be very effective in reducing violent incidents.

“Predictions made by mental health professionals are not going to solve this problem,” Barcus said, later adding his impression of the politics behind the issue. “What I’m worried about is politicians who don’t want to do anything about weapons and by doing something about mental illness, they’re able to tell their constituents that they’re being proactive.”

Mental illness and violence
Though the vast majority of people with a mental illness will never become violent, statistics indicate that they are slightly more likely than the average person to physically hurt themselves or another. According to a study led by Duke University professor Jeffrey Swanson in the 1990s, while 2 percent of the general population committed acts of violence (from shoving to shooting someone), 7 percent of those with a serious mental illness (schizophrenia, depression, or bipolar or disease) committed violent acts.

The mass shootings that have occurred over the past 30 years have been disproportionately perpetrated by those with mental issues. According to a 2002 U.S. Secret Service study on school shootings between 1974 and 2000, a third were committed by those who had received mental health evaluations, and almost 80 percent involved a shooter who had experienced suicidal thoughts. According to news reports, the shooters involved in the attacks at the youth camp in Norway in 2011, the shopping center in Tuscon, Ariz. where Congresswoman Gabby Giffords was injured, Virginia Tech in 2007, the movie theater in Aurora, Colo. last summer and the elementary school in Newtown, Conn. in December, all involved perpetrators with mental illness.

However, there is an even more consistent factor associated with violence — being male. According to a recent story in Time, being a man multiplies one’s risk of becoming violent by a factor of nine. And of the 62 mass shootings in the U.S. since 1982, all but one have been committed by men (44 of them white males), according to a Feb. 27 story in Mother Jones.
Yet just as society isn’t going to monitor all men as criminal suspects, neither should we expect that the mentally ill should be excluded or accorded fewer rights because of their differences, Callahan said. Instead, they should be given access to good healthcare and effective treatment plans. According to Callahan, former chief of psychology for Ohio’s adult prison system and current director of mental health programming for the Greene County Learning Center, with the help of recent discoveries in neuroscience and epigenetics, scientists have a much better grasp on how the brain works and are now able to treat symptoms of mental illness as effectively as the medical system treats physical ailments.

“You’re having psychotic episodes, command hallucinations? We can treat that!” Callahan said in an interview last week. “We can’t throw the person away because they have symptoms.”

Mental health funding
Treating people, however, requires public programs both to identify those who need help and to maintain a course of treatment over a period of time. But, according to Callahan, instead of increasing funding to make mental health treatment more widely available, the federal and state governments have cut mental health funding. State funding through Medicaid for public community mental health programs has been cut by 70 percent over the past four years. That includes services to homeless shelters, treatment programs and school programs such as the educational service center.

Mental health hasn’t been sufficiently funded since President Lyndon Johnson launched his “Great Society” domestic social programs in the 1960s, according to Barcus. At that time, mental health was regionalized and professional therapists and counselors were mandated to serve in local schools, community centers and as advisors to local law enforcement. But the fiscal conservative backlash of the 1980s led to the centralization of services and the closing of many mental health facilities and hospitals. Though patients were supposedly being maintained on drugs as outpatients at a fraction of the cost of more comprehensive therapy, there were suddenly a high number of mentally ill people going untreated, many of them homeless, Barcus said.
Since then, for budgetary reasons, the state closed the 110-bed Twin Valley mental hospital in Dayton, shortly after which six Montgomery County emergency rooms reported a 13 percent increase in mental and behavioral health cases, according to a 2011 Dayton Daily News story. The following year the state closed its psychiatric hospital in Cambridge, leaving those in need of residential treatment to travel to Columbus, Cincinnati or Toledo for the service. Twin Valley reopened under private ownership in 2011 with one fourth the patient capacity.

If mental health patients don’t get the treatment they need, a system that doesn’t understand their needs often sees them as criminals. Jail then becomes their treatment facility, which is neither inexpensive nor effective in the long-term, Callahan said. Prisons are not just facilities to secure criminals, but also serve as a place to put people society doesn’t want to deal with because they think differently.

“It is easy to forget that we are in this together. You can lock people up and sit inside your house and not think about it, but we need to recognize that prisons are a symptom of our highly normalized, stigmatizing, and excluding society,” he said.

Proposals to track the mentally ill
But at a time of economic duress, it’s hard enough to maintain current funding levels, let alone request an increase, Callahan said.

And though legislators do talk about mental illness as one factor sometimes associated with violence, instead of advocating for better funded treatment programs, they are now talking about better ways to track the mentally ill and prevent them from acquiring firearms.

Most states currently prohibit anyone who has been adjudicated as mentally ill from possessing a firearm, but so far the names of the adjudicated have been poorly tracked by the National Instant Background Check system. Now, both the federal government and legislators in 23 states are considering bills to further limit gun ownership by certain mentally ill people, according to the Law
Center to Prevent Gun Violence.

The Senate introduced a bipartisan bill earlier this month to include in the definition of those adjudicated “mentally incompetent,” those judged to be a danger to themselves or others and those found not guilty in a criminal case by reason of insanity.

Local representative Chris Widener co-sponsored a similar bill in Ohio, known as the Deputy Suzanne Hopper Act, after the Clark County Sheriff Deputy who was killed at an Enon trailer park in 2011 by a gunman with a known mental illness. Ten years earlier, Michael Ferryman had again engaged in a 26-hour shootout with police in McConnelsville and was found mentally incompetent to stand trial. He subsequently spent several years in treatment facilities and was under supervision of the Clark County mental health system at the time of the Enon shooting.

The Ohio law would mandate the courts to report to local law enforcement when they order mental health evaluation or treatment for someone who has committed a violent act. Police would then be responsible for reporting the offender to the National Crime Information Center.
According to Kent Youngman, executive director of the Mental Health and Recovery Board of Madison, Clark and Greene counties, following Hopper’s death, the Springfield police and the Mental Health board instituted its own policy of information sharing. They maintained patient privacy by sharing only the legal status of the convicted patients, not their medical/treatment information, Youngman said. Currently there are two such area residents who have been identified by both agencies, he said.

“It also benefits the mental health system when law enforcement lets [us] know that someone isn’t following their treatment plan,” Youngman said. “It’s a balance between public safety and privacy rights.”

Long-term solutions
Systems that regulate the use of firearms for anyone, including the mentally ill, are about gun control, which Callahan is prepared to consider. But making a conversation about gun control into one about mental health is changing the subject, he said.

“If you want to deal with guns, let’s deal with guns,” he said. “But if the NRA wants the names of the mentally ill…then it becomes a civil liberties issue, like women’s rights, and African-American rights.”

In addition, Barcus said, models that rely on even the most skilled professionals to predict when a patient will become violent are unreliable. According to a 2012 study published in Psychiatric Services journal, trained psychiatrists were only 70 percent accurate in predicting violent behavior in their patients. Barcus agrees with the assessment based on his own practice.

“The problem is if we reported to the police every person who was angry, had violent thoughts, and acted out, they’d have to hire 40,000 new officers just to manage it,” Barcus said.
Instead, Callahan advocates for better preventative treatment, and not just for the severely mentally ill, but for a large segment of the current generation of youth, many of whom exhibit symptoms that concern him. According to Callahan, at least 20 percent of the population struggles with mental health issues, but 32 percent of children have anxiety disorder, with the earliest onset observed at 6 years of age. As children grow up, their disorders often evolve from anxiety into behavioral issues and mood disturbances, eventually becoming substance abuse disorders. According to Callahan, the stress of our fast-paced and highly pressurized culture is being voiced and acted out by our youth.

“There’s a lot of exposed stress, and there’s no sanctuary,” he said.

But youth should at least be able to access the early support they need as their brains are developing to manage their lives. Callahan calls the management tools prosthetics, or accommodations.

One that Youngman highly recommends is the PAX Good Behavior Game, a classroom tool for teachers that uses soft competition and positive behavior reinforcement to help students control the impulsive behavior that’s regulated by the prefrontal cortex of the brain. Over 30 years of research by Johns Hopkins University and 70 randomized trials have shown that the game gives students better control and leads to long-term positive effects in adults, according to local expert Anya Senetra, the school-based mental health supervisor at the Greene County Education Service Center.

In one of the most influential longitudinal studies begun in 1984, researchers at Johns Hopkins studied 900 first grade students in the Baltimore city schools. The students were divided into three cohorts and each given a one-year intervention, including the PAX game, a parenting support group, and a control group. According to Senetra, researchers followed the students for 30 years and found startling results for the group that received the PAX game. The immediate impacts included a 50 percent reduction in class disruptions, an increase in active learning and a corresponding increase in test scores. But the long-term results showed that PAX students were 70 percent less likely to commit a violent crime or get involved with the legal system later in life; they were less likely to engage in substance abuse, be diagnosed with depression or commit suicide, and they were more likely to graduate from high school, Senetra said. PAX has a measurable impact, and the results are repeatable, she said.

“We call it the overall universal behavior vaccine,” said Senetra, who trains for the PAXIS Institute and plans to help Wright State University incorporate the PAX methods into its early education program in the fall.

T is greatful that her son was able to get the care that he needed for his mental condition. But society doesn’t make it easy, she said, noting that it was only through the combination of R’s qualifying for Medicaid and her own love and persistence as a mother that R found help. Though she doesn’t know how to prevent the next violent episode, she believes that something should be done.

“I don’t know what the answer is, but it’s important to not do nothing,” she said. “It would be a good idea if there were more access to [treatment], but people have to acknowledge that they even have a problem. And sometimes that’s hard too. There’s people in town that don’t.”

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