OP-ED

After the Navy Yard Shooting: A Call to Action On Mental Illness


The Navy Yard shooting in Washington, D.C. has once again confronted us with the issues of guns and mental illness, but what we really should address is the inadequacy of mental health care in the United States. Since 2009 there have been 21 mass shootings and the perpetrators in over half of these were suffering from or suspected to have a serious mental illness like schizophrenia, bipolar disorder and depression. (The other killers with no signs of mental illness were ideological zealots, disgruntled employees and disaffected loners.)

After each incident there is a great hue and cry, and calls for action but no substantive action is taken. Our reflexive approach has repeatedly failed to provide care in a timely fashion to individuals in need. As a country, we continue to ignore the growing public health need for greater access and a more proactive approach to mental health care. It is time that we say enough is enough and do something to prevent future tragedies.

When you strip away the hype and politics, the causal factors in these horrific incidents are clear and solvable. Yet we’ve lacked the social and political will to fashion and apply the solution.

The plain truth of the matter is that we do not provide adequate services to the 26% of the U.S. population with mental illness. The scope of and access to mental health services available to most people are limited and fragmented. Moreover, insurance coverage is all too often lacking and discriminatory. Consequently, we do not provide the level and quality of care of which physicians and health care providers are capable. It is the equivalent of knowing that a woman has breast cancer but not offering the indicated treatment options of surgery, radiation and chemotherapy. The result is that many people go untreated or inadequately treated.


Most simply suffer but many end up in jail. Our penal system has become the largest institutional provider of mental health care in the country. A very small number, (but any in this case is too many), left to the mercy of their symptoms, are impelled to violence directed at their family, co-workers or innocent strangers. In such rare but shocking instances as at the Washington Navy Yard they take the form of mass carnage.

This can and must change. We are not in a situation in which we have to wait for some research breakthrough discovering the cause of these illnesses or next miracle drug. We have the knowledge and means to prevent these seemingly senseless crimes.

For starters, we must bolster the front line of engagement for people with mental health problems so that preventive efforts are on par with other health conditions. We encourage routine screenings for physical ailments such as tuberculosis, diabetes and hypertension, and vaccinate for infections. There’s no reason we cannot develop a similar proactive public health strategy for mental health.

Rather than waiting for people with symptoms of mental illness to seek help, which they all too often delay or never do, we should engage them proactively in school systems, the work-place or through their primary care providers. As former Congressman Patrick Kennedy has said why shouldn’t people have “a check-up from the neck-up” along with their annual physical exams.

Perhaps our greatest challenge will be overcoming the stigma of mental illness as well as some individuals’ lack of confidence in psychiatric diagnosis and treatment.  However, we must be willing to confront both and deal with the accompanying fears and misperceptions. Otherwise, we risk more heartbreaking consequences of illnesses that go untreated and violent death and injury as a consequence.

The first concrete step that offers the prospect of improving the quality and availability of mental health care is the adoption of final rules for a bill passed and signed into law almost five years ago: the Mental Health Parity and Addictions Equity Act. This will allow for the law’s true implementation and enforcement and will close loopholes that have kept people from receiving benefits and desperately needed care.

Combined with the likely impact of the Patient Protection and Affordable Care Act, final rules will clear the way for improved mental health care access nationwide and, in so doing, will reduce the stigma that often prevents people from seeking help or sticking with treatment.

In his recent book, American Psychosis, the mental health advocate E. Fuller Torrey writes that “at least one third of the homeless and 20% of the incarcerated” are mentally ill and that “our public (mental health) facilities are overrun by untreated individuals”. The recent spate of mass shootings is a tragic and preventable consequence of our failed policy.

Jeffrey A. Lieberman, MD is the President of the American Psychiatric Association. He is psychiatrist-in-chief at NewYork-Presbyterian Hospital/Columbia University Medical Center and chair of the Department of Psychiatry at Columbia University College of Physicians and Surgeons.

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learn hebrew onlinemental health disordersDaryl @ home health care SarasotaVik Khannaplaton20 Recent comment authors
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learn hebrew online
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mental health disorders
Guest

Hi,

This is such a nice blog and It is really helpful for me, But i am looking for the mental health disorders related post,So please suggest and share if you have.

Thanks

Daryl @ home health care Sarasota
Guest

I think an annual checkup for mental illness is a great idea. There are solutions to help people who suffer from mental illnesses and like physical ailments it’s better to catch it early rather than late.

John Ballard
Guest

Thanks for this, Vik Khanna. It’s the first time I have seen the term deinstitutionalization in print for some time. It’s hard to speak of this subject without being accused of advocating some Dickensian dystopia. It was a movement of the Sixties with good intentions that, as Justice Thomas might say, went seriously awry. Having been identified as one of the “ignorant and uneducated” commenters in this thread I’m reluctant to say much more, but here is a six-year old link to something I wrote following the Virginia Tech shooting. http://hootsbuddy.blogspot.com/2007/04/deinstitutionalization-hasnt-worked.html After all this time the links I cited there… Read more »

platon20
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platon20

Predicting who will commit violence is not some enigmatic mystery that nobody can figure out. Consider these facts: 1. 82 percent of all violent crime is perpetuated by somebody who had a previous history of violent acts 2. Of all killers who were labeled mentally ill after the fact, ninety seven percent had a history of both delusions and previous history of violent acts. Now, advocates of the mentally ill say that 90 percent of mentally ill persons are nonviolent. And they are RIGHT about that. The vast majority pose no threat whatsoever. But where the mental health advocates are… Read more »

Emily Pierce
Guest

– Since you seem to be such an expert on delusions, there are three types what are they? – Please cite your resources – Because of ignorant, uneducated people like yourself and that’s putting it nicely the stigma associated to mental illness is no less today then it was when President Obama held the conference on Mental Health. – The mass shootings that have taken place ( almost all) have been pre-meditated. In order to pre meditate anything you need to be of sound mind. A delusional person is not of sound mind. If you actually did your research on… Read more »

Vik Khanna
Guest

Platon20 is on to something. Overall, I like Dr. Lieberman’s piece, mostly because it focuses the attention where it belongs, on both mental health diagnostics and therapeutics. In 1986, just out of graduate school (and the experience of working as a physician assistant in the Baltimore City Jail and Maryland SuperMax Penitentiary), I because advisor on health policy to sitting Attorney General and gubernatorial candidate Stephen H. Sachs. Although he lost the race, one health policy aspect I did not advise on because he had already committed to a particular stand, was that of deinstitutionalization of the mentally ill. Sachs… Read more »

Emily Pierce
Guest

Just to highlight my educational background and a little work experience, I graduated cum laude with my bachelors of science degree in criminal justice, I have worked in a county jail, worked as a social work intern in a substance abuse program with paroles, clients that were on probation, TASC Clients, Clients who were incarcerated for murder and other violent offenses all who had co-existing disorders or just a substance abuse diagnosis. During my time as a social work intern I not only did intakes, I did full biopsychosocials, had my own individual clients, co-faciliated substance abuse groups, facilitated my… Read more »

John Ballard
Guest

Thanks for this, Vik Khanna. It’s the first time I have seen the term deinstitutionalization in print for some time. It’s hard to speak of this subject without being accused of advocating some Dickensian dystopia. It was a movement of the Sixties with good intentions that, as Justice Thomas might say, went seriously awry. Having been identified as one of the “ignorant and uneducated” commenters in this thread I’m reluctant to say much more, but here is a six-year old link to something I put together following the Virginia Tech shooting. http://hootsbuddy.blogspot.com/2007/04/deinstitutionalization-hasnt-worked.html After all this time the links I cited… Read more »

Emily Pierce
Guest

I just researched more facts about the Virgina Tech Shooting and while there is evidence that the shooter may have been psychotic it is very hard to say because of the pre-meditation that was involved. When ever you pre-meditate an act you are thoughtfully thinking something out in sound mind and in the tape he sent NBC News which you can view below he clearly states how he pre meditated his act. As I stated above there was no clear psychiatric diagnosis that I am aware of and if some one were to show actual facts about mass gunmen and… Read more »

Peter1
Guest
Peter1

“t’s also interesting to me that in our area of largely professional/entrepreneurial families, I would say that there is an average of one firearm per household. It seems like no one owns just one gun. The violent crime rate in our city of 50,000 is one-fourth the national average, and the total number of murders committed this century is under a dozen. Just 35 miles to the east is the city of St. Louis, which is one of the poorest and most crime-ridden urban areas in the nation” What’s your point? That there is an irrational fear in your neighborhood… Read more »

Emily Pierce
Guest

Was that a rhetorical question? “What’s your point? That there is an irrational fear in your neighborhood that not having a gun will leave you vulnerable?” or directed at someone, because I know that I clearly stated, I am against the use of guns, but it is an individual decision and it should not be taken away, because of misuse from anyone. We know that whether a criminal obtains one legally or the majority of the time illegally they are not going to sit and count the bullets. By putting laws in place that absolutely, make no common sense, because… Read more »

Vik Khanna
Guest

Ummm, I’ve gotten to know my neighbors pretty well over the years. And, I’d say none of them are irrationally afraid of anything. They grew up in a gun culture and just like shooting. That doesn’t bother me in the least. Would any of them use a gun to defend family and property? Absolutely…and MO has the most liberal castle doctrine in the US. The neighbor whose decisions make most nervous? Just bought his 17 yo high school student son at 465 hp Shelby Mustang, modified to be race track ready. In a neighborhood full of pedestrians and playing children,… Read more »

userlogin
Editor

RELATED: If the story which broke last week about Nevada authorities putting the mentally ill on buses to San Francisco and Los Angeles, with a sandwich lunch, some spending money and a few days of medication is true — which it seems to be — California needs to file a lawsuit against Nevada seeking damages and the Feds need to get involved. http://nyti.ms/18KkEuG

We also need to determine how many other states are engaged in similar schemes. I’ve heard stories about this in enough parts of the country to believe that it is common practice .. .

Bobby Gladd
Guest

That’s actually old news. Been going on for quite some time. Really sux.

Bobby Gladd
Guest

Repeal the Second Amendment.

Peter1
Guest
Peter1

Is that an intelligent proposal or a challenge?

Bobby Gladd
Guest

The Second Amendment distorts all thinking and argument pertaining to rational regulation of lethal weaponry. It’s a serious (and now dangerous) anachronism. I proffer one lone (albeit Quixotic) vote to get rid of it. I’ve managed to live 67 years thus far without need of it.

That is NOT to advocate a blanket ban on private ownership of firearms, just a shifting of burden of proof.

And, everyone can please spare the Perfectionism Fallacy pushback.

Peter1
Guest
Peter1

Tax bullets and guns to pay for mental illness treatment.

But again this will be blocked by the power hungary fascists in the NRA.

“The first truth is that the liberty of a democracy is not safe if the people tolerate the growth of private power to a point where it becomes stronger than their democratic state itself. That, in its essence, is fascism — ownership of government by an individual, by a group, or by any other controlling private power. ”

Franklin D. Roosevelt, April 29, 1938.

John Ballard
Guest

Several realities about crazy people have been apparent for years. –Crazy people can legally buy and use firearms. That crap about “When guns are outlawed only outlaws will have guns” is plainly wrong, as this most recent example illustrates. –Community mental health resources and aftercare are not preventing crazy people from killing others. –Deinstitutionalization, which started about forty years ago, is as much a failure as the so-called War on Drugs. It is time for a reality check for both. –Everyone I know has personal knowledge of somebody who is crazy. Not eccentric or strange or a loner or with… Read more »

Emily Pierce
Guest

My first response will be to the ignorant comment made by John Ballard. -Please define Crazy – The Statistics stated in Dr. Jeffrey Lieberman’s Article are not true. In an article titled Newtown, Conn Shooting: Timeline of Mass Killings Since Columbine they cite ONE person who supposedly has a mental illness and was released from jail, and committed a mass shooting. However, the media or investigators who are in charge of investigating the horrific acts up until the DC Shooter this past week or so when it occured has never released intimate details about a mass shooters psychiatric history so… Read more »

John Ballard
Guest

Thank you, Ms. Pierce, for your response. If my use of the word “crazy” was offensive, I apologize. It’s a careless layman’s term like geek, cancer victim, freak or queer with no clinically accurate definition, which I have heard used casually and unselfconsciously by a number of people in those respective categories. My comment is to urge everyday people to recognize their role in resolving what appears to be a uniquely American phenomenon, multiple instances of killing by deranged individuals. If social workers, medical professionals and policy makers had a remedy the problem it would have been solved long before… Read more »

Peter1
Guest
Peter1

“This is a cultural sickness”

The cultural sickness is guns and the “crazies” are in the NRA.

John Ballard
Guest

*Hits like icon*

Emily Pierce
Guest

The pressing issue here is that a psychiatrist who is the head of the AMERICAN PSYCHIATRIC ASSOCIATION and CHIEF PSYCHIATRIST of Columbia Presbyterian in New York City is adding to the stigma of Mental illness and putting out false information. This is a big problem! Why is he doing it, for his own gain if you’ve ever read other articles written by him he has a dire need to get the Mental Health Parity Act passed. Now I haven’t followed the Mental Health Parity Act as of late, but if you read what is in it, basically what it’s stating… Read more »

Peter1
Guest
Peter1

“this gives them free rein to do it without any one overseeing what their doing.”

Who would you trust to do the overseeing?

Emily Pierce
Guest

Sorry for the grammatical errors :), it’s early. Let me explain. With anything you always want somebody providing some oversight to make sure that everyone is doing their jobs. With that being said, if the insurance companies are no longer allowed to do reviews and they do have qualified RN’s doing these reviews then it gives psychiatrists the ability to keep patients past the time they need to be in the hospital. We all know that if you are articulate, especially in psychiatry where it’s all about documenting then you can continuously document reasons why a patient needs to be… Read more »

Peter1
Guest
Peter1

Everyone should have an advocate, but its always about a middle party (usually a judge) trying to find the truth in one side of the argument – a very difficult task in mental illness and open to tragic mistake. We have deinstitutionalized the mentally ill but now rely on the police to administer treatment by arrest and incarceration, or worse by gun fire, but there is no way to force patients in open society to take their meds or see a professional. My take on insurance companies and treatment coverage is that they never wanted to pay because they could… Read more »

Emily Pierce
Guest

Very well stated, it’s always much more complicated than one issue like money and guns. I’m not against psychiatry at all, medication has saved my life. I take it everyday. In fact, I have a medication box just for two medications. I suffer from Major Depression. I am a fierce Mental Health Advocate, but I try to look at everything as they have taught me while taking classes for my masters of social work as an entire picture, not just a snapshot. In Social Work it’s called the Person in Environment Perspective. Which simply means the person and correlation between… Read more »

userlogin
Editor
userlogin
Editor

“My concern is the amount of mental problems in the general population and the lack of investment in this field. When I mentioned investment I don’t mean SSRI or analogues I mean effective psychotherapy and in some cases prescribed medications.”

userlogin
Editor

I am deeply sympathetic to your cause. I am a bit skeptical about the numbers you cite though. Can you cite your source for the 26%? Can we assume this is the conservative estimate?