Don’t focus on mentally ill

Opinion: February 17, 2013 at 12:00a.m.

By Georgann Witte

Hartford Courant

The horrific mass murder of children and school personnel in Newtown, Conn., prompted calls for more screening of gun buyers to identify the mentally ill and prevent or restrict purchases of weapons and ammunition. This simplistic, impractical and unfair proposal wrongly stigmatizes a large (and constantly shifting) group of our fellow citizens, without adequately addressing the underlying dangers of loosely regulated guns.

Although the recent mass killings (in Aurora, Colo., Tucson, Ariz., and at Virginia Tech) were committed by young men believed to have severe mental illness, the vast majority of those with mental illness are no more likely to commit acts of violence, and are no more likely to want to inflict harm, than the general public. As the director of the National Institute of Mental Health, Thomas Insell, said, those with severe mental illness, known as SMI, are more likely to be violent, particularly during a psychotic episode with paranoid delusions, but “mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI.”

How would screenings of the mentally ill be done, and what would they accomplish?

Clinicians treating patients hear their fears, anger, sadness, fantasies and hopes, in a protected space of privacy and confidentiality, which is guaranteed by federal and state laws. Mental health professionals are legally obligated to break this confidentiality when a patient “threatens violence to self or others.” But clinicians rarely report unless the threat is immediate, clear and overt.

Incomplete knowledge

Mental health professionals understand that, despite our intimate knowledge of the thoughts of our patients, we are not very good at predicting what people will do. Our knowledge is always incomplete, and conditional, and we do not have the methods to objectively predict future behavior. Tendencies, yes; specific actions, no. Clinicians have a nuanced but uncertain grasp on patients’ state of mind.

What about diagnoses?

If mental health professionals were required to report severe mental illness (such as paranoid schizophrenia) to state authorities, it would have an immediate chilling effect on the willingness of people to disclose sensitive information, and would discourage many people from seeking treatment. What about depression, bipolar disorder, substance abuse or post-traumatic stress disorder, along with other types of mental illness that have some link to self-harm and impulsive action? The scope of disclosure that the government could legally compel might end up very wide, without any real gain in predictive accuracy.

Diagnosis is an inexact and constantly evolving effort, and it is contentious within the profession. To use a diagnosis as the basis of reporting possible violence to the authorities would make the effort of accurate evaluation much more fraught. And what of the families and friends of the mentally ill? Should their weapons purchases be restricted as well? A little reflection shows how unworkable in practice any screening by diagnosis would be.

Expansion of mental health services and outreach to troubled individuals are welcome and long overdue — a policy mental health professionals would strongly support. But these changes cannot offer a quick or complete solution.

The shortage of qualified clinicians, particularly in child and adolescent therapy, will take a long time to offset. Graduate training takes years, and already the demand for qualified therapists far exceeds the supply. And these proposed solutions do not take into account those individuals who never seek treatment at all — the loners, the odd and isolated ones, the marginal, who may not even respond to free and readily available services.

In any case, successful therapeutic interventions cannot be forced or compelled. Most clinicians have experience with court-ordered therapy and know the difference between false and true cooperation.

The U.S. does not have a monopoly on mental illness. Every country has citizens with severe mental illness at about the same rate we do. But in countries where no one has access to assault weapons or high-capacity ammunition magazines, the rate of murder and gun violence is a small fraction of our rate.

Georgann Witte is a psychologist with Behavioral Health Consultants in Hamden, Conn. She wrote this for the Hartford Courant. Distributed by McClatchy-Tribune.