Tricky business: Identifying someone mentally ill who’ll become violent

In the best of times and most favorable of circumstances, it’s tricky business to identify whether a person who is mentally ill might become violent, so that those in his path can be protected from potential harm and he can get the treatment he needs, according to a story in the Chicago Tribune.

But with community mental health services stretched taut by budget cuts and growing need, these are not the best of times, say many experts at the intersection of mental health and public safety. Nor were circumstances ideal to single out Jared Lee Loughner — the suspect in Saturday’s Tucson shooting rampage — as a clear-cut case of someone about to become violent.

Loughner’s increasingly bizarre and mistrustful pronouncements, combined with his age — 22 — suggest to many mental health professionals a flowering of mental illness marked by delusional thinking. People diagnosed with schizophrenia, for instance, most often begin showing signs of the illness in their late teens or early 20s, when they suffer episodes of hallucinations and become preoccupied with delusions — for instance, of persecution or conspiracy.

Loughner’s apparent embrace of notions such as mind control, a new currency and “conscience dreaming” — all mentioned in a YouTube posting he reportedly made — speak to a troubled mind but reveal little actual propensity for violence, said Dr. Mark A. Kalish, a forensic psychiatrist who teaches at UC San Diego.

The mentally ill, Kalish noted, are no more likely to engage in violent behavior than members of the general population.
 
Nonetheless, the shooting has already stirred debate about how to protect the public from violence perpetrated by some among the mentally ill.

Some activists, citing Loughner’s apparent early signs of instability, suggest that state laws need to be broadened to allow involuntary commitment of the potentially violent mentally ill.

Most states require that a mental health professional find an individual not only to be severely disabled by mental illness but also to be an imminent danger to himself or others before allowing involuntary commitment to a psychiatric facility.

Others, including many mental health professionals, just as forcefully note that no laws will ensure safety from the violent mentally ill unless state and community mental health services are in place to find them and treat them.

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