For the past fifteen years, my sister Meg Kaveny has worked with the homeless in Portland, Oregon. Many of them are mentally ill. Meg moved to the Pacific Northwest as a Holy Cross Associate, and stayed on to earn a graduate degree in social work. She has helped teach law-enforcement officers how to better serve the mentally-ill homeless, including how to make more accurate on-street assessments of the risk homeless people pose to themselves and others. I asked Meg what larger lessons for mental-health policy she would draw from the Tucson tragedy. Here are her reflections.
The ultimate culpability of Jared Loughner in killing six people and injuring many others will be debated for a long time. But the responsibility for creating the environment in which mental illness goes undetected and untreated, and in which it’s easier to obtain a firearm than a driver’s license, lies with all of us.
The good news is we already know what works in treating serious mental illness: client-centered, recovery-oriented treatment that takes into account the biological, psychological, and spiritual needs of the person. The terrible events in Arizona in January are only the latest addition to a long, tragic story—one we’ve heard before. Young men in their twenties obtain guns in order to extract retribution from those whom they perceive as enemies. (In general, people with severe and persistent mental illness are far more likely to be the victims of crime than the perpetrators.) Still, if we are to have any hope of changing the conditions that likely contributed to the devastation in Tucson, we must face some difficult facts and answer some difficult questions.
Effective mental-health treatment costs money. The longer a psychotic episode goes untreated, the less likely the person will regain his or her previous level of functioning. Are we willing to fund a comprehensive mental-health treatment system that emphasizes early intervention? Are we willing to pay the people who work in this system a living wage? The evidence suggests we’re not. The National Association of State Mental Health Program Directors estimates that $2.1 billion has been cut from state mental-health budgets in the past three years alone. The current movement to repeal “Obamacare” in order to preserve personal liberty suggests that we are not willing to make comprehensive health care, including mental-health coverage, more available to people who need it.
Individuals make terrible choices about their physical health and their medical treatment, often knowing full well the negative consequences. But when it comes to those with a psychotic illness, the decision to live under a bridge, or not to eat, or not to seek treatment that would alleviate the suffering is not merely a lifestyle choice. In their case, the organ that evaluates options for treatment, risks, benefits, and alternatives is sick. Make no mistake: A person in the midst of a psychotic episode is suffering terribly. Are we willing to reverse a twenty-five-year trend in the United States in which people with severe mental illness are allowed to live on the streets, marinating in their own excrement, under the pretext of preserving their individual freedom and civil rights? In Multnomah County, Oregon, it is not unusual for a person who is floridly psychotic to be released from civil-commitment court if the person is able to state the names of nearby shelters and free-meal sites, even when previous actions indicate that she is not able to meet her most basic needs.
Finally, are we willing to make it harder for people to buy guns? The Constitution guarantees the right to bear arms, but when the Constitution was written, the arms in question were muskets, not semi-automatic handguns capable of firing many rounds per minute. In order to purchase an automobile, a person has to show proof of insurance—to cover the cost of repair or replacement of the vehicle in the event of an accident, but also to compensate people for injuries or death caused by a reckless or negligent driver. Why don’t we require equivalent licensing and insurance before allowing someone to purchase a weapon capable of instant and indiscriminate carnage?
If we are not willing to address these issues, we can only expect to see a repeat of the events in Tucson. A poorly funded mental-health system and lax gun laws don’t cause deadly rampages like that of Jared Loughner. But better mental-health funding, more comprehensive treatment programs, and tighter gun control might have helped prevent it.