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Mental Illness and Mass Murder

Mental Illness and Mass Murder, By E. Fuller Torrey, WSJ.com, Aug. 4, 2019

Dr. Torrey is founder of the Treatment Advocacy Center and author of “American Psychosis.”

The FBI found 70% of shooters had ‘stressors’ or ‘concerning behaviors’ prior to the attack.

Law-enforcement agencies respond to an active shooter in El Paso, Texas, Aug. 3. Photo: joel angel juarez/Agence France-Presse/Getty Images

Based on the increase in the U.S. population, there are now some one million people with serious mental illness living among the general population who, 60 years ago, would have been treated in state mental hospitals. Multiple studies have reported that, at any given time, between 40% and 50% of them are receiving no treatment for their mental illness. With the best of intentions and the worst of planning, America has emptied out its public psychiatric hospitals without ensuring that the released patients would receive the necessary treatment to control their symptoms. What did we think would happen?

Now we have two more mass shootings, committed over a 13-hour period. In El Paso, Texas, 20 people were killed in what authorities have called a hate crime, while in Dayton, Ohio, the death toll is nine. One database claims these were the 21st and 22nd mass killings in the U.S. in 2019. Such databases vary depending on the number of dead required to meet the definition.

They also vary according to other factors. If, for example, they only count gun deaths, then they don’t include Adacia Chambers, diagnosed with bipolar disorder, who in 2015 killed four and injured 48 by driving her car into a parade crowd in Stillwater, Okla. What is clear from all the databases is that these mass killings are increasing in frequency and have been since the 1980s. Not coincidentally, that was when the emptying out of state mental hospitals was at its peak.

So what role does mental illness play in these mass killings? Multiple studies done between 2000 and 2015 suggest that about a third of mass killers have an untreated severe mental illness. If mental illness is defined more broadly, the percentage is higher. In 2018 the Federal Bureau of Investigation released a report titled “A Study of the Pre-Attack Behavior of Active Shooters in the United States Between 2008 and 2013.” It reported that 40% of the shooters had received a psychiatric diagnosis, and 70% had “mental health stressors” or “mental health concerning behaviors” before the attack.

Most recently, in July 2019, the U.S. Secret Service released its report “Mass Attacks in Public Spaces—2018.” The report covered 27 attacks that resulted in 91 deaths and 107 injuries. The investigators found that 67% of the suspects displayed symptoms of mental illness or emotional disturbance. In 93% of the incidents, the authorities found that the suspects had a history of threats or other troubling communications. The results were similar to those of another study published by the Secret Service on 28 such attacks in 2017.

It thus seems clear that untreated mental illness is playing a significant role in the rising incidence of mass killings. The widespread availability of guns obviously also plays a role. It should be emphasized that mentally ill patients who are receiving treatment are no more at risk for violence than the general population. Yet it is also clear that without treatment some seriously mentally ill people are at greater risk for violent behavior than the general population.

For those who are seriously mentally ill but who, because of their brain disease, are unaware of their illness and refuse treatment, it is sometimes necessary to require them to accept treatment as a condition for living in the community. This is often done under a program referred to as assisted outpatient treatment. Such treatment may involve injectable antipsychotic medication that can be effective for as long as three months. This should always be accompanied by a judicial process and legal protection of individual rights.

We know what to do to reduce the number of mass killings associated with mental illness. The question is whether we have the will to do it.

Dr. Torrey is founder of the Treatment Advocacy Center and author of “American Psychosis.”

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