Bob O’Leary

People want to talk about how the vitriolic rhetoric contributed to the shooting that left  Judge John Roll and five others dead and U.S. Rep. Gabrielle Giffords critically wounded. Some liberal blogs blamed Sarah Palin and others in the Tea Party.

I agree we need to be more civil, but the shooting was not the work of the Tea Party.  The shooter, Jared Lee Loughner, posted plenty of anti-government rants, but none were anti-Semitic (Giffords was Jewish), pro-gun rights, or even against Obama. In fact, had Giffords been a tea partier and birther, she still might have been in Loughner’s crosshairs.

But one fact is apparent – Jared Lee Loughner is a mentally unbalanced man. His YouTube rant makes little sense. His classmates at Pima Community College were scared of him, sitting next to the door in case he snapped. He was suspended from class , not allowed back until he underwent a mental health evaluation.

Eventually, the focus of discussion of the shooting is going to be on mental illness. Online psychologists say Loughner is probably paranoid schizophrenic, but no one can diagnose him from a distance. And even if he was truly paranoid schizophrenic, that alone does not make him dangerous. People with schizophrenia are no more likely to be dangerously violent than anyone else.

But Loughner was not just weird and fearful; he was downright scary. So, the question remains – was Loughner ever evaluated?  The warning signs were there, but did anybody try to get this man any help? Could anyone get him any help?

And if the help was there, it is doubtful that Loughner would take the help voluntarily. He thought the Army, the Government, and Pima Community College were out to get him. Imagine how he would feel about psychiatrists.

If we’re going to discuss the politics behind the shooting, let’s discuss the politics of mental health. There is no part of government that needs more reform than our current public policy on mental health. Years ago, we threw the mentally ill in jail. Reformers came, and we established sanitariums. When those were deemed too cruel and expensive, we closed the. But we never replaced them with anything useful.

So where do we put the seriously mentally ill now? In jails! The three largest mental health institutions in the United States are New York’s Riker’s Island, Chicago’s Cook Island Jail, and the Los Angeles County Jail. None of the three are known for their compassionate care, although they do get care. Many more are homeless and  receive no treatment at all.

Another problem is that we no longer commit people unless they are “an imminent danger to themselves or others.” In other words, before he shot of the Safeway, Loughner could not be forced into treatment. He made no direct threats to anyone. With 31 rounds into 20 innocent people, he can be committed now.

Some states, including New York, California, and Florida, have laws that allow less stringent standards for involuntary outpatient treatment. These laws resulted from tragedies similar to the one in Arizona. Many do not, despite proof that the laws help.

But even with those laws, the treatment is inadequate. Public mental health is poorly funded. Once the committed are stable, they are released. And when they are released, they discontinue treatment and relapse.

Part of the reason governments don’t fund mental illness treatment properly is the stigma behind mental illness. Tell someone you have cancer, and that person will give you compassion. Tell someone you’re seriously mentally ill, and you are treated as if you are contagious.

Because of that stigma, the privacy laws regarding mental illness are stringent to the point of doing more harm than good. If you want to find out the condition of a family member who is in the hospital with a heart attack or even hemorrhoid surgery, the doctor can fill you in on the relative’s condition. But ask about an adult relative who is being treated with a mental illness, and the doctor cannot talk to you. Unless the patient signs a release, the doctor cannot even acknowledge that the relative is a patient.

Tea partiers may complain about the ACHA (aka Obamacare), but mental illness requires government-backed health programs. Many private insurance plans limit the amount of mental health treatments to between 8 and 12 a year, but some patients need to see their therapists more than once a month.

The most effective treatment for mental illnesses are drug therapy, but drug policies often prevent the right drug getting to the patient. Take for example two anti-depressants, Prozac and Zoloft, and two patients suffering from depression. Two drugs are similar, and the patients are about the same age, sex, and body type. They have the same symptoms.  Prozac may work for first patient, but Zoloft doesn’t. The second patient responds to Zoloft, but Prozac does nothing for the patient. Suppose the second patient’s insurance allows only Prozac? The patient must pay out of pocket for Zoloft, a drug that can cost hundreds of dollars a month.

Yes, treating mental illness is expensive, and the ones who need treatment the most cannot afford it. But if governments do not treat mental illness, it becomes more costly. Effective community treatment reduces the amount of time spent institutionalizing the patient, whether the institution is a jail or a hospital.

But right now, governments are cutting back on mental health along with other public services. When help is most needed, most agencies have to figure out a way to keep the same treatment with less resources. It’s getting worse.

We need to change our public policy to allow more assertive treatment for mental illness and properly fund programs. We also need to change our attitudes about mental illness, removing the stigma involved. Some of the changes require more government, but this is one time we need government to act. Other changes only involve our attitudes and don’t cost anything.

If we don’t change, we will have more incidents like those in Tuscon, at Virginia Tech, and other places.