Monday, January 10, 2011

Mental health

As Ezra notes, one of the few things that actually could have prevented last weekend's tragic events is if Loughner had receives proper mental health care. Apparently, Loughner's logic professor thought he had a messed up brain, although didn't foresee any violence. The narrative here thus becomes, How is our mental health system failing?

But, of course, it's not nearly that simple. Even if Pima Community College had the world's finest mental health care system, there's no guarantee Loughner would have availed himself of it. Several people reportedly advised him to seek help; he chose to drop out instead.

We can call this "slipping through the cracks," but what's the alternative? College professors who can force a student to undergo psychiatric care? Are we even remotely qualified to exercise that kind of power? How many quirky but otherwise harmless students would get caught up in that net?

1 comment:

Andrew Oh-Willeke said...

"[W]hat's the alternative?"

Suppose that anyone can, and that many people (teachers, physicians, police officers, etc.) have a duty to call the county "mental health" board to express concern that someone seems to be having a mental problem that impairs their ability to regulate their own conduct. The model would be the way that anyone can, and that many people have a duty to, call the department of social services to report suspected child abuse or neglect.

Suppose further that the "mental health board" had no power other than the power to send a letter to that someone suggesting that they receive a free mental health evaluation from a qualified psychiatrist of their choice, if the board finds that the report it received from a citizen was credible enough to provide probable cause to believe that the person does have a mental health problem. Anyone who refused to be evaluated would be put on the "ineligible to buy a gun list" just as someone who is a felony, or has a restraining order against them, or a domestic violence misdemeanor is, until such time as they receive a clean bill of mental health from a psychiatrist that says that any mental illness present is not a threat to themselves or others (essentially what Pima College requested of him), but would face no other penalty for non-cooperation.

The result is that people about whom concern has been expressed are nudged to get help, and are prevented from owning firearms without closer than average investigation.

College professors and others did do something very similar within their own college community, and a duty to report serious concerns about a student to a county official with more expertise who would decide if they agreed would hardly be awesome power.

(In Japan, police make annual house visits, and in China, the neighborhood party official has the power and duty to intervene in subcriminal disharmony in the neighborhood, and while formally the U.S. doesn't have these practices, the reality in rural policing can look pretty similar.)