Santa Barbara Killings Reopen Debate on Involuntary Treatment - Sovereign Health Group
Articles / Blog
10-20-12 Category: Mental Health

Involuntary Treatment

In the wake of the most recent mass killings, the deadly May 23 rampage of 22-year-old Elliot Rodger that claimed seven lives including his own has reopened public debate on how to prevent such acts of violence before they actually happen. Rodger, a former Santa Barbara City College student, stabbed his three roommates, students at University of California, Santa Barbara (UCSB), to death, then armed himself with three semi-automatic handguns and went on a shooting spree, killing three more people and wounding several others before apparently taking his own life.

Rodger, son of assistant director of the film The Hunger Games, Peter Rodger, posted numerous videos on YouTube, the most recent one just hours before the crime, indicating that his actions were pre-meditated and carefully planned. His final video talked about a “day of retribution,” in which he would take revenge for the suffering he felt he had endured since puberty. Rodger also wrote a 137-page document outlining his views and his anger against women. Weeks before the actual crime, Rodger’s family had reported him to police because of concern about his behavior and his YouTube videos. However, after a visit and brief interrogation, the police left because “he did not meet the criteria for an involuntary hold,” or committal for assessment or treatment

This incident has raised a number of questions, including the potential need for more involuntary treatment of people with a history of mental health disorders who pose “imminent danger” to themselves or others. Rodger reportedly had a history of mental illness, and his parents were concerned about the deterioration of his mental stability was deteriorating, but there was nothing to indicate to police that he was dangerous.

Mass killings occur roughly every two weeks

Mass killings in the U.S. are not common events, but they are not rare, either. In 2012, USA Today reported that there had been one on average every two weeks from 2006 through 2010. The Federal Bureau of Investigation (FBI) definition of a mass killing, used by the newspaper, involves four or more deaths. USA Today found that there had been 156 cases in the five-year period, with 774 people, including more than 160 children, murdered.

Aside from the Santa Barbara incident, other recent high-profile mass killings and the perpetrators include:

  • Fort Hood, Texas shooting, 4/2/2014 (Ivan Lopez)
  • Washington Navy Yard, 9/13/2013 (Aaron Alexis)
  • Santa Monica, CA, 5/7/2013 (John Zawahri)
  • Mohawk Valley, Herkimer County, NY, 3/13/2013 (Kurt Myers)
  • Sandy Hook Elementary School, Newtown, Conn. 12/14/2012 (Adam Lanza)
  • Accent Signage Systems, Minneapolis, MN, 9/27/2012 (Andrew Engeldinger)
  • Sikh Temple, Oak Creek, WI, 8/5/2012 (Michael Page)
  • Aurora theater shooting, 7/20/2012 (John Holmes)

Mass killings account for about one percent of all murders in the U.S., and more than 50 percent of the people killed are family members, neighbors or people known by the killer. About 13 percent of mass murders occur during the course of a robbery or burglary. Only 15 percent of mass killings are public massacres, although 42 percent of victims are strangers to the killer. More than three-quarters of the victims are killed by guns – for the most part, obtained legally – and one-third of mass killers die at the scene after being shot by law enforcement personnel or as a result of self-inflicted gunshot wounds.

Although only a small percentage of people with mental illness are violent, some mass killers have been people diagnosed with a mental health disorder, whether they are receiving treatment or not. Others, appear in hindsight to have been mentally unstable. In the aftermath of these tragic incidents, public sentiment is high, and people focus on two issues: gun laws, and improved mental health laws. Experts say that it is difficult, if not impossible, to predict who might become a mass killer.

Mental health disorders and mass killings

The National Instant Criminal Background Check System, or NICS, is a database established in 1998 to prevent gun dealers from selling weapons to people who are prohibited from owning firearms, including convicted felons and individuals who have been treated for severe mental health disorders. As of 2014, however, 12 states have submitted less than 100 records each about people with mental health disorders. Those states and others have cited privacy restrictions under the Health Information Portability and Accountability Act (HIPAA) for not sharing information. And if someone with a mental illness does not seek treatment, then there would be no record anyway.

Privacy and civil rights issues often frustrate the families of people with mental illness, who can only get access to medical records of an adult child or other family record with the consent of the person receiving treatment. Sometimes it appears that a person is in need of treatment, but it is very hard to force the individual to get that treatment against his or her will.

Anosognosia (lack of insight) is a condition that affects as many as 50 percent of people who have schizophrenia, as well as smaller percentages of people with bipolar disorder or other conditions. The result of this phenomenon is that individual does not have the insight to accept that he or she has a serious mental health disorder. Assisted Outpatient Treatment (AOT) programs, which exist in 45 states, are one approach for dealing with someone who has anosognosia by imposing involuntary, court-mandated treatment.

Families of people with serious mental illness often support AOT. The community of health professionals is divided about whether voluntary treatment assures better outcomes. Violations of the terms of treatment generally results in involuntary hospitalization, according to the Treatment Advocacy Center. However, this goes against the right of a person to refuse treatment, unless he or she is a danger to him- or herself, or others.

Mental health laws and involuntary treatment

Laura’s Law which was passed more than a decade ago in California, is one example of an involuntary treatment program, although the law puts the responsibility on individual counties to implement AOT program.

There are currently two major competing bills at the national level to reform mental health laws. Last year, Rep. Tim Murphy of Pennsylvania, often described as the only working clinical psychologist in Congress, introduced the Helping families in Mental Health Crisis Act of 2013, intended to “fix” the country’s “broken mental health system by focusing on programs of psychiatric care for patients and families most in need of services.” Although it has bipartisan support, the proposed legislation has been criticized for several reasons. It calls on states to revise the standards for committing people with serious mental illnesses to hospitals for psychiatric care. It has been called regressive for provisions that would give more power to families and courts to intervene, and in some cases, impose court-ordered therapy and medication. Which some say would violate the right of people with mental health disorders to refuse treatment. Murphy’s bill also calls for reduced funding for the federal Substance Abuse and Mental Health Services Administration (SAMHSA).

A more recent bill, The Strengthening Mental Health in Our Communities Act of 2014 was introduced by Rep. Rob Barber of Arizona, who was wounded along with his former boss, then-Rep. Gabrielle Gifford in a mass shooting in 2011. Barber’s bill has support from the National Association of School Psychologists, the American Foundation for Suicide Prevention, the American Psychological Association, and Mental Health America.

Key aspects of Barber’s proposed legislation would:

  • Create a White House Office of Mental Health Policy, responsible for developing and implementing a National Strategy for Mental Health;
  • Establish a Mental Health Advisory Board comprised of individuals with mental illness, parents and guardians of individuals with mental illness, mental health professionals, advocates, and others to advise the federal government on ways to improve mental health services and outcomes ;
  • Ensure collaboration between mental health programs and services across federal, state and local agencies;
  • Reauthorize major programs and services under SAMHSA that provide comprehensive, community-based mental health services through Fiscal Year 2019;
  • Create a national media campaign to reduce the stigma associated with mental illness; and
  • Provide grants for schools and communities to create comprehensive mental health programs.

Sovereign Health Group

Sovereign Health Group knows that only a small percentage of people with mental illness are violent, and that most pose a far greater danger to themselves than they do to others. We offer comprehensive assessment and treatment for mental illness and dual diagnosis of concurrent disorders including substance abuse. To learn more about our programs or get help for a loved one, call our Admissions team at 866-264-9778.

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