Identifying the violent mentally ill is a challenge, experts say

[cali]

Shooting suspect Jared Lee Loughner showed signs of apparent mental illness, professionals say, but it's not always possible to predict if someone will become violent. And in Arizona, budget cuts have severely taxed mental health services.



In the best of times and most favorable of circumstances, it's tricky business to identify whether a person who is mentally ill might become violent, so that those in his path can be protected from potential harm and he can get the treatment he needs.

But with community mental health services stretched taut by budget cuts and growing need, these are not the best of times, say many experts at the intersection of mental health and public safety. Nor were circumstances ideal to single out Jared Lee Loughner — the suspect in Saturday's Tucson shooting rampage — as a clear-cut case of someone about to become violent.

Loughner's increasingly bizarre and mistrustful pronouncements, combined with his age — 22 — suggest to many mental health professionals a flowering of mental illness marked by delusional thinking. People diagnosed with schizophrenia, for instance, most often begin showing signs of the illness in their late teens or early 20s, when they suffer episodes of hallucinations and become preoccupied with delusions — for instance, of persecution or conspiracy.

Loughner's apparent embrace of notions such as mind control, a new currency and "conscience dreaming" — all mentioned in a YouTube posting he reportedly made — speak to a troubled mind but reveal little actual propensity for violence, said Dr. Mark A. Kalish, a forensic psychiatrist who teaches at UC San Diego.

The mentally ill, Kalish noted, are no more likely to engage in violent behavior than members of the general population.

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http://www.latimes.com/health/la-he-mental-health-20110111,0,2679941.story

[Lancer]

1. Violence and mental illness

The mentally ill, Kalish noted, are no more likely to engage in violent behavior than members of the general population.

This is statistically true, but one does not have to become physically violent, presenting an immediate risk to the safety of himself or others, to need mental health treatment. I lost one family member to suicide. Pulling the trigger that ended his life was the ONLY violent act he ever committed in his 31 years. He was receiving outpatient treatment at the time of his death, but seemed resistant to drug therapy of any kind.

Another family member is lost now because of his alcohol and substance abuse, combined with specific and non-specific rage, delusions, threatening, erratic and impulsive behavior. But here in NC, as in AZ and many other states, state and county mental services have been slashed to the bone, and he cannot receive the treatment he needs unless he does act in a violent manner, threatening suicide or homicide right there at the admissions desk.

Whether this family member will ever explode and turn into a killing machine I don't know. Nor can doctors or mental health professionals predict this with any certainty. But he has caused an unimaginable amount of damage to his family without becoming physically violent. He is sane enough to walk that very fine line between wild, unspecified threats and specific threats of bodily harm to anyone who tries to approach him. As long as he stays on the other side of the line, no judge in NC will recognize that he is mentally ill and needs help. To the courts he's just a nuisance. Not worth their time. :::gavel bangs:::

[HereSince1628]

2. Can't speak for NC, but in Wisconsin, particularly Milwaukee County

where budgets for mental health have been cut to the bone... just being distraught is sufficient to initiate an involuntary detention that will include observation and psychiatric evaluation. That service isn't free, the detainee will get a bill for about $1400 a day/night, however the cost can be reduced or the detainee released from obligation to pay if they have insufficient means.

Regarding costs...many private mental health providers based in the community have billing structures that have sliding scales according to a person's ability to pay. Assistance finding public or private providers as well as support for families with mentally ill members is available through mental health support groups such as the National Alliance on Mental Illness; www.nami.org

Anyone who has had a family member with a serious mental illness can appreciate the destructive power of such illness to the family and to the immediate suffer. Help is usually available in a community. It may require setting aside fears of being stigmatized and fears of encumbering a large debt. If you don't know where to turn, other people do. Look in the Yellow Pages, or do an internet search on mental health services in your community. The first provider you reach may not be able to help you directly, but they WILL put you in touch with people who can help. Really.

[Lancer]

4. But in my area,

only if the person whose mental health is at issue is over 18, and WILLING to, or agrees to go and get professional help. You cannot have someone who is over 18 involuntarily committed in NC, unless they attempt to harm themselves or become violent against others. That's also just about the only way someone over 18 can get help at state- or county-owned facilities.

I and several other family members voluntarily used our County Mental Health Center for treatment and services over the years. We did pay on a sliding scale and often got samples of our meds so we did not have to pay full prices. (One of my seven meds costs $800/mo. if you don't have insurance.)

But we went because we knew we needed help. The disturbed member in my family thinks everyone else is insane. Pretty tough to deal with unless he does something that will involve bringing in law enforcement.

My heart goes out to everyone on DU and elsewhere who is dealing with someone who refuses to acknowledge they have a mental illness, or drug or alcohol problem and will not seek help.

[jody]

3. Even more difficult to identify "violent not-mentally ill" like those that fill our prisons. n/t