The Trade-Off: Should We Commit Mentally Unstable People?

13 Jan, 2011 by John Hawkins

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“There are no solutions. There are only trade-offs.” — Thomas Sowell

James Lee Lougher, the shooter in the Tucscon massacre, was a scary dude and a lot of people knew he had serious issues before he went on a rampage.

After he was accused of shooting 20 people last Saturday, school officials described his behavior while at Pima as odd and disruptive. But police reports show in chilling detail that the behavior frightened students and teachers.

In February, a rattled student told school officials she feared he had a knife, after Mr. Loughner upset his Advanced Poetry Writing class by making comments such as, “why don’t we just strap bombs to babies.”

In May, an instructor was so worried about physical violence on Mr. Loughner’s part that she requested–and received–a police guard outside her class. By June, a dean told the police that students in Mr. Loughner’s math class were “afraid of any repercussions that could exist from Loughner being unstable in his actions.”

The school finally suspended Mr. Loughner in late September, after police officers who removed him from a biology class told the school they believed he had mental health problems. On the day of his suspension, the police were able to recognize his voice and his “reflection in the window” in a video posted on YouTube. In the video, according to the reports, he made statements such as, “We are examining the torture of students,” and, “I haven’t forgotten the teacher that gave me a B for freedom of speech.”

There is no evidence that Mr. Loughner had been diagnosed with a mental illness, and it is unclear whether Mr. Loughner ever received psychiatric treatment.

But the trove of records demonstrates more clearly than before how abruptly Mr. Loughner’s life spiraled out of control. When his problems began in February, he had no disciplinary record, the school told police at the time.

A number of people have talked about different laws in response to this tragedy, but there’s only one that has been discussed that could have conceivably made a difference: Making involuntary commitment easier. Despite what you may have heard, locking someone up against his will for mental helath issues is not so easy:

For that minority of people with untreated mental illness that may drive them to violence, identifying them and getting them into treatment can be formidable tasks psychiatrists note.

“You can’t be involuntarily treated unless you’re an imminent danger to yourself or others,” says Lehman. “Just because someone speaks loudly and scares other people doesn’t mean they’re an imminent threat to others. I think that’s the dilemma here. [For Loughner] was scary, but he wasn’t directly threatening anybody.”

In Arizona, courts would have required that two clinicians evaluate Loughner and conclude that he was a danger to himself or others or both to initiate committing him involuntarily to a mental health facility, but that would have involved forcing him to be evaluated.

Some have questioned whether the Tucson massacre makes a case for more lenient requirements on involuntary commitment, but Robinowitz warns that “there’s a tendency to overreact” following violent incidents.

“It becomes an issue of balancing public health and individual civil rights,” she says. “The pendulum has gone from a time [in the 1940s and 1950s], when it was relatively easy to force people to have treatment against their will,” to now, when there is much more emphasis on protecting the rights of individuals.

In other words, to get committed, essentially you’ve got to be so out of it that you’re willing to flat out tell someone in authority that you’re willing to kill yourself or someone else. That’s a very, very high standard.

So should it be easier to commit people?

After a shooting, the instinctive answer most people have is “yes.” Moreover, I have previously advocated making it easier to commit homeless people with mental issues. I still believe we should do that. If your mental illness gets so out of hand that you’re out on the streets, then as a society, I think it makes sense for us to step in, take you off the streets, and force you to get treatment.

But, in all fairness, that’s really a separate issue from someone like James Lee Lougher. Let me explain why. I was talking with someone about this issue and how crazy the guy was and she told me that in her life she’d twice known people she thought were loopy enough to potentially pick up a gun and go on a shooting spree. So, I asked the obvious question: “Did they ever do anything crazy? Did they ever shoot anyone?” The answer was “No.” And there it is.

Yes, we could make it much easier to commit people. But, guess what? 99.9% of the “scary” people out there aren’t going to go on a shooting spree. That’s just statistics. Are we, as a society, willing to lock those people up against their will anyway? Are we willing to lock up a lot of people who aren’t that mentally ill at all — because that will happen, too. People who aren’t experienced at dealing with the mentally ill, people with grudges, people who get angry, all of them will want people locked up and psychologists won’t be savvy enough to catch all the mistakes.

Moreover, here’s a little secret that most people don’t realize: Almost everybody, in some way, form, or fashion, has some kind of mental issue. On a superficial level, they may appear fine, but you go below the surface and poke the right spot and you would be surprised at the demons that will pop out — and that’s almost EVERYBODY. So, you make it easier to commit people and there are a lot of people who, given the right circumstances, could end up committed against their will.

Since that’s the trade off, I don’t believe we should make it easier to lock people up for mental health reasons — with of course, the exception for mentally ill homeless people that I mentioned, that really doesn’t fit that well with this particular discussion.