December 18, 2012, 6:11 p.m. ET
The Potential Killers We Let Loose
The U.S. would have fewer mass killings if individuals with severe mental illnesses received proper treatment.
THE WALL STREET JOURNAL
By E. FULLER TORREY AND DORIS A. FULLER
There are many good reasons to improve gun control in the United States, including the obscene firepower available in many weapons. But better gun control will do little to prevent many mass killings, such as occurred last week in Newtown, Conn. Even if you ban guns completely, there are many alternative weapons available for use by untreated severely mentally ill persons who are so inclined.
Knives, for example. On the same day Adam Lanza killed 20 children at Sandy Hook Elementary School in Connecticut, Min Yingjun stabbed 22 children at an elementary school in central China. Similar assaults using knives killed about 20 and wounded more than 50 children in China last year. Almost all the attacks were carried out by severely mentally ill men. So maybe we should ban knives.
What about cars? In 1999 Steven Abrams, diagnosed with schizophrenia, drove his car onto a school playground in California, killing two young children. He had been hospitalized for psychiatric problems and had talked of killing children. Also in California, Marie West, diagnosed with bipolar disorder and with 19 previous hospitalizations, intentionally ran over an elderly man in 2000. The following year David Attias, diagnosed with bipolar disorder and previously hospitalized, drove his car onto a sidewalk in the Golden State, killing four and injuring nine. He then got out of his car and said he was an “angel of death.” Perhaps we should ban cars as well.
The heart of this problem is not the availability of weapons but the abundance of individuals with severe mental disorders who are not being treated.
Severe mental disorders are defined by the National Advisory Mental Health Council as including schizophrenia, schizoaffective disorder, bipolar disorder, autism and the severe forms of major depression, panic disorder, and obsessive-compulsive disorder. According to the National Institute of Mental Health, 7.7 million Americans currently qualify for the first three diagnoses, with 3.5 million of them receiving no treatment at any given time.
Among this 3.5 million, approximately 10%, or 350,000 individuals, become societal problems because of their untreated severe mental illness. According to federal statistics or academic studies, they comprise one-third of the homeless population and one-fifth of the inmates of jails and prisons, and they are responsible for at least 10% of all homicides in the U.S.
Mass killings by individuals with severe mental illness are one tragic symptom of a much larger problem. Over the past half-century, the availability of public psychiatric beds in the U.S. has decreased to 43,000 from 559,000, even as the population has increased. When individuals with severe mental illnesses are hospitalized at all, they are not kept long enough to become stabilized because of the bed shortage. Many are eventually incarcerated for petty crimes or worse.
A 2010 survey by the Treatment Advocacy Center reported that there are over three times more severely mentally ill individuals in jails and prisons than in hospitals. The problem is further exacerbated by state commitment laws that impede the hospitalization of those who resist treatment.
At this time, Adam Lanza’s psychiatric diagnosis is not publicly known. Published accounts suggest that he fits into the autism spectrum, and it is known that a small number of such individuals become violent as adults. Such individuals require medications to control their behavior.
While it isn’t yet known whether Lanza was being treated, it is known that Connecticut is among the worst states to seek such treatment. It has among the weakest involuntary treatment laws and is one of only six states that doesn’t have a law permitting court-ordered “assisted outpatient treatment.” In study after study, AOT has been shown to decrease re-hospitalizations, incarcerations and, most importantly, episodes of violence among severely mentally ill individuals.
Would we have fewer mass killings in the U.S. if we made sure that individuals with severe mental illnesses were receiving treatment? Examining the other 10 largest mass killings suggests that the answer is yes.
Seung-Hui Cho, who killed 32 at Virginia Tech; Howard Unruh, who killed 13 in Camden, N.J.; and Jiverly Wong, who killed 13 in Binghamton, N.Y., all had untreated schizophrenia. James Holmes, who killed 12 in an Aurora, Colo., movie theater almost certainly was severely mentally ill, but clinical information has not yet been released. George Hennard, who killed 23 in a Killeen, Texas, cafeteria, had definite paranoid thinking. Patrick Sherill, who killed 14 in an Edmond, Okla., post office, was known as “crazy Pat” by his neighbors but never formally diagnosed.
By contrast, little or no evidence of severe mental illness exists for Eric Harris and Dylan Klebold, who killed 13 at a high school in Littleton, Colo.; James Huberty, who killed 21 at a McDonald’s MCD -0.89% in San Ysidro, Calif.; and U.S. Army Maj. Nidal Malik Hasan, who killed 13 at the Fort Hood military base in Texas. Yet Charles Whitman, who killed 14 in Austin, Texas, was found at autopsy to have a tumor in the part of the brain that controls aggression.
It is now clearly established that people with severe mental illnesses who are being treated are no more dangerous than the general population. But some with severe illnesses who are not being treated are more dangerous. Therefore, if we ensure treatment for those who are known to be potentially dangerous, we may not eliminate mass killings but we would reduce them significantly. And perhaps if we had already done so, 20 small children in Newtown, Conn., might be alive today awaiting Christmas.
Dr. Torrey is the founder and Ms. Fuller is executive director of the Treatment Advocacy Center in Arlington, Va.
A version of this article appeared December 19, 2012, on page A19 in the U.S. edition of The Wall Street Journal, with the headline: The Potential Killers We Let Loose.