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January 13, 2011

2
P.M.

Tucson Shooting: The mental state of Jared Lee Loughner

Total Responses: 13

About the hosts

About the host

Host: Kristina Ragosta

Kristina Ragosta

Kristina Ragosta is Legislative & Policy Counsel with the Treatment Advocacy Center. The Treatment Advocacy Center works to improve state mental health treatment laws - and to remove barriers to the timely and effective treatment of severe mental illness. Twenty-two states have made important changes to their treatment laws as a direct result of our advocacy since we were founded. Kristina has visited numerous states that use their existing treatment laws in order to help with the implementation of those laws and to help make needed improvements.

About the topic

Kristina Ragosta of the Treatment Advocacy Center will be online Thursday Jan. 13, at 2 p.m., to discuss the mental state of alleged Tucson, Ariz., shooting subject Jared Lee Loughner.
Q.

Kristina Ragosta :

The Treatment Advocacy Center is a national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illnesses. The organization promotes laws, policies and practices for the delivery of psychiatric care and supports the development of innovative treatments for and research into the causes of severe and persistent psychiatric illnesses, such as schizophrenia and bipolar disorder.  You can learn more about our activities on our website

Q.

Warning Signs

So there were obviously numerous warning signs there for friends, classmates, as well as school officials and even law enforcement that this young man was deeply troubled. What prevented anyone from compelling him to seek treatment? What can an individual close to a mentally troubled person do to get them help and perhaps stop another act of violence by someone lacking control over their mental/emotional faculties?
A.
Kristina Ragosta :

Every state has different laws as to who can seek an emergency mental health evaluation when a person is concerned about another’s mental state.  Furthermore, every state laws has different standards for civil commitment – you can find summaries of those laws on our website.

 

Arizona law provides “The application for emergency admission shall be made by a person with knowledge of the facts requiring emergency admission. The applicant may be a relative or friend of the person, a peace officer, the admitting officer or another responsible person.” 36-524. Application for emergency admission for evaluation; requirements. 

 

 If it is an immediate crisis or emergency, you can call 911.  Let them know that you think it might be a mental health emergency, so that if they have a special response team trained in mental health crises they will be involved. If it is not an emergency, please know that every state has a mental health agency and local mental health providers.  If you think someone needs help, you can look up “mental health” in your local published or online directory and call them to get assistance.  We have even more specific tips on getting help for a person with severe mental illness on our website.  The tips include: knowing your state law, preparing for an emergency, knowing the available options and responding in crisis.

 

– January 13, 2011 2:03 PM
Q.

psychological disorder

Did Loughner have a history of treatment for a psychological disorder? If not, is there any evidence that this was the result of a psychoic state? This seems more the act of someone in a delusional state than a politically motivated act.
A.
Kristina Ragosta :

From the media accounts I have seen, Loughner did not have a history of treatment for a psychological disorder.

 

I am not a medical expert, but my understanding is that he has been reported to have had symptoms associated with schizophrenia—incoherent thought processes, delusional ideas, erratic behavior—and almost certainly was seriously mentally ill and untreated.

 

Schizophrenia is a neurological brain disorder that affects 2.2 million Americans today, or approximately one percent of the population. Schizophrenia can affect anyone at any age, but most cases develop between ages 16 and 30.

 

Schizophrenia interferes with a person’s ability to think clearly, manage emotions, make decisions, and relate to others. Specific abnormalities that can be noted in individuals with schizophrenia include: delusions and hallucinations; alterations of the senses; an inability to sort and interpret incoming sensations, and an inability therefore to respond appropriately; an altered sense of self; and changes in emotions, movements and behavior.

 

You can read more about schizophrenia on our website.

 

– January 13, 2011 2:06 PM
Q.

Mental Health

I was startled to read in a posting by NAMI that up to 6 percent of Americans live with severe mental health issues. It follows that a small percent might harbor violent tendencies which could be triggered by numerous things. If we somehow learn about this risk, what is the best way to proceed?
A.
Kristina Ragosta :

Individuals with severe mental illnesses are no more violent than the general population – so long as they are being treated. You can read about the link between untreated severe mental illness and violence on our website.

As I stated earlier, if it is an immediate crisis or emergency, you can call 911.  Let them know that you think it might be a mental health emergency, so that if they have a special response team trained in mental health crises they will be involved. If it is not an emergency, please know that every state has a mental health agency and local mental health providers.  If you think someone needs help, you can look up “mental health” in your local published or online directory and call them to get assistance.  We have even more specific tips on getting help for a person with severe mental illness on our website.   The tips include: knowing your state law, preparing for an emergency, knowing the available options and responding in crisis.

 

– January 13, 2011 2:08 PM
Q.

How to deal with the mentally ill

The we are all at fault editorial in today's post was great. We all do walk by homeless and people who seem to be very mentally disturbed every day, and at the most say thats bad. However these people are unstable and its impossible to know how they will react if approached. I have also heard its often unwise to give money directly to homeless because the money often won't be used effectively, and that instead the money would be much better used given to a shelter. At the end of the day, what can the average person do?

A.
Kristina Ragosta :

Thanks for the question. The bottom line is this suspect appears to have needed mental health treatment. And, as far as we know, the mental health system never had a chance to succeed or fail in this case – because no one ever brought his plight to the attention of the proper authorities.

 

As I stated earlier, if it is an immediate crisis or emergency, you can call 911.  Let them know that you think it might be a mental health emergency, so that if they have a special response team trained in mental health crises they will be involved. If it is not an emergency, please know that every state has a mental health agency and local mental health providers.  If you think someone needs help, you can look up “mental health” in your local published or online directory and call them to get assistance.  We have even more specific tips on getting help for a person with severe mental illness on our website.  The tips include: knowing your state law, preparing for an emergency, knowing the available options and responding in crisis.

 

As my colleague Brian Stettin pointed out in a recent op-ed, “It is time to face a few facts about the untreated severe mental illness that surrounds us: That it's a medical problem, with a medical solution; that we ignore it at our own peril; that common decency obligates us to help people in dire need through no fault of their own, even when they can't recognize their own need for help, and that this obligation includes, at a minimum, the responsibility of any citizen bearing witness to a psychiatric meltdown to pick up a phone and share information with the rescue workers who we expect to do something about it.”

– January 13, 2011 2:09 PM
Q.

Very Worried

I hate to say this, but I see a relative in Jared Laughner. He hasn't shown signs of violence, but he does show that same disordered thought pattern. He seems perfectly functional on the outside - holds down a job, has a place of his own, manages money - but in talking with him the disorder becomes clear. Frankly, it's scary and I am uneasy to be around him. I have urged him to get help, but he usually doesn't even recognize that there is a problem. The few times he has said something close to recognition that there is a problem, he still refuses to consider treatment. Beyond that, what can I do? I did talk to a friend in criminal justice about the criteria necessary for emergency evaluation and I don't have anything nearly specific enough to do it. I just have vague unease.
A.
Kristina Ragosta :

 I’m sorry to hear about your loved one.

 

As you may already be aware, lacking the ability to understand that you are sick is a physical symptom of many mental illnesses. It sounds like that may be the case with your relative - he may suffer from anosognosia (lack of insight). It is a major problem because it is the single largest reason why individuals with schizophrenia and bipolar disorder do not take their medications (or seek treatment).

 

You should be trying to get him to voluntarily seek treatment- even if you don’t succeed now, you may be laying the groundwork for progress down the road.

 

I cannot more highly recommend the book “I’m Not Sick, I Don’t Need Help” by Dr. Xavier Amador.  It explains many techniques to promote treatment compliance by people with mental illness who lack insight into their condition.  You may be surprised that the best ways to do this are not necessarily what you might logically think.

 

In addition  – you should visit the “get help” section of our website - we have even more specific tips on getting help for a person with severe mental illness. Some of the tips include: knowing your state law, preparing for an emergency, knowing the available options and responding in crisis. 

– January 13, 2011 2:14 PM
Q.

Blame the Mental Health Community

it bothers me that the conversation does not seem to focus on the fact that "advocates" for the mentally ill have gone TOO far in the direction of protecting the seriously mental ill that involuntary or long term committment is next to impossible unless a serious incident happens. Don't we want to get people committed BEFORE they are caught with a weapon? I understand the mentally ill have been abused historically but now we have gone too far in the other direction. These mass shootings always have the same back story. Everyone knew the shooter was mentally ill but there was not way to force them into residential treatment.

A.
Kristina Ragosta :

Thanks for the comments/questions.  You are absolutely correct in that - STATE LAWS NEED TO PERMIT INTERVENTION BEFORE DANGEROUSNESS.  Many states, including Arizona, have standards which permit court ordered treatment for severe mental illnesses that are more progressive than “danger to self or others.”   Existing treatment laws based on “grave disability” or the “need for treatment” are too often overlooked, ignored or underused. As long as that's the case, the consequences of non-treatment will be chronic and tragedies will continue to occur.

 

These tragedies are the inevitable outcome of years of failed mental-health policies. Arizona has some of the worst public mental-health services in the country. Arizona ranks second to last in the country in the number of psychiatric hospital beds per capita.

 

One needed solution to this situation is to ensure that individuals with severe mental illnesses are receiving the treatment they need. Many patients are able to voluntarily take medication (when it’s made available). However, others lack insight into their illness (anosognosia) and might only get needed community treatment if required by law to receive it (assisted outpatient treatment).

– January 13, 2011 2:15 PM
Q.

Declining mental state

A few of my friends have adult children who suddenly developed schizophrenia. Apparently this is a fairly common trajectory: otherwise healthy young adults suddenly go off the rails. Is this indeeed a common trajectory for the disease? And do you think that's what happened in Loughner's case? I must say that I really object descriptions of people like Loughner as evil or deranged. I can't help but think that interventions existed that, if employed, might have prevented the tragedy. Writing the perpetrator off as either evil or deranged, it seems to me, only increases the likelihood of future tragedies.
A.
Kristina Ragosta :

I am not a doctor, but my understanding of schizophrenia is that – yes – it does typically rear its head in otherwise healthy young adults. Schizophrenia can affect anyone at any age, but most cases develop between ages 16 and 30. My understanding is that Loughner has been reported to have had symptoms associated with schizophrenia—incoherent thought processes, delusional ideas, erratic behavior—and almost certainly was seriously mentally ill and untreated.

 

You can read more about schizophrenia on our website.

– January 13, 2011 2:18 PM
Q.

Washington, DC

It seems we learned nothing from the Va. Tech. massacre. The college has released a 51-page file on Loughner's disruptive conduct in class, and in the entire pdf file, the word "counseling" appears only once. Schizophrenia often surfaces during a person's young adulthood -- the college years -- and the people who observed Loughner's conduct didn't once steer him to the campus counseling services. Loughner has not owned a handgun for two months yet.
A.
Kristina Ragosta :

It’s easy to place blame after the fact. And I can only imagine how devastating it is for the victims and their families to hear of Loughner's mental health issues leading up to this awful tragedy.

 

The bottom line is this suspect appears to have needed mental health treatment. And, as far as we know, the mental health system never had a chance to succeed or fail – because no one ever brought his issues to the attention of the proper authorities.  

 

My hope is that this awful tragedy leads to us focusing on – rather than ignoring - individuals with severe mental illnesses – to ensure they are receiving the treatment they need. Many patients are able to voluntarily take medication (when it’s made available). However, others lack insight into their illness (anosognosia) and might only get needed community treatment if required by law to receive it (assisted outpatient treatment).

– January 13, 2011 2:21 PM
Q.

Reporting an unstable person

What exactly is the process to report someone who you think is unstable and a potential threat to the community? Is this process different in states that do not have AOT laws?
A.
Kristina Ragosta :

The process is different in every state. Generally speaking, where someone is unable to voluntary seek services – the process begins with an emergency evaluation (whether or not the state has an assisted outpatient treatment law).  Every state varies as to who can initiate/seek an emergency evaluation.

 

If it is an immediate crisis or emergency, you can call 911.  Let them know that you think it might be a mental health emergency, so that if they have a special response team trained in mental health crises they will be involved. If it is not an emergency, please know that every state has a mental health agency and local mental health providers.  If you think someone needs help, you can look up “mental health” in your local published or online directory and call them to get assistance. Many local mental health authorities have 24 hour crisis numbers. 

 

We have even more specific tips on getting help for a person with severe mental illness on our website.  Some of the tips include: knowing your state law, preparing for an emergency, knowing the available options and responding in crisis.

– January 13, 2011 2:25 PM
Q.

Epathy for Jared

I may be the odd man out, but I definitely have empathy and compassion for Jared Lee Loughner and what appears to be his untreated severe mental illness. It is difficult for me to see the "evil" in this person when his mental disease has control of him. Am I being unreasonable?
A.
Kristina Ragosta :

I don’t think you are the “odd man out.” People that understand the ravages of severe mental illness – understand that this act of violence – was likely the result of a man with untreated mental illness. It doesn’t make the situation any less awful or tragic. But it provides some insight – and perhaps some empathy – for the suspect. 

 

Your comment reminds me of a quote from a man who lost his legs after being pushed in front of a subway train in New York by a person with untreated mental illness - that event - although tragic - is of a different caliber - nonetheless it speaks to your point- Mr Rivera was quoted as saying - ''I have no legs, but at least I have my mind,'' Mr. Rivera, 37, said from Bellevue Hospital. ''This guy doesn't have that. I think I'm ahead.''

– January 13, 2011 2:26 PM
Q.

compelling someone to seek treatment

My Dad was Paranoid Schizophrenic. We knew he was ill, but we were told that unless he presented an immediate threat to himself or someone else there was nothing that we could do. The fact that we knew that he was ill and acting bizarrely didn't carry any weight, one magistrate told us that one person's "crazy" was another person's "eccentric" and that there was no law against either one. Unless you can get someone committed you cannot make them take their meds. You can beg, plead, whatever, but most mentally ill people are like my Dad. According to him there was nothing at all wrong with HIM, it was everyone else. We did call the mental health crisis unit and they actually took him in for evaluation. The only reason he was committed was because he had stopped taking his Diabetes medication (he believed that the doctors were poisoning him) and his blood sugar was through the roof; hence he was ruled a danger to himself. The only problem was that he was sick but not stupid; he "played the game" as he put it and took his meds and 'responded' to treatment while he was in the hospital. But as soon as he was out we went right back off his meds. He had been diagnosed in the 70's ( and had a nervous breakdown) and took his meds until he retired so the last episode was not something new and out of the blue. Still the law can only do so much until someone actually hurts, or attempts, to hurt themselves or someone else. Even when you KNOW there is something wrong with someone it's not at all easy to get them help. And until you've been there yourself you have no idea of just how difficult it can be. My Dad eventually died from complications of diabetes because he stopped taking his insulin along with his psych meds.
A.
Kristina Ragosta :

I’m so sorry to hear about your dad. I wish I could say that I didn’t hear similar stories on a regular basis - and that there was an easy answer. In many states, the standards for civil commitment are much broader than dangerousness – and allow intervention when someone is considered gravely disabled or in need of treatment – you can find a summary of them on our website.

For people looking to get help for a loved one - we have some good tips on our website

I don't know whether it would have helped in your dad's situation - but assisted outpatient treatment (AOT)- when implemented - has been proven to help people get and stay on their medications. 44 states currently have some form of AOT - but many do a very poor job of implementing it.

– January 13, 2011 2:36 PM
Q.

Arizona Laws

What is wrong with Arizona's Laws that there wasn't preemptive help prior to the tragedy? I thought they were good? Why aren't they being implemented?
A.
Kristina Ragosta :

Good question. I don't know that Arizona's law was the issue in this particular case.

Many states, including Arizona, have standards which permit court ordered treatment for severe mental illnesses that are more progressive than “danger to self or others.”  

 

The issue, as you imply, may be with implemention. Existing treatment laws based on “grave disability” or the “need for treatment” are  too often overlooked, ignored or underused. As long as that's the case, the consequences of non-treatment will be chronic and tragedies will continue to occur.

– January 13, 2011 2:45 PM
Q.

Crazy Message board postings

What can we do if we think a user on a message board consistently posted troubling comments, but does not threaten a specific individual. They just sound mentally unstable.
A.
Kristina Ragosta :

Without knowing more details of the situation - it's hard to make any specific recommendations. That said, if there is a moderator of the particular message board you are using, it sounds like it would make sense to contact him/her - and alert them of the troubling behavior. And, perhaps suggest it might warrant further intervention, depending on the details of the situation. 

– January 13, 2011 2:51 PM
Q.

Kristina Ragosta :

I hope some of the responses were helpful. If you need more information or I was unable to answer your question - feel free to visit our website - www.treatmentadvocacycenter.org - or email info@treatmentadvocacycenter.org. 

-Kristina

 

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