MILWAUKEE — The gunmen in many of the mass shootings in recent years — shared a trait that offers a critical clue to abating future attacks.
Each showed clear signs of psychotic behavior and, had they been treated, the disasters might have been avoided, experts said.
Wade Michael Page, who killed six Sikh worshippers at a temple in Oak Creek, Wis., on Aug. 5 before being shot by police and killing himself, was a heavy drinker who was so unstable after his girlfriend broke up with him years earlier that his friends feared he had committed suicide. A psychiatric nurse who lived downstairs from him in Cudahy, Wis. said if one mental health professional had taken the time to examine him, “a gazillion red flags would have gone off.”
The psychiatrist treating James Holmes, the man who killed 12 and wounded 58 in a shooting last month at the premiere of a Batman movie in Aurora, Col., recently revealed she was so worried Holmes might do something violent that she contacted the police at the University of Colorado, where Holmes had studied.
Jared Loughner, who pleaded guilty last week to killing six and wounding 13 others — including Rep. Gabrielle Giffords — at a Tucson shopping center in January 2011, was expelled from his community college until he could provide proof that he was in psychiatric treatment.
Seung-Hu Cho, who killed 32 students and professors at Virginia Tech before killing himself in 2007, had been declared an imminent danger and was ordered by a judge to undergo psychiatric care. But he failed to appear at his appointments, and no one made certain that he complied with the court order.
“We can’t afford to keep looking the other way,” said Jon Lehrmann, a psychiatrist at Veterans Affairs in Milwaukee and acting chair of the psychiatry department at the Medical College of Wisconsin.
At least 2,956 people have been killed in 646 mass shootings over the past 35 years, according to statistics compiled by Northeastern University criminology professor James Alan Fox. Mass killings are defined as four or more deaths, not including the shooter. The numbers show no upward trend or pattern.
“Most of the public attention is directed at the headline tragedies, like the recent shootings in Colorado and Wisconsin,” said Doris Fuller, executive director of Treatment Advocacy Center, an advocacy group that pushes for stronger commitment laws. “In reality, it’s the smaller everyday tragedies that are epidemic.”
The center estimates that about 1,600 people are killed each year by people with untreated mental illness. This does not include people who commit suicide. Those figures come from a database the center maintains of news accounts, titled “Preventable Tragedies.”
Any discussion of how to curb violence by people with mental illness makes Peter Hoeffel uneasy. He is the director of the Milwaukee chapter of the National Alliance on Mental Illness, an advocacy organization for people with mental illness and their families.
“Talk about violence in relationship to people with mental illness reinforces myths and feeds stigma,” he said. “People with mental illness are much more likely to become a victim of violent crime than to be the perpetrator.”
But Steven Hargarten, chairman of the emergency medicine department at the Medical College of Wisconsin, said society needs to take a long, hard look at the reasons why so many people die at the hands of mentally disturbed people wielding guns and conduct an autopsy of sorts.
“As the outline of these cases unfolds, it is clear that there were multiple missed opportunities,” he said. “When there is an Ebola outbreak, we do what we can to identify the contagion. We need to do the same here.”
Hargarten points to what he considers flaws in the system. For instance, gun permit applications ask the buyer if he or she has ever been adjudicated as “mentally defective” or committed to a mental institution, but the value of that depends on the person to give an honest answer. Gun shop owners cannot, by law, check on another person’s medical condition.
“We expect bartenders to pour responsibly,” Hargarten said. “Why wouldn’t we ask the same of gun shop owners?”
Lehrmann, the VA psychiatrist, said real reform and improvement won’t come until society eliminates the stigma of mental illness and encourages people to come forward to get treatment. Then, we have to pay for the care in the same way that we pay for other illness, he said.
Mental health care providers have a harder time getting insurance companies to reimburse them for services than other doctors, Lehrmann said.
“We have a shortage of mental health professionals because we don’t pay them in the same way we pay other providers,” he said.
Hoeffel, the mental health advocate, said patients need to be encouraged to seek care.
“We have to get mental health care out of the closet,” he said. “People have to know that it is OK to talk to family or neighbors or schoolteachers about this.”
Mental illness is a medical condition in the same way that diabetes is, Hoeffel said.
“It’s not a weakness or a character flaw,” he said. “It’s no one’s fault that they have depression or anxiety. We now know that conditions like that are biological. They are hereditary.”
That same candor has to include the acknowledgment that some people with mental illness have paranoia and delusions that make them dangerous, said Fuller of the Treatment Advocacy Center.
“When tragedies like Virginia Tech, Tucson, Aurora and now Milwaukee strike, there is inevitably a well-intentioned but unfortunate rush from a number of quarters to assure the public that people with mental illness are no more dangerous than anyone else,” Fuller said. “While this is true with regard to the vast majority of individuals with mental illness, especially those who are under treatment and stable, it is simply not true for a small subset of the population that is acutely ill and driven by paranoia, delusions or other forms of disordered thinking.”
She points to federal health data that show at least 10 percent of the homicides in the United States are committed by people with severe mental illness even though they make up only about 3.3 percent of the population.
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In the weeks after shootings in Tucson and Aurora, friends and neighbors came forward to say that they should have acted sooner to identify signs of the shooters’ mental illnesses and encouraged them to get help.
Early intervention is critical, Lehrmann said.
“When someone does have mental illness and is decompensating, we need to have a system that allows us to get them into care,” he said.
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Lehrmann said he has been frustrated over the years by laws that emphasize patient rights over public safety.
“It is important to protect patients’ rights,” he said. “But we have to be able to get help to people who need it even when they don’t recognize that they do.”
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In Wisconsin, as with most states, people cannot be compelled to accept treatment for mental illness unless they are found to be incompetent by a judge. That standard was established after the case of Alberta Lessard, a 1971 federal court case brought by a West Allis schoolteacher, intended to curb abuses of patients’ civil liberties.
“Mental health is a public health matter,” Lehrmann said. “But we have to be careful to protect the individual’s rights, too. It’s very tricky.”
It’s easy in the face of these violent outbursts to become overwhelmed and figure nothing can be done, said Lehrmann. But we can all do something to help, he said. People can learn the signs of mental illness and be willing to speak up when they see others struggling, he said.
Jennifer Dunn, Page’s downstairs neighbor for the two weeks before the shooting, said she was concerned about Page’s mental well-being. Dunn, a psychiatric nurse, described Page as “creepy.” She said his bizarre behavior scared her 10-year-old daughter.
“He was definitely sick,” she said.
Christopher Robillard, who served with Page at Fort Bragg from 1995 to 1998, said he, too, had worried about Page’s mental instability but covered up for him, a decision he says he now deeply regrets.
“I wish now that we would have done more,” he said.
As the families of the Sikh worshippers prepared to bury their dead late last week, Dunn was angry to think of how many opportunities people had and missed to urge Page to get help, presuming he would even accept it.
“There were huge warning signs,” she said. “And the consequences of that inaction are enormous. No one spoke up or was able to step forward to help him, and just look at the devastation that followed.”