It’s been nearly two weeks since the tragedy in Isla Vista, Calif., that resulted in the killing of six students and injuries to 13 others, and once again the mental health field is confronted about what to do in order to avert future tragedies.
While more details are emerging, news reports indicate that Elliot Rodger,a 22-year-old student, had been seeing therapists since he was a child. In the weeks before the tragedy, his concerned parents had called the police to check on him. Officers, however, saw no cause for alarm, according to news reports.
Meanwhile Democratic Assembly members Das Williams of Santa Barbara and Nancy Skinner of Berkeley announced they will introduce a bill that would allow concerned family members or friends to notify authorities when a loved one is at risk of committing violence. That would allow law enforcement to investigate the person and potentially prevent him from buying firearms, the Sacramento Bee reported.
Members of the mental health community are advocating for research, education and expansion of crisis-related services. The National Alliance on Mental Illness (NAMI) released a statement about the steps needed to prevent future tragedies:
- Fill the gaps in our community mental health care systems. That includes the creation and promotion of crisis services and partnerships between mental health professionals and all first responders.
- Improve communications between mental health professionals, individuals receiving care and their families. Mental health privacy is important, but privacy laws should not stand in the way of coordinated information and action in a crisis.
- Talk about it — within families as well as with teachers, clergy, students and community leaders. Encourage conversation about mental health, about what we are experiencing and what we can do to help. By doing so, we create and promote the space for open and honest dialogue that saves lives.
“There are simple things that can also be looked at to improve the system to make sure this doesn’t happen again,” Katrina Gay, director of communications for NAMI, told MHW. “There’s a big gap in our community around crisis services, such as mobile crisis services, crisis intervention specialists who are trained to de-escalate [a situation].”
Gay explained that at one time such services were robustly available but that was before huge mental health budget cuts began during the recession. “Most communities only have a ‘patchwork’ of crisis mental health services at best,” she said. Crisis Intervention Team (CIT) programs are a part of that, she noted. However, there needs to be an array of assessment, crisis stabilization services and hotlines available, Gay said.
CITs know how to de-escalate in a crisis, but intervening in a crisis to provide care is another situation, she noted.
When Rodger’s parents contacted police, a mental health professional should have accompanied them to provide an evaluation and/or intervention, noted Gay. “Clearly someone in the family recognized a concern,” she said. “It’s not reasonable to send a police officer in those situations as a first responder.” CIT programs do help, but in this particular case somebody should have accompanied the police, she said.
In her discussion with NAMI leaders last week, Gay said the consensus was on the need for mental health providers to be a part of the crisis service array. A trained mental health provider can ask questions and has more skills about engaging an individual, she said. “Only a mental health crisis team member can determine whether a person can qualify for an intervention,” she said.
Gay added, “The system is broken. In this case, there’s very little the police could have done that would have resulted in a different outcome. We can always say ‘what if.’”
Events like this tragedy are unpredictable, said Gay. If the family knew there was a crisis and they were worried and concerned, they should be taken seriously, she added.
“There’s a huge gap in our very broken system,” said Gay. “We need to fill those gaps. Partnerships between mental health providers and law enforcement are vital to the outcome for individuals who are in crisis and struggling. It’s vital to ensure the health and safety of individuals in crisis and our community — they go hand in hand.”
More bipartisan action and agreement are needed to address the pending mental health reform bills, said Gay. “There are different pieces of legislation being discussed that have components of what we’d like to see,” she said.
Minimizing the risk
“We cannot prevent all tragedies but we can do some things that can minimize the risk,” Linda Rosenberg, president and CEO of the National Council for Behavioral Health, told MHW. “We need to get down to working on education, treatment and research.”
Like NAMI, the National Council is also promoting and supporting the need for more crisis services, which was a key area of focus during the organization’s annual conference in early May in Washington, D.C., said Rosenberg.
Rosenberg explained that for the first time during its national conference, the National Council offered a crisis track for attendees. “There’s a need to ensure that crisis services are available,” said Rosenberg. Mobile teams, crisis stabilization units, peer support, respite beds and a crisis track are all critical, she said.
The National Council is planning a series of webinars on crisis services, she said. “Our members are bringing more attention to the need for crisis services,” Rosenberg said.
Regarding treatment, Rosenberg pointed to the Excellence in Mental Health Act, which recently became a law. The Excellence Act will increase Americans’ access to community mental health and substance use treatment services while improving Medicaid reimbursement for these services. “It’s a down payment on increasing treatment capacity for individuals with both mental health and substance use disorders,” she said. “We need to make sure we have capacity.”
Nearly a billion dollars has been added to this bill, she said. The legislation calls for an eight-state demonstration program that would allow states to expand services 24/7 to support families. “It’s something we can build on,” said Rosenberg, who added that the National Council is pushing for this in all states. “We want a full payment. We will work on that.”
Research in the field is another priority. “The brain is uncharted territory in many ways,” she said. “We need a better understanding of these mental illnesses and the support of institutions like the National Institute on Mental Health [NIMH].”
“What do we know about violence and how the brain functions?” Rosenberg noted. “What goes on in the brain that motivates violence? Is it a mental illness or some other process that we’re unaware of?”
Education about mental illness as part of the National Council’s public education program, Mental Health First Aid, continues to be critical, Rosenberg said. “We’re having these conversations in communities,” she said. Teachers, aunts, neighbors and others need to know how to help people who are having a tough time, she said. “Bad things will always happen,” said Rosenberg. The field can work together to help minimize or even avert future tragedies, she noted.