Patients, Prisoners, and Mass Shootings

Closure of mental hospitals and rise in prison rates, 1934-2010, US. From Bernard Harcourt


The medical resident PetulantSkeptic drew my attention to the graph above, which he included in a short, sad post he wrote last fall:

I’m currently doing a psychiatry rotation at an outpatient behavioral health clinic which primarily serves the substantial indigent population here. I’ve tried to sit down and write about the experience but all that comes out is a structureless jeremiad about the tragedy of a shredded safety net and those with psychiatric problems.

Rather than subject you to that I’d rather just present this chart by Bernard Harcourt.

The graph comes from a paper that Harcourt, a criminologist, wrote after the Virginia Tech shootings in 2007, which he blogged about at the Volokh Conspiracy:

Was the tragic incident at Virginia Tech the result of a failure of Virginia’s mental health system? Slate recently posted Seung-Hui Cho’s commitment papers and they are revealing: the magistrate who heard Cho’s case determined that he was “an imminent danger to himself as a result of mental illness,” but determined that there were “alternatives to involuntary hospitalization.”

After the shooting, Sally Satel at AEI argued that Virginia needs to reexamine its involuntary treatment laws and adopt a lower threshold for commitment, more in line with states like Arkansas and Hawai’i. Others, like Brian Jenkins at RAND, contend that the tragedy probably could not have been prevented and might not have a solution.

It’s impossible to make sense of the debate, though, without understanding the extent to which we’ve dismantled our mental health system in this country. Brick-by-brick, cell-by-cell, we deconstructed what was once a massive mental hospital complex and built in its place a huge prison.

Harcourt isn’t arguing that everyone in prison should be in mental hospitals; the rise in prison population is far more complex than just jailing the unstable. Yet he and many others note that we are imprisoning many people who are mentally ill — essentially because, as a nation, we’re far more enthusiastic about imprisoning people who commit crimes than we are about treating people who are mentally ill.

We should not be surprised that there are so many persons with mental illness behind bars today. We deal with perceived deviance differently than we did in the past: instead of getting treatment, persons who are viewed as deviant or dangerous are going to jail rather than mental hospitals.

The second is that we should not be surprised that our mental health systems are in crisis today. The infrastructure is simply not there. This is evident in states across the country where persons with mental illness are being housed in jails rather than treatment facilities.

He’s not arguing for more institutionalization — but for better treatment. See his post or the paper for more.

I agree too with the many who feel our gun culture — from easy ownership and defend-your-turf laws to a fetishization of violence — makes it far more likely that the violently inclined will express their fury in spectacular ways like the Aurora shooting. I don’t think you can separate the development of an obsessive psychotic fixation from the culture in which it develops; this is why we see these mass shootings so often here in the U.S. and so seldom elsewhere. The list of mass shootings in the U.S. since 2005 alone runs 62 pages. Is it coincidence that the alleged shooter dressed up in SWAT-team-like gear? I found it chilling and somehow utterly normal, almost expected, that (if this account is correct), after shooting 71 people in a theater amid a screenplay that reportedly made some at first think this strange live-action before the screen was part of the show, the shooter went outside to his car in the parking lot and there surrendered without trouble to police similarly clad and armed. I found it too easy to imagine that he felt a sort of fraternity with his new captors.

We’ve reached a point where it all feels quite scripted. Yet no one seems tired of this movie.

9 responses

  1. I can’t see your shooing data (I’m having internet issues right now). There are lots of mass killings of this sort outside the US, though the rate may be higher here, it is also worth noting (I think this is true) that a higher proportion of spree or mass killings elsewhere use other methods than guns (cars, stuff that blows up, etc … and I’m not talking about suicide bombings). This does not mean that guns are not a factor…no, you can’t kill a bunch of fellow students with a length of string or a knife…and in fact it underscores the role of easily obtainable serious firearms and ammo as part of the chain of events that leads to this kind of thing.

    I assume that dip in the 70s corresponds to the defunding of mental health facilities in the US under The Teflon President, a time prior to the replacement of those facilities (and other things like, I don’t know, summer camp or just hanging out on street corners) with incarceration.

    Also, this: Let’s not forget teen/young adult suicide. That accounts for a large share of the gun deaths in the US. Guns don’t kill people, people kill people. But they use guns. Young folks who attempt suicide and survive and get help rarely re-attempt successfully; young folks who attempt suicide with a method other than a firearm have a very low success rate on that first try; young folks who attempt with a firearm have a very high success rate on that first (and last) try.

    Our culture may enhance the likelihood of killings and suicide. People argue about that. Our culture seems to fail at reducing the rate even it it does not enhance it. And, our culture very clearly provides the technology to make it fairly easy.

    • Greg, I could not find graphed data on mass shootings that ran same time frame (or close to it) as the graph above — or anything comprehensive other than the report linked to above in the middle of the next to last paragraph. That report lists over 300 mass shootings in the US since 2005. I suspect that’s an increase from prior stretches, but don’t know. The test would not be so much whether we’re seeing a steady increase, but whether we saw an increase starting roughly around 1980, when the combination of closed hospitals and increasing cuts to services under Reagan really consolidated. Again, that would hardly be absolute proof; lots of other cultural things at work, and I point to some of them in my last paragraph.

      • The data are very difficult. The question’s being asked here require somebody doing an MA! One of the problems (or, opportunities) is that a lot of “mass killings” are “man kills family, self” sort of events, or some criminal act gone terribly wrong. Example of how tricky the data are: few months ago, not far from me, someone entered a daycare with sort of nefarious act in mind having to do with an abusive relationship but essentially found himself in the wrong place, so he randomly killed the three adults, the home-day care operater and her parents. He did not know the victims, so it was a “rampage” but in every other way this was a “kills family self” act, really.

        I suspect that if you count up the number of people killed over the last few decades where 3 or more are killed by one person, the majority are individuals annihilating their own families, and often self. In a way, that is more like suicide than rampage. Also, the causes may be very different. There are major stress points within families. Then again, that probably overlaps with workplace killings in a way.

        I don’t know of a list of multiple killings within families in the US. Such killings get on the list of “mass killings” randomly, and I think only a small percent are included (and for the present discussion, we probably don’t need to consider them).

  2. Convicted felons and the mentally ill are prohibited by federal law from buying or even possessing firearms. If we wish to prevent the mentally ill from having firearms it would be helpful to have a list of those people that have been institutionalized. My sense is that the ACLU would move to prohibit such a list as an invasion of the person’s privacy.

    • Why not. They make sex offenders available to the public. Why not simply have a database, where a firearms dealer would type in the name of the person purchasing a gun, and if there is no “hit” on their name, they can buy a gun. If they do have a hit, the dealer simply does not sell to them. It doesn’t have to be anything more than that – you don’t get to see their criminal record, they are just a name on a list. Essentially it would come down to the dealer/seller at that point though, and a lot more blame would be placed on them than there already is when it comes to gun violence. Unless a law was enacted which identified said database and prohibited sale to anyone on the list, sellers would have a choice. As in currently, If they choose to sell to a felon, with/without knowledge, it is still primarily the fault of the felon (the seller could theoretically get in trouble by aiding and abetting, but even then, there is no way to enforce that since sellers don’t have any such list of felons). If caught in possession of a firearm, the felon would be arrested. However, if there were such list, and sellers were required to check it every time they sold a gun, the responsibility would be theirs. I like this idea, but I have a feeling gun owners wouldn’t.

    • “If we wish to prevent the mentally ill from having firearms it would be helpful to have a list of those people that have been institutionalized.” The odds of someone being mentally ill (offically) and being institutionalized are very very slim. My husband is biplolar and has never been institutionalized. He could easily go out and buy a gun. There is nothing that is on his “record” that says “HEY! I’VE GOT A PROBLEM OFF OF MEDS, DON’T SELL ME A GUN.” The article stated that hosptialzation fof mental illness is extremely unlikely now becasue there are no longer any hopstials to put these people in. In my state, there is 1. 1 Hosptial that is offically for mental illness and substance abuses.

  3. I want to just take a moment to send out a giant Fuck You to the GOP in Virginia since the Va Tech shootings were the result of policies that are entirely their fault, and they are entirely to blame for those deaths. Here’s hoping they die in a fire.

    • And their little libertarian toy poodles too. They can all die in a fire as well, just alone, cause that’s how they want it.

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