In an article entitled: “Airport shooter shows challenges of nation’s mental health system,” published this week of January 15, 2017 in the San Diego Union-Tribune, authored by Paul Sisson & Jeanette Steele, the very difficult shortcomings of our mental health care system which is based in a system of laws that provides for basic human rights as much as we possibly can, is full of holes and flaws. This article eloquently shares with us the very perceptive thoughts of two local figures of the San Diego area, one from the field of psychiatry and one from law enforcement. They discuss the incredible impossibilities facing us now as we see self-radicalized severely mentally ill turn into mass shooters with perhaps slowly increasing frequency.
What has emerged in the investigation, retroactive/retrospective scrutiny of the alleged shooter, Esteban Santiago, are two main elements: 1) it appears now that this man was genuinely severely mentally ill, i.e., psychotic; 2) that he presented himself and was known to an entry level mental health body/agency and personnel, and released, and, 3) later was legally able to retrieve his firearm that he used in the Fort Lauderdale Airport travelling from across the country, and, 4) that he had become “self-radicalized,” (the new buzzword for adopting the perversion of mainstream Islam into terror based jihadist mass murder.
These now known facts of this case illustrate a number of dilemmas:
1. even though the vast majority of the mentally ill, even the very severely chronically or severely psychotic, are not violent and do not commit major crimes, though those forced into survival modes such as homelessness, may commit minor crimes such as burglary, panhandling, theft, etc., to survive (which does not make some of those behaviors legal or tolerable on a large scale or whatever, but 2) most mentally ill are much more the victims of violent crimes by far in their lives, 3) there is no fool proof method of identifying accurately or totally all the individuals who become self-radicalized: 4) one does not have to be of Muslim cultural and familial upbringing to become radicalized into jihadism (in fact this reminds of the enigma of the hippie years in which many wealthy young adults of the 1960’s and 1970’s became “radicals,”); 5) we still do not possess reliable methods of identifying who will convert from a gun owner, of any religion or political persuasion into a mass shooter, nor how to prevent or counter this modern cultural phenomenon though we have had terrorists for centuries of all religions and ideological persuasions, from individuals to mass movements to countries committing genocides; and 6) firearms still have to be legally returned to those who have had them confiscated by law enforcement agencies in certain situations prompting and legally mandating their removal from the possession of the owner, such as domestic violence/disputes, instances of verbalized threats of harm/murder by firearm or other means when the threat is deemed by authorities or authorized mental health professionals to be no longer extant.
Many of these factors have operated in the last 15 years or so in the mounting number of cases of mass shooters we have endured in public places, theaters, schools, churches, post offices when the “going postal” phenomenon started in the 1980’s, places of employment, colleges, almost any place where groups of people gather. Terrorists, whether the IRA of the Irelands, the German Bader-Meinhoff gang, jihadists of our time, the North Korean dictatorship, the Iranian Revolutionary Guard of Iran, or all the other terror groups through modern times have utilized terror to control populations, eliminate opposition and subjugate populations to impose their fanatical world, statist and governing views upon their (captive) “citizens.” Perhaps the modern arms industries of the last 150 years have in some ways contributed to the more ready availability of arms worldwide so that even those most geographically removed from modern ‘warfare centers,’ of markets for arms that I suppose were more restricted to populations areas, have increased the spectre of terrorism than ever before. In some ways, it may matter little and it is hard to know whether in centuries to come this will run its course somewhat as lessen as history and time march on. But it is now everywhere it seems, and that does seem to be goal of the modern terrorist who has the means of modern pervasive communication means and media that did not exist in the day of say, Pancho Villa, a terrorist in his own right, but who was ‘restricted to northern Mexico for the most part and parts of the American Southwest.
The article above cites some interesting though disquieting issues and ‘statistics:’
Figures in law enforcement all over this country such as the sheriff quoted and referred to in the above article, SheriffBill Gore of San Diego County California stated that he has “has noticed a definite escalation in mental-health incidents across the region,” further explaining and clarifying, “I can probably speak for most of the chiefs in San Diego County when I say there’s been a dramatic increase in the number of mental health-related calls that we’ve had in the last five or six years.” He was including all manner of mental health related community crises that required the intervention of law enforcement, not specifically the extreme of mass shootings, but all the rest of very troublesome to dangerous incidents involving threats to life.
The other representative of the other field of interventional professionals, those of us in the broad and varied fields of mental health quoted in the above article was Chief Medical Officer of Sharp Behavioral Health Services Dr. Michael Plopper spoke eloquently [in an inserted web video on the above URL-referenced site that the reader is very much encouraged to view]. Dro Plopper spoke quite movingly of the issues we and the mentally ill face as the stigma of mental illness is now being, if you will, unfairly magnified by the recent string of mentally disturbed mass shooters who have arisen since the Columbine High School teen shooters who were clearly uniquely disturbed it appeared in retrospect and driven to commit their horrific acts on that fateful day.
The article cites admirable responses in the San Diego area including one method of response and engagement-intervention called the “Psychiatric Emergency Response Teams,” which handled according to the article an impressive “6,752 calls for services during the 2015-2016 budget year.”
The article reminds us of the sobering statistic that at least “3.6%” of Amerian adults have mental illness needing real treatment, so the need is not insignificant ANYWHERE in this country and represents as mental health epidemiologists have known since 1950’s when accurate widely based population surveys began to be done scientifically, and no longer relying on extrapolations from numbers of mentally ill in hospitals or presenting for services in hospitals and clinics and practitioners’ offices. We now know that perhaps 1 in 4 or 5 Americans will experience a major life and social functioning psychological crisis or illness needing treatment in their/our lifetimes, that perhaps 1 in 10 will experience some form of depression and/or anxiety/panic disorders that often are either lifelong or recurrent and not “self healing.” And frankly, I have not even included the massive issue of substance abuse in which perhaps at least 1 in 4 families are affected by at least alcoholism alone and other addictions elevate the figures far higher in the last several decades.
As an aside, I must add my own views of the prevalence of substance abuse in which every war that America has participated in since the Civil War has participated in, has generated massive numbers of persons driven to addictions. The Civil War coincided with the discovery and popularization of the opiates that began in the late 1700’s as opium was discovered in the Far East and taken over by predominantly by the British trading companies as a valued commodity and brought in ever large quantities to the Western World. The Civil War with primitive medicine in those days for the wounded which largely consisted of amputation (the doctor as “sawbones” on the battlefield) generated hundreds of thousands of amputees with chronic pain and so on. Then the two World Wars generated large cohorts of wounded with all kinds of wounds and pain control needs, “shell shock,” “combat neurosis,” [both of which we now know were our present still poorly understood neuropsychiatric malady of “post-traumatic stress disorder,” And the Vietnam Conflict/War generated tens of thousands of opium, pot, heroin and other drugs of abuse users/addicts trying to cope with the every second of one’s existence sense of “death at any at the hands of any person,” anxiety/terror, and now the same issue together with the modern closed head injury curse of brain trauma from exposure to nearby explosions and the bewildering array of neuropsychiatric misfunctions that arise in perhaps 100,000 to 400,000 Middle East vets who are also at great risk for drug abuse.
Unfortunately, even accounting for the rise in population in the USA, the rise in mental illness/substance abuse is one heck of a “growth industry,” that rivals or outpaces almost any other mass endeavor in this country in these troubled modern times.
So as the article cited notes, the psychiatric beds are all full, waitings lists are bursting everywhere in the area, and nowhere are sufficient resources to meet the demand and needs. As the article stated: “The San Diego Association of Governments reported an 84 percent increase in the county’s calls for mental health service from 2009 to 2015, a rise that is not fully understood. The county government’s mental-health operations are also handling significantly more cases of severe mental illness, including schizophrenia and bipolar disorder.”
In sad summary as written so aptly in the above article: “airport mass shooter Esteban Santiago appears to be the latest high-profile example of the nation’s struggle to deal with mental health cases before they lead to crises such as a deadly crime.”
On the other hand, while acute and inpatient services are still suffering all over this country from the over-reaction to the real and also misperceived evils on over-institutionalization with the resultant closure of close t0 80% of all public beds, then in the last 30 years, loss of insurance funding and loss of over HALF of all private psychiatric beds by rough estimate, outpatient services are truly improving and have seen tremendous progress in many states and locales all over the country. But they are still underfunded, but better, more organized with ever growing numbers of clinicians starting finally to enter the fields and disciplines of counseling, social work, substance abuse counseling, peer counseling, the massive God send (in my humble view) growth of support groups since the early 1980’s, psychology, psychiatry, child therapy and child development, many in locales totally lacking in such a luxury of choice of services, is all to the good. Progress has been undeniably made in service delivery, but honestly speaking it has been long overdue and is still begrudgingly funded and provided, all too often at the push of federal lawsuits and legal threats and “nudges,” to afford compliance and provision of undeniably societal services. To do otherwise, will risk partial deterioration of our civil life that we could find overwhelming and that could drive the more authoritarian among to call for inhumane solutions.