The Mental Health ‘System’ That Brought Us the Tucson Tragedy

By Steve Luxenberg

Jared Lee Loughner didn’t fall through the cracks, as the cliche goes. Nor did the mental health system “fail” him in the years before Jan. 8, when he fatally shot six people and wounded 13 others.

The mental health system performed much as we have designed it over the past 40 years, ever since the courts and state legislatures adopted “a danger to themselves or others” as the standard for taking action against those showing signs of a mental illness that might lead to violence.

But wait, you say. Loughner’s behavior clearly showed he was a danger. Lynda Sorenson, his bclassmate at Pima Community College, wrote in her now-famous e-mails to a friend: “We have a mentally unstable person in the class who scares the living crap out of me. He is one of those whose picture you see on the news, after he has come to class with an automatic weapon.”

So the cry has gone out: Why didn’t anyone – family, neighbors, teachers, Loughner himself – take action? Why didn’t the system intervene, treat him, lock him up if necessary?

Too little is still known, but this much can be said: Some people did see danger. Some people did act. But the “system” we have constructed – a patchwork of laws that vary by state – tolerates the odd, the strange, even the disruptive ravings of a Jared Loughner. This was a direct reaction to the days when behaving oddly or strangely, in the opinion of others, too often meant a long-term stay in an insane asylum of the kind that once dominated the country’s mental health system. The system has yet to figure out the best way to deal with the tiny fraction among us who have a severe mental disorder and an apparent capacity for violence.

Ben McGahee, who taught the math class where Sorenson grew so nervous, made several complaints to college administrators. He told The Post, “They just said, ‘Well, he hasn’t taken any action to hurt anyone. He hasn’t provoked anybody. He hasn’t brought any weapons to class.’ ”

Perhaps Pima administrators should have acted sooner, but Loughner certainly did not slip through the college’s cracks. Campus police reports document six complaints about Loughner between February and September 2010. At least three administrators met separately with Loughner before he was finally suspended—for posting a YouTube video accusing the school of genocide.

The overriding question in the reports was a legalistic one: Had he violated the school’s code of conduct? If school officials wrestled with whether and how to refer him for a psychiatric evaluation, there’s no evidence of that in the records released thus far. The mental health system can’t fail someone it never sees.

In theory, Arizona’s mental health law offers more leeway to intervene than other states. Almost anyone can ask a court to order a psychiatric evaluation, and judges can require treatment of anyone who is “a danger to self or to others, is persistently or acutely disabled or is gravely disabled,” in the opinion of two physicians. But proving persistent or acute mental disability is difficult and less tested. In practice, danger is the standard that has permeated the consciousness of police and public institutions.

The college’s Oct. 7, 2010, letter to Loughner presented a novel twist on that standard. To be reinstated, he would need to “obtain a mental health clearance indicating, in the opinion of a mental health professional, his presence at the College does not present a danger to himself or others.” The college was putting the burden on Loughner, the student with impaired judgment, to get help.

The danger standard also has become embedded in Arizona’s gun regulations, which prohibit anyone “who has been found to constitute a danger to himself or others” from owning a firearm, unless a court hears “clear and convincing evidence” that the person no longer suffers from the mental disorder.

Yet that law did not keep a gun out of Loughner’s hands. Even if authorities had known of his suspension from school, it wouldn’t have mattered. No court had “found” him to be a danger.

We have asked police, courts, mental health professionals – the system – to walk a fine line between the individual’s right to liberty and the public’s right to safety. Legislators and public officials need to determine whether the legal origins and applications of the “danger” standard are so restrictive they are inhibiting its common-sense use. We have good reasons to tolerate disconcerting behavior, but that doesn’t require us to arm it with a Glock semiautomatic.

Loughner is awaiting trial, held without bail because a judge has now determined him to be a danger to others. Irony has no place in such tragedy.

Steve Luxenberg, an associate editor of The Post, researched the history of mental health treatment while writing his book, Annie’s Ghosts: A Journey into a Family Secret.

The Washington Post
January 18, 2011