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First Thoughts on Newtown, CT

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As Kent notes, there seems to be two issues in the Newtown case that has everyone talking:  access to firearms and mental illness.  I'll leave it for others to debate the merits of gun control, but I wanted to make a few comments about the role of mental illness and violent crime.

First, as Kent noted, the issue of involuntary commitment looms large in these discussions.  It is true that the legal standard for involuntary treatment has changed considerably over the years to the present state where it is exceedingly difficult to involuntarily commit someone for a prolonged period of time. For the most part, our nation has adopted an outpatient mental health treatment model, know often as the hospital without walls, that simply fails to provide the appropriate amount of care because it cannot do so: there's only so much that mental health providers can do in an outpatient setting.  Many people with serious mental illness do not believe that they are sick and consequently do not want help.  Since our modern commitment standards operate primarily under the rubric of the state's police powers instead of the parens patriae model, commitment is reserved for those individuals who are deemed dangerous not sick and in need of treatment.  The focus is wrong and needs to be changed.

But even if the laws were different it is not clear that the results would have been much different with Adam Lanza.  Details are still sketchy and much of what is supposedly known is mere speculation, but if it holds true that Mr. Lanza's sole mental health problem was Asperger syndrome, it's unlikely that even a broad civil commitment standard would have captured him.  The link between Asperger's syndrome and grave disability - the broader commitment standard - is remote.

Kent also mentions access to mental health services.  It is true that access is often trotted out in these tragic cases as examples of why our nation should increase funding for mental health services.  In many of these cases it's not self-evident that access to more services would have brought a different result.  Services are underutilized because many people with serious mental illnesses do not believe they are sick and therefore do not want treatment.  But it is also a question of priorities.  Our nation spends a lot on what can reasonably be said is a vast overdiagnosis of ADHD and even Autism at the expense of adequate funding for programs that deal with severe mental illness.  As a mental health professional I can attest to the fact that this segment of our mental health services is indeed vastly underfunded.

Whether that would have made a difference in the case of Adam Lanza is unknown.  But every year there are preventable tragedies that could be avoided if our public mental health funding had different priorities and our approach to civil commitment was more rationale given what we know about serious mental illness.   The defining issue when it comes to civil commitment shouldn't be dangerousness but illness and its need for consistent, effective treatment.

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I agree that the involuntary commitment process is broken. It is worth mention that, in many cases appropriate for involuntary commitment, the person in question is now, instead, convicted of a crime and incarcerated. At least in Texas, there have been no meaningful increases in funding to meet the needs of these inmates, much less the regular inmates who might benefit from programs to reduce recidivism. What then was the benefit of the Supreme Court's foray into mental health commitment?

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