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How Would Better Mental Health Care Reduce Gun Violence?


I'm Michel Martin and this is TELL ME MORE from NPR News. Coming up, the Supreme Court case that established abortion rights in this country is now 40 years old, but the political and cultural fights about abortion are going on still. We'll talk about this with our panel of women commentators. That's our Beauty Shop roundtable and that's in just a few minutes.

But first, we want to talk about another issue of great national concern. Even before President Obama delivered his inaugural address, he set forth a plan aimed at curbing gun violence in this country. He asked Vice President Joe Biden to move quickly to develop a set of proposals after that tragic shooting at an elementary school in Connecticut, a day Mr. Obama called the single worst day of his presidency.

While a lot of the reaction to the president's proposals has focused on the weapons, the president also emphasized the importance of mental health. Here's a clip from President Obama's remarks.

PRESIDENT BARACK OBAMA: We will make sure mental health professionals know their options for reporting threats of violence, even as we acknowledge that someone with a mental illness is far more likely to be a victim of violent crime than the perpetrator.

MARTIN: So we decided today to focus on some of the mental health proposals that the president is advancing. To do this we've called once again on Dr. Carl Bell. He is a psychiatrist. He's currently serving as acting director of the Institute for Juvenile Research at the University of Illinois School of Public Health. He worked in community mental health for many years and has been involved in study and treating issues related to violence for many years.

Dr. Bell, welcome back. Thanks so much for joining us once again.

CARL BELL: Thank you.

MARTIN: Also joining us is Michael Fitzpatrick. He is the executive director of the National Alliance on Mental Illness. That's a grassroots organization that aims to improve the lives of persons living with serious mental illness. He's also trained in social work.

Welcome to you also. Thank you so much for joining us as well.


MARTIN: And Michael Fitzpatrick, I'm going to start with you because the first thing that occurred to me is - I was wondering about your reaction to the attention being paid to the role of mental illness in these shootings - not just the Newtown shootings, but there have been others related to that that have gotten a lot of attention, like the one in Aurora, Colorado. And I was wondering, you know, in a way is your group like any other mental - any other minority group, in the sense that, you know, on the one hand you're relieved of the attention. On the other hand, I could see where one might be very worried that the attention is actually not all positive.

FITZPATRICK: Well, I think, Michel, there's a pervasive stigma surrounding mental illness and mythology surrounding mental illness, and for some people a connection between violence - or some commentators use the word evil - so it is, for us, three steps forward as we talk about mental illness in the community - and organizations like mine have done that for years - but it's four steps backwards when these tragedies happen.

They do create a sense for America to have an opportunity to have a dialog about this very broken, long broken mental health system, and to have the White House involved in that dialog is a tremendous change.

MARTIN: Dr. Bell, how do you feel about this? I mean on the one hand a lot of the work that you have been most engaged with is not the kind that gets a lot of attention. I mean...

BELL: Right.

MARTIN: And so I'm wondering, how do you respond to the attention that this issue is now getting?

BELL: Well, you know, I'm concerned that it'll increasingly stigmatize mentally ill. I was glad the president said that the mental ill are more likely to be victims than perpetrators, because that's certainly true. But I get concerned about the stereotype and the notion that we can somehow identify who's mentally ill and who's going to be dangerous, because that's actually quite difficult to do.

MARTIN: What else are you concerned about, Dr. Bell? And then we're going to obviously wheel it around and ask what you're most interested in and what you think is most constructive.

BELL: Well, you know, I get concerned that this whole - it's a double-edged sword. On the one hand, I'm of the notion that some of these mass murders have actually been suicides, but before the suicide the person perpetrated a mass murder. The issue with that is, is that those kinds of suicides are extraordinarily rare, as are suicides in general, despite being the leading cause of death - third leading cause of death in teenagers.

So I think it's difficult for a president to make a broad, sweeping policy change and hit the complexity of an issue like mental illness and violence and just violence in general.

MARTIN: Of what you've heard, Dr. Bell, what do you think is most constructive about the president's proposals?

BELL: Well, you know, the most constructive thing was his lift of the CDC ban because when the other group was in power, they were - put the kibosh on research on violence and gun violence in CDC, and the reason they did that, as I understand it, is that the NRA was pushing them because most of the research coming out was showing extraordinarily clearly and scientifically that having a gun in the home was several times more likely to be used in a suicide or many more times more likely to be in an inter-personal altercation resulting in a homicide, so they didn't like that kind of truth coming out.

So I can recall when Dr. Satcher was the 16th surgeon general and he could barely mention the word gun in any of his talks, because, you know, there's been a lot of push-back from the NRA on it.

MARTIN: Let me just clarify this. From the president's proposals, from the paperwork where he's announcing his proposals, the White House says for years the Centers for Disease Control, the CDC, and other scientific agencies have been barred by Congress from using funds to, quote, "advocate or promote gun control," unquote, and some members of Congress have claimed this prohibition also bans the CDC from conducting any research on the causes of gun violence. However, research on gun violence is not advocacy. It is critical public health research that gives all Americans information they need. And so that's the president, by executive orders, then ordering the CDC to then proceed with research...

BELL: Right.

MARTIN: ...that they consider to be helpful. And they also are saying that they should conduct research on the causes and prevention of gun violence, including links between video games, media images and violence. And so you feel...

BELL: Right.

MARTIN: ...that would be particularly constructive.

BELL: Well, but you know, they weren't advocating in the first place.

MARTIN: I understand.

BELL: They were doing science.

MARTIN: I understand. What the president is saying, he specifically wants that research to go forward.

BELL: Right. That's right.

MARTIN: Michael Fitzpatrick, what about you? What, of you have heard, do you feel is most constructive?

FITZPATRICK: I think the most constructive part is really three things. One is the need to have a year-long community dialog in communities across this country about the mental health system that's been long broken. I think these problems don't get solved in Washington, D.C. They don't get solved in state houses. They get solved in local communities, so to bring the whole community in to talk about the mental health system and how to fix that - revision, rethink. This is a tremendous opportunity. It's one of those things that happen, I think, once in a generation.

The other thing the president focused on was early intervention and early identification. Get in there early. We spend too much time in the mental health system in America looking at the back end, commitment laws, inpatient beds, jails and prisons. Let's talk about getting in there early, and particularly with transitional youth, that 16 to 25-year-old age group where they're transitioning from the children's system - such as it is - into the adult system. They get lost. They're not in school. They're not working. They're isolated. They can't access care.

MARTIN: What would that look like, Michael Fitzpatrick, when you're saying get in there early? What would that look like?

FITZPATRICK: Well, in the beginning, educate school personnel, create links between families, school personnel and the mental health system so they're all talking to each other. This doesn't happen too often. Families become isolated. Caregivers become isolated.

MARTIN: Dr. Bell, does the infrastructure even exist? Let's say people are identified as having a mental health issue and the parents are concerned about it. I'm thinking here of Russell Weston, who's the person who drove to the capital and shot a capital police officer and attempted to kill a number of other people before he was himself subdued, and in reporting on this story, you know, discovered that his parents had been concerned about his mental health state since he was 15 years old and had made, in my mind, heroic efforts to get help for him and had...

BELL: Right.

MARTIN: ...were very - had not succeeded. So does the infrastructure even exist to help people?

BELL: No. The system is broken, broken, broken. The new Freedom Commission report of Bush came out with that. More recently we've been looking at the system. It's been broken. I think what can happen, though, is that regardless of whether a child has a mental illness or not is that we can be more welcoming to children. You know the old saying of keep your friends close but your enemies closer? Not that the mental ill are enemies, but rather than stigmatize and shun people because they're a little bit different or a little bit quirky, we should be able to be diverse enough and tolerant enough to welcome people in so that we can keep an eye on them in a loving, close environment instead of castigating them and shunning them.

MARTIN: What would that look like?

BELL: So that's something that could happen.

MARTIN: But what would that look like?

BELL: That would be having all teachers and all principals and everybody in schools and other places being very clear about nurturing and helping children to transform, teaching children social, emotional skills, letting children know that they are, in fact, connected to a supportive, caring adult, letting children know that they are in a community and they are citizens of this community and they have an obligation to act like they've got some sense.

MARTIN: You mean emphasizing more of - I don't know what you call it...

BELL: Pro-social behavior.

MARTIN: A social curriculum?

BELL: Exactly.

MARTIN: You think that that should be as much a part of our educational experience.

BELL: And that families in crisis and in trouble should be supported and strengthened rather than having the child protective services Gestapo going in and snatching their kids, which at times is essential because those kids may be in physical from those families. But of our experience, in Illinois, at least, shows that if you can strengthen families, there's far less a need to take kids, and the kids actually come out better.

MARTIN: If you're just joining us, we're talking about President Obama's plan to reduce gun violence. It includes provisions for increasing access to mental health care. Our guests are psychiatrist, Dr. Carl Bell. That's who was speaking just now. He's with the Institute for Juvenile Research at the University of Illinois School of Public Health. He has a longstanding interest in issues related to violence. And, also with us, Michael Fitzpatrick of the National Alliance on Mental Illness. He's also trained as a social worker.

Dr. Bell, as we mentioned, you're in Chicago, a city that had more than 500 homicides last year alone, and I'm wondering about whether the president's plan deals with the mental health issues that one might think are implicated by that circumstance. I mean, people...

BELL: Well...

MARTIN: ...who've witnessed violence, people for whom violence has become routine.

BELL: Yeah.

MARTIN: Even the city itself, which - you know, experiencing this on such a regular basis.

BELL: Ten years ago, the homicides ran 950 and they ran about 950 before the preceding 10 years. So actually, the homicides are relatively lower. They're half as much as they were. One of the things that's in Obama's plan is this whole notion of psychological first aid, mental health first aid, whatever you want to call it. That is a situation where you actually learn basic skills around children that have been exposed to any type of violence, any type of trauma - whether it's hurricanes, terrorism, domestic violence, school shootings - and you help the child use their natural recovery skills to deal with that sort of trauma.

So that's - if that could become as ubiquitous as people knowing what to do if somebody's choking on a piece of food, I'd be very happy.

MARTIN: Michael Fitzpatrick, what about that?

FITZPATRICK: We're certainly very supportive of that. We routinely teach first aid for physical health injuries in this country and mental health first aid that was first tested in Australia is now being around the - in communities around the country. It needs to be something that school personnel, families and other key people in the community that come in contact with children and young adults who may be experiencing mental health problems and it would give them a step to not only identify what they're seeing, but also - what do you do now?

And the whole issue around these tragedies, if you go back and look at them, is the system of care is inaccessible. People don't understand...

BELL: Right.

FITZPATRICK: to take that first step and so the notion of mental health first aid is a terrific one. Also, crisis intervention training for police officers.

BELL: CIT, right?

FITZPATRICK: Yeah. CIT training is absolutely something the president has talked about.

MARTIN: What about, Michael Fitzpatrick, the idea of barring persons with serious mental illness or a record of mental illness from having access to a weapon to begin with? That is something that is being discussed and it's something that, apparently, people on all sides of the political spectrum seem to have a fondness for. What about that idea?

FITZPATRICK: Right. You know, clearly, people who are seen to be dangerous should not have access to weapons. How you do that is the trick here. You don't want to set up a system where you're barring people who have a mental health history from having a hunting rifle, for example. If people - if we're going to refine the current list of people who are involuntarily committed and put on a national registry, there needs to be some look at - how long do you stay on the registry? How do you get off the registry?

The other thing - I think Carl brought this up from the beginning. Within the social work, psychology and psychiatry professions, there's not a whole lot of training on how do you identify someone...

BELL: Right.

FITZPATRICK: ...when they're dangerous? I mean, the state of the art is very limited on this. And so, it sounds like an easy fix. It's kind of a political fix on identifying people who are dangerous, but who's going to identify? How long do you stay on the list and are you going to act as a barrier from people taking that first step to get treatment because they're afraid they're going to put on some government list?

BELL: Right.

MARTIN: Before we let you go, Dr. Bell and Michael Fitzpatrick, if I could have a final thought from each of you. If we were to get together five years from now - you know, presumably and hopefully, it'll be sooner than that. What kind of conversation do you hope we'll be having? What kind of conversation do you think we'll be having, Dr. Bell?

BELL: Well, hopefully, since 20 percent of the American public has some sort of psychiatric problem, it would be kind of ignorant to prevent them from all protecting themselves if they felt that need. The other huge problem is we just have a hard time identifying people and so that's an issue.

And, plus, currently in psychiatry, there's already a Tarasoff decree, which says that, if you as a psychiatrist think somebody's harmful to someone else, you have a duty to report it. So that stuff is kind of already in there.

MARTIN: OK. Michael Fitzpatrick.

FITZPATRICK: And the system really gets swung, I think, Michel, towards early identification, early intervention, help and support for families to find the care when they need it and that there's a larger community dialogue. Mental illness is an illness like any other. It becomes normalized in the day-to-day conversation. People can find help when they need it.

MARTIN: Do you think that, five years from now, that will be the way - you think that it'll be that way five years from now?

FITZPATRICK: We have no choice. We have no choice.

BELL: I think so. Affordability Care Act should help push it forward.

MARTIN: So you think, five years from now, we'll be having a more...

BELL: Oh, yeah.

MARTIN: ...hopeful conversation than we are having now?

BELL: Absolutely. I've seen...

FITZPATRICK: If the Affordable Care Act works the way it's intended to...

BELL: Right. That's right.

FITZPATRICK: ...and integrates the systems, we get there, I think.

BELL: Yes.

MARTIN: All right. Well, we will see. Michael Fitzpatrick is the executive director of the National Alliance on Mental Illness. That's a grassroots organization that seeks to improve the lives of people with serious mental illness. He joined us in our Washington, D.C. studios. Dr. Carl Bell is the acting director of the Institute for Juvenile Research at the University of Illinois School of Public Health. He was kind enough to join us from the studios of member station WBEZ in Chicago.

Gentlemen, thank you both so much for speaking with us.

BELL: Thank you.


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