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How Proposed Plans to Stop the Next School Shooter Might Affect People With Mental Illness

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Sometimes the news isn’t as straightforward as it’s made to seem. Sarah Schuster, The Mighty’s mental health editor, explains what to keep in mind if you see this topic or similar stories in your newsfeed. This is The Mighty Takeaway.

As a nation, we want to prevent the next school shooting.

We’re just divided on exactly how.

In the time between February 14, 2018, the day 17 people were shot and killed at a high school in Parkland, Florida, and last weekend’s March for Our Lives, both the Trump administration and Parkland students released their plans for preventing the next tragedy.

While their visions for gun reform and school safety differ in some ways, one part of their proposals align — their stance on policies that might affect people with mental illnesses.

Below we’ve outlined the mental health aspects of both proposals, and how people living with mental illnesses — and those who advocate for mental health policy — have reacted so far.

Trump’s Proposal: A List of “Immediate Actions”

On March 12, almost one month after the Parkland shooting, the White House released a list of “immediate actions” the administration wants to take to protect schools from mass shootings. On a fact sheet explaining Trump’s positions, a section called “Mental Health Reform,” details how the administration sees mental health working into the equation.

“President Trump is proposing an expansion and reform of mental health programs, including those that help identify and treat individuals who may be a threat to themselves or others,” it reads, citing specifically:

The President is proposing increased integration of mental health, primary care, and family services, as well as support for programs that utilize court-ordered treatment.

Court-ordered treatment is mandated treatment that goes through the court system, Frankie Berger, director of advocacy at the Treatment Advocacy Center, a nonprofit that serves to eliminate treatment barriers for severe mental illnesses, explained. This action takes away someone’s right to choose their medical treatment and is typically reserved for people who are proven to be an imminent threat to themselves or others — something called the “dangerousness standard.”

For someone in acute psychosis, who perhaps threatens a family member, attempts suicide or is detained by the police after a violent altercation, this could mean forced hospitalization. But psychosis and violence aren’t strongly linked, and most people are not a threat to themselves or others in a psychotic state. In some states, then, the “dangerousness standard” can be overturned in certain situations. In these cases, family or guardians can petition the courts for their loved one to receive assisted outpatient treatment (AOT). Rather than hospitalization, AOT includes forced interventions like medication and therapy.

But what does this have to do with school shootings?

I think it’s hard to directly relate how this would help with a school shooting incident,” Berger told The Mighty. “Broadly speaking, it’s a measure that could help both decriminalize mental illnesses and reduce some of the incidents that happen outside of school shootings.”

Those who advocate for court-ordered treatment like AOT see it as a tool to get those with mental illnesses out of jail and off the streets, while also reducing violent incidents caused by mental illness, that while rare, do exist.

According to the National Alliance of Mental Illness, two million people with mental illness are arrested each year, and nearly 15 percent of men and 30 percent of women in jail have a serious mental health condition. The U.S. Department of Housing and Urban Development found that one in five people experiencing homelessness had a serious mental illness, and a similar percentage had a chronic substance use disorder.

The problem is, there’s not a lot of evidence this has anything to do with school shootings. In a piece about mental health and mass shootings, Newsweek reported there’s “no consensus on what portion of mass killers show signs of mental illness.” Dr. Jeffrey Swanson, one of the leading researchers on mental health and violence, told Newsweek predicting who will be the next mass shooter is akin to finding a needle in a haystack, and that in order to be sure you’d have to “detain the haystack.”

And that is why many experts say treating court-ordered treatment like a solution to mass shootings is misguided. In fact, after authoring a report about the effectiveness of AOT in New York, Swanson told Behavioral Healthcare that while AOT did save the state money and could be effective when paired with community-based services, “People who understand what outpatient commitment is would never say this is a violence prevention strategy… outpatient commitment isn’t going to prevent mass shootings.”

While there’s a movement of mental health advocates who fight against all forced treatment, Frank Farley, former president of the American Psychological Association, said along with the general concerns that come with forcing someone into mental health treatment, mental health policy based on “catching” the next mass shooter could make people with mental illnesses even more vulnerable to unnecessary forced treatment.

“In the rush to deal with this mass shooting, we need to watch out for human rights violations,” Farley told The Mighty. “Predicting dangerous is an imperfect science at best, and we don’t want to take away people’s freedoms to not be treated, to say no…we have to make sure we’re not scooping up people who shouldn’t be forced to do anything.” 

In a listening session held at the White House with students and parents from the Parkland community, Trump didn’t mention court-ordered treatment specifically, but he did cite a lack of institutions as a roadblock in preventing mass shootings. He said:

You know, years ago we had mental hospitals, mental institutions, we had a lot of them, and a lot of them have closed. Some people thought it was a stigma, some people thought, frankly, the legislators thought it was too expensive. Today if you catch somebody they don’t know what to do with them. He hasn’t committed the crime, but he may very well, and there’s no mental institution, there’s no place to bring them. We have that a lot.

“If you catch somebody they don’t know what to do with them.” 

That seems to be the basis of the President’s thinking when it comes to mental health. We need court-ordered treatment because we need a way to detain those with mental illness. We need more institutions because we need a place to put them — not because everyone deserves accessible and compassionate healthcare.

Parkland Students’ Proposal: A Gun Law Manifesto

While organizers from March for Our Lives released a five-point action plan that exclusively focuses on gun law reform, staff from the student newsletter at Parkland’s Marjory Stoneman Douglas High School also released a “manifesto to fix America’s gun laws,” which they published in The Guardian.

Editor’s note: It is unclear whether March for Our Lives endorses all the points found in The Guardian article. The Mighty is still waiting to hear back for comment. 

Some of the points endorsed by the student publication have people in the mental health and disability communities concerned. 

“So I’ve been more or less on board with up until this point, but then I read the Guardian editorial that the Parkland teens put out regarding their policy proposals and I’m honestly horrified. Horrified,” Twitter user @tea_comrade wrote. Specifically, she’s referring a point where Parkland students advocate for changing privacy laws to allow mental healthcare providers to communicate with law enforcement. The section reads:

As seen in the tragedy at our school, poor communication between mental healthcare providers and law enforcement may have contributed to a disturbed person with murderous tendencies and intentions entering a school and gunning down 17 people in cold blood.

We must improve this channel of communication. To do so, privacy laws should be amended. That will allow us to prevent people who are a danger to themselves or to others from purchasing firearms. That could help prevent tragedies such as the Parkland massacre.

In a Twitter thread that has over 4,900 retweets, @tea_comrade explained why this proposal made her uncomfortable as someone with a mental illness.

Allowing mental health professionals to collaborate with cops on this scale is on the table now? Is it really? ‘Cops’ and ‘mental health treatment’ are not really words that should be uttered in the same sentence.

The vast majority of mentally ill people will never harm a fly. They are actually FAR more likely to have violence inflicted upon them—not just by their peers, but by the state. This proposal would only accelerate that process.

If the gun control movement puts disabled autonomy on the sacrifical altar in exchange for legislative victory, well, I’m out. We can have gun control, but not like this.

The Parkland students’ specify that the purpose of this communication would be to prevent individuals from purchasing firearms, however, one-fourth of police shootings involve someone with a mental illness. It makes sense that people in the mental health community — especially people of color — would be nervous about more police involvement in mental health treatment. Of all police fatal shootings, a disproportionate amount involve black people.

Another Twitter user, Farheen Ehsan‏, pointed out the Parkland students’ policy proposal was full of ableist language. Under a point called, “Dedicate more funds to mental health research and professionals,” Parkland students wrote, “Many of those who commit mass shootings suffer from these kinds of illnesses” — referring to mental illnesses. 

We do need more mental health professionals to help people struggling and we need more research about preventing mass shootings. However, concluding that “those commit mass shootings suffer from these kinds of illnesses” falls into the same trap as Trump’s proposal. While yes, it’s true, the mental health system likely failed the Parkland shooter, profiling people based on their mental illness does little to prevent violence

At the end of the day, we should be fixing the mental health system to help people who need it — not to prevent violence. Mental health reform for the sake of preventing violence isn’t compassionate, it unfairly stigmatizes an entire group of people, and it won’t work. At least, it won’t work without trampling over a lot of people’s human rights.

“In the whole equation, the mental health case is the weakest,” Farley told me. “Most people with mental illness wouldn’t hurt a fly. Yeah, they need our attention, but they need our protection, too.”

Originally published: March 27, 2018
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