Could A Better Mental Health System Have Prevented The Tucson Tragedy?

Time’s Nathan Thornburgh asks some smart questions about why 22-year-old Jared Lee Loughner, a man who was kicked out of his community college because of his mental state, passed a federal background check and was allowed to purchase the gun with which he killed six people and gravely injured 20 others:

Who else knew of Loughner’s mental illness? What obligations did his college have, and which ones did they fulfill, to report Loughner to other agencies? Most of all: Why is Arizona (along with other states) so far behind in reporting disqualifying mental illness to the federal background-check system? If there is anything that both sides should be able to agree on, it’s that unstable individuals should not have access to any kind of weapon, much less the so-called fourth-generation semiautomatic Glock 19 that Loughner bought. This time, the price for bureaucratic torpor was too high.

Click over to his full article to read about how states have been slow to report cases of mental illness to the National Instant Criminal Background Check System (NICS), but it’s also worth pointing out that the more important point point is whether the mental illness gets treated. The Treatment Advocacy Center reports that Arizona “is one of the worst states in the nation to be an individual with severe mental illness who needs help.” According to the organization, the state “jails or imprisons 9.3 times more people with severe mental illness than it hospitalizes,” “has 5.9 psychiatric beds per 100,000 population. (the recommended level to meet public need: 50 beds per 100,000,” and “is home to more than 50,000 people with schizophrenia, of whom a minimum of 25,000 are likely to be untreated at any given time.” State budget cuts are further diagonalizing the system.

The situation is even worse for those who don’t have insurance coverage, can’t purchase affordable insurance in the individual market (sometimes because of a mental health condition), or don’t qualify for Medicaid coverage or other forms of state aid. Estimates show that one-fifth to one-third of the uninsured are people with mental and substance use disorders and health reform may help them obtain coverage. Some are undoubtedly receiving insurance through the temporary high-risk insurance pools, and by 2014, they’ll be able to enroll in insurance through the exchanges, where private companies will have to offer mental health and substance use disorder services as part of the essential package of benefits. The law also expands parity — a requirement that benefits for mental illnesses to be on par with benefits for medical illnesses — “to a much wider pool, making it possible for millions more people to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression and schizophrenia as they would for, say, diabetes or cancer.” Reform could also prove a vital tool in fighting the onset of mental illnesses in children and adolescents by defining “prevention broadly and make our focus on prevention a holistic one that includes promoting both physical and behavioral health.”

Experts estimate that four million Americans “have severe psychiatric disorders with a subset of 400,000 homeless and untreated not complying with their needed medications and another sub-sub set of 40,000 considered the most dangerous, not being treated or taking meds and demonstrating very violent behavior.” Of course it’s still unclear if Loughner would have benefited from mental treatment or care could have prevented Saturday’s tragedy. But as Jonathan Cohn points out, “After a major disaster, like an airliner crash or terrorist incident, we conduct thorough investigations to determine what caused the tragedy and how we might avoid another one like it. This occasion calls for a similar response. We may never know whether a better mental health care system would have averted this massacre. But we can be sure that it would avert some future ones.