When Tragedy Strikes at Home: The Need to Change the Mental Health System
On Wednesday, March 7, 2012, one of my mother’s worst nightmares came true.
At Western Psychiatric Institute and Clinic (WPIC) in Pittsburgh, Penn. — one of the state’s best psychiatric hospitals — a shooting spree left two dead and seven injured.
WPIC helps educate future psychiatrists, psychologists, and masters-level mental health therapists. Medical doctors of other specialties, including surgeons, anesthesiologists and radiologists, and other health care professionals also receive training there. It is an institution where education, science, and practice merge together.
I remember the day I spoke to my mother about potential danger at mental health hospitals and the possibility of violent occurrences becoming my reality as a therapist providing treatment to various populations. Her eyes said it all; I could see the terror across her face. Many — primarily professors, professional speakers, and coworkers — reassured me that such incidents were rare because most institutions were highly secure and provided their employees with emergency protocols and trainings. WPIC trains their employees on issues relating to mental health policies, emergencies, and “unusual occurrences” — that is, patient violence.
Unfortunately, the reality of such occurrences often is discounted by more mentally stable “consumers” of mental health treatment, society in general, advocacy groups, specialty groups, and even mental health professionals themselves. It is true, according to the Treatment Advocacy Center (2012), however, that “there are approximately 1,000 homicides – among the estimated 20,000 total homicides in the U.S. – committed each year by people with untreated schizophrenia and bipolar disorder.”
What increases the probability of violence (perhaps even in institutional and clinical settings) is when individuals with severe mental illness are untreated or overlooked by a society wholly uninformed about the signs and symptoms of severe and untreated mental illness. In fact, the National Institute of Mental Health (2010) estimates that “7.7 million Americans suffer from schizophrenia and bipolar disorder – approximately 3.3 percent of the U.S. population when combined. Of these, approximately 40 percent of the individuals with schizophrenia and 51 percent of those with bipolar disorder are untreated in any given year.”
Tragedies in and around some mental health institutions are a reality. We must be willing to accept the reality that there are individuals who suffer from severe mental illness or untreated mental illness — along with substance abuse — and often cannot control their impulses and their thought processes, which often provides the conditions necessary for such tragedies as what happened in Pittsburgh.
The gunman was 30-year-old John Shick, whose first victims were a receptionist and security guard. His other victims included an engaged 25-year old male therapist, a unit clerk, and psychiatrist.
While the topic of violence among individuals suffering from mental illness is quite controversial, it is a conversation that deserves fervent attention, mature conversation, and unbiased interpretation of statistics of previous acts of violence committed by individuals untreated or improperly treated by the mental health system. Progress can only happen once we lay aside our feelings and objectively look at the facts. The Treatment Advocacy Center provides statistics from the Department of Justice:
- of spouses killed by spouse – 12.3 percent of defendants had a history of untreated mental illness
- of children killed by parent – 15.8 percent of defendants had a history of untreated mental illness
- of parents killed by children – 25.1 percent of defendants had a history of untreated mental illness
- of siblings killed by sibling – 17.3 percent of defendants had a history of untreated mental illness
These statistics do not represent those with severe mental illness who are appropriately treated. They reflect only incidents where a severe mental illness was untreated. Although we have yet to access the full details of the shooting in Pennsylvania, it is important that we consider what actually happened, how we can prevent such incidents from occurring in the future, and what policies (state and federal) need to be adjusted, changed, or implemented to protect innocent bystanders and workers in mental health settings.
Implementing new policies or adjusting current policies (e.g., gun laws, assisted outpatient treatment laws, etc.) can help us prevent tragedies. For example, WPIC sits almost directly in the middle of the University Of Pittsburgh School Of Medicine, the university itself, and other large institutions. If, hypothetically speaking, the gunman would have escaped from the institution, he could have taken many, many more lives of bystanders who were commuting from one institution or university to another in the area.
I often refer to Oakland, a microcosm of Pittsburgh, as a “small community.” It is filled with various apartment complexes, halls, schools, hospitals, mental health clinics, churches, playgrounds and parks, and businesses. The area is very highly populated. As a result, this shooting spree could have been a much greater tragedy if the university hadn’t reacted as promptly as they did. I’m sure many families are grateful for its dedication and expertise. Nevertheless, this incident brings to the table a fresh discussion about institutional policies and state and federal laws.
What can we do to prevent future occurrences? A few ideas may initiate greater discussion:
- Assure increased security presence in ALL mental health settings. The reality is that some mental health clinics, primarily community outpatient centers, do not always include strict security. At WPIC, security was not present during the time the gunman entered the building. There are other settings where security is completely nonexistent. This must change.
- Extensive training in emergency protocols. It is extremely important that mental health professionals and other staff receive appropriate training in order to respond to and be aware of emergency situations involving patient aggression and violence. This includes police and other law enforcement officials learning about mental illness and the typical behavior of individuals with severe, untreated mental health problems.
- Community education. Education about mental health problems, behaviors of those untreated, the legal rights of the mentally ill and their families, and how to protect our society from unfortunate circumstances such as violence or aggression is a significant component of proper advocacy of the severely mentally ill and their loved ones.
- Advances in state assisted outpatient treatment laws. Assisted Outpatient Treatment (AOT) is a court-ordered treatment (including medication) that is available in 44 states. It is often utilized with individuals who have a history of medication noncompliance and noncompliance with mental health treatment. AOT is for individuals with severe mental illnesses who require strict maintenance. Learn more about AOT here.
It is presently unknown whether the gunman had an untreated mental illness, but many of his neighbors, friends, and acquaintances stated that he was acting very bizarrely days before the shooting spree. The signs were there, the treatment was not. According to University of Pittsburgh police Chief Tim Delany, “three of the Pitt officers ‘engaged in gunfire’ with him… This is what we prepare for and hope it never happens. It happened. I don’t want to think about what could have happened with all those people in there.”
We need our citizens to get involved and become more knowledgeable about state laws and the consequences of untreated mental illness. We need our police officers to continue their trainings and to continue to be the great protectors they have strived to become. We need our mental health professionals to embrace reality and strive to educate others on the potential of violence and aggression that sometimes lies directly before us all. In turn, we protect the severely mentally ill from losing their lives.
Our attention to tragic realities will keep us protected from future tragedies that might involve loved ones. I encourage you to get involved, to become knowledgeable, and to effect change wherever and whenever you can. Our future depends on it.
For more information on state mental health laws, visit http://www.treatmentadvocacycenter.org/legal-resources.
For more information on getting involved in your state, visit http://www.treatmentadvocacycenter.org/solution/getting-involved.
Hill, T. (2012). When Tragedy Strikes at Home: The Need to Change the Mental Health System. Psych Central. Retrieved on June 25, 2017, from https://psychcentral.com/blog/archives/2012/03/28/when-tragedy-strikes-at-home-the-need-to-change-the-mental-health-system/