Preventing Mass Violence A Balance Of An Individual's Rights, Community's Safety

As governors present their ideas about reducing gun violence and the White House meets with so-called "stakeholders," we look at how mental health policy fits in. Many advocates and policymakers stress that mental health must be a part of the conversation, but they are short on specifics. Audie Cornish talks with Dr. Jeffrey Lieberman, president-elect of the American Psychiatric Association. The APA took part in the meeting on Wednesday at the White House with Vice President Joe Biden.

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AUDIE CORNISH, HOST:

All over the country, people are debating what role mental health policies can play in reducing gun violence. Researchers found that, broadly speaking, people with mental illness are not more likely to commit violence, but people with certain symptoms such as hallucinations may be more at risk of hurting themselves or others.

So could those people be more effectively screened or treated? Take, for example, the case of Jared Loughner, who killed six people and injured many others two years ago in Tucson, Arizona.

DR. JEFFREY LIEBERMAN: Jared Loughner was obviously suffering from schizophrenia and actively psychotic, who had been symptomatic and ill for not just weeks and months, but years and received no care.

CORNISH: That's Professor Jeffrey Lieberman, chair of the Department of Psychiatry at Columbia University. He's also the president-elect of the American Psychiatric Association. His group took part in today's meeting with Vice President Biden. Dr. Lieberman says Jared Loughner is a prime example of the inadequacy of mental health care services.

LIEBERMAN: An untreated patient who is actively symptomatic is at the highest risk for potentially harming themselves or harming others. So when we talk about training people to assess risk, we have to have services that are available to be able to conduct these assessments. Secondly, if we want to be able to educate our schools or our community-based organizations to be able to assess whether individuals may be at risk for violent behavior, we need to be willing to engage in a kind of surveillance of behavior and then requesting that individuals respond to a series of questions. And there's been a reluctance to infringe on people's personal rights, their autonomy, their confidentiality by doing these things. This becomes kind of a civil rights issue.

CORNISH: Are there good reasons for that? I mean, considering sort of the nation's history in terms of committing people against their will, but also the problem that we've heard other researchers say of false positives, essentially people finding any socially awkward person potentially a danger.

LIEBERMAN: Well, that's, I think, the key issue which is that you have to strike a balance between trying to not infringe upon somebody's individual rights to be the persons they are and not intrude on their privacy but at the same time protect society. When the deinstitutionalization movement occurred in the United States and the Homestead Act was - or decision was made by the Supreme Court, it enabled a lot of people who had serious mental illnesses to be discharged from hospitals and cared for in the community. And in doing so, it assumed there would be adequate resources to provide them with a good level of care to maintain them in a stable, supportive and safe fashion. Sadly, that never came to pass.

Now, because of the fact that our society is based on personal freedoms, that equates to right to refuse treatment, and the only standard for imposing treatment against someone's will or hospitalizing them against their will is if they are - meet a certain threshold of dangerousness. And that threshold of dangerousness is making a threat against somebody, having a plan for how they would do it or having engaged in violence themselves, in other words come close to where already sort of committed the violent act. We don't have...

CORNISH: So are you arguing to change that threshold, to make that a lower threshold?

LIEBERMAN: I'm not necessarily advocating we change it, but I think we have to deal with the issue of do we elevate the rights of the individual to a degree where, in protecting those, we potentially place at risk the well-being of our society as a whole and the collective population?

CORNISH: Now, the National Rifle Association has advocated some sort of national database of the mentally ill. Is that even feasible? Your response.

LIEBERMAN: Well, having a database to single out the people with mental illness for a national registry seems to me to be discriminatory. Why not have registries for other types of individuals also for different purposes? In Scandinavia, for example, they have national registries on all medical problems which are very helpful for health care policy in determining rates of illness and how to track efficacy of treatment. We don't do that effectively because of our fragment - the size of our country and the fragmentation of our health care system. But to have a registry that's imposed solely for mental illness in order to reduce the frequency of violent incidents, I think, would be discriminatory by itself and we can accomplish the same goal of reducing the likelihood of these incidents by other means that would be much more constructive.

CORNISH: Dr. Jeffrey Lieberman is professor and chairman of psychiatry at Columbia University and the incoming chief of the American Psychiatric Association. Dr. Lieberman, thank you for speaking with us.

LIEBERMAN: My pleasure.

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