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A portrait of Adam Lanza: Gun control and mental health system at a crossroads

January 16, 2014
by Alison Knopf
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How 'converging truths' shaped tragedy in Newtown, Connecticut

The story of guns and mental illness is one of converging truths about two badly broken systems – one for caring people with mental illness and another for regulating guns – that come together tragically. The true inadequacies of both systems are seen especially in young men who are no longer children but whose parents can’t help them, and who are at a time of life when neither gun laws nor the mental health system seem to pay attention to them. Access to guns is easy, and among the huge pool of troubled youth, there are a few whose lives cross that access.

Behavioral Healthcare interviewed several mental health experts a year after the horrific Newtown tragedy; some offered insights, albeit speculative, into the mind of Lanza; others said emphatically that the best solution to gun violence is, as they said in the immediate aftermath of the shootings, to limit access to guns for everyone.

‘You would have to detain the haystack’

Three experts in mental illness and the law concur:  All told BH that gun violence by the mentally ill is so rare that looking for it is like looking for a needle in a haystack. “You would have to detain the haystack,” said Jeffrey W. Swanson, Ph.D., professor in psychiatry and behavioral sciences at Duke University.

Let’s say the mental health system was not overburdened, said Swanson. The overall problem of gun violence would go down by 4 percent. “If you want to have a discussion about improving the mental health system, great. But we want to shine the light on the need to improve mental health but not by increasing stigma.”

This is not to say that guns and mental illness mix. But is Lanza an example of multiple casualty shootings by troubled young men, or is there a public health problem with guns? Swanson, along with his colleague Marvin S. Swartz, M.D., and Paul Appelbaum, M.D., past president of the American Psychiatric Association, emphatically state that the problem is guns, not mental illness. Here’s why: Of the 85 gun-related deaths that occur every day in the United States, fewer than four deaths (3.4 deaths or 4% of the daily total) are linked to mental illness.

Swanson adds that while crimes like Lanza’s are very rare, young men whose profiles are similar to those of Lanza are not: “The average 17-year-old has a good chance of living in a home with multiple firearms,” he said. “Add to that the characteristics of young men who have had some psychopathology, are isolated, probably angry, and perhaps delusional, perhaps something else – it’s not a very small set.”

“There are two converging sets of truths here,” said Swartz, who is professor in psychiatry and behavioral sciences at Duke University School of Medicine. “One is that the mental health system is fragmented and under-resourced, and the other is that we have a terrible problem with gun safety.” The convergence of these two important, but inadequate systems in the Newtown massacre couldn’t help but be painfully tragic. Neither system is “up to the task,” Swartz said.

Swartz stated that, in hindsight, there could have been many ways that better “systems” might have altered the ultimately tragic decisions made or not made by Nancy Lanza with regard to her son: “If,” he suggested, “she had better access to family services for troubled kids, she might have gotten better guidance.”

So, even as mental health professionals try to dispel public misperceptions about people with mental illness, there is no denying the fact that the focus on mental health problems that resulted from the Newtown tragedy has brought considerable benefit to the mental health field – namely, Congressional attention and increased funding.

The police report

The Connecticut state police released the final report on the Adam Lanza Newtown massacre of December 14, 2012, on December 27, 2013. It is severely redacted, but does indicate that when offered help for her son’s mental illness, Lanza’s mother declined. The report is based on interviews with many of the people who knew the troubled young man starting in his early years. It forms the basis of the state’s division of criminal justice report, released November 25, which concluded that the investigation found no motive for Lanza’s shooting of 20 schoolchildren, six school staffers, his mother, and himself.

Significantly, the report also concluded that there was no connection between Lanza’s mental health problems and the crime. But this question received special attention, since Lanza’s history included a diagnosis of Asperger’s disorder (a diagnosis which was folded into the autism spectrum in DSM-5) and had been noted to have odd behaviors including a preoccupation with violence.

In the wake of the December 2012 Newtown shooting, the mental health field spent an anguished year trying to dispel the notion that people with mental illness are more likely to commit violence – they’re not, they’re more likely to be victims – while at the same time taking advantage of welcome consideration by lawmakers about the limitations of our current mental health system.  

Elsewhere in Congress, efforts by a broad coalition of groups to place greater restrictions on access to certain guns and accessories (assault style weapons and high capacity magazines) failed. Gun advocates suggested that the mentally ill were a key culprit in gun-related violence and argued, with some success, for restrictions based on mental health history. 

A forensic psychiatrist’s view of Lanza’s crime

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WOW, first inflate the rapidly shrinking 10k/year firearms deaths by lumping in the 20K/year suicides by firearm, and then pretend not to notice that 90% of those suicides had a diagnosed serious mental illness. Now argue that only 3.4 firearms deaths each day involve the mentally ill. WOW.

See: Chang, B; Gitlin, D; Patel, R (September 2011). "The depressed patient and suicidal patient in the emergency department: evidence-based management and treatment strategies.". Emergency medicine practice 13 (9): 1–23; quiz 23–4. PMID 22164363.

I'm checking back with the author on this. I apologize for the delay.

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