Reflection on Depression

What happened?

Last week, police shot and killed a mentally ill man in San Mateo (a few miles from Palo Alto, where I live). Click here for the story. 

Robert Caron, 35, apparently threatened CVS employees when he was unable to pick up his medication (Caron reportedly had schizophrenia but it's unclear what the medication was for). He then returned to his house and, according to a neighbor, was brandishing a weapon in his backyard when police surrounded the property. A police negotiator tried to engage him but Caron was killed by police fire after he discharged his own gun.

Several questions immediately come to mind:  Why couldn't Caron get his medication? Did Caron suffer from paranoia, believing that the police were going to harm him? Did the officers and negotiator respond appropriately knowing that Caron was schizophrenic (police were familiar with him because of several previous runs ins)? Why did he have a gun? Could his family have done more to prevent him from having weapons?

Too often police treat the mentally ill like criminals when their only "crime" is being sick.  I don't want to speculate about Caron's motives--we don't know if his illness contributed to the shooting or not--it's possible he was thinking and acting just as intentionally as any other criminal when he fired his gun. However, if Caron was persuaded by paranoid delusions that the police were out to harm him or his family then his actions, in light of those delusions, were arguably rational (or at least understandable). Should the police have considered this possibility when responding? Should they have refrained from surrounding his house with lights and sirens knowing it might feed the delusions, exacerbating an already precarious situation?

We may never know Caron's state of mind when he fired his gun, but his case highlights the challenge of responding appropriately to mentally ill offenders. 

Mental illness, violence, and psychiatric treatment

Ronald Reagan is more to blame for the shooting in Tuscon than Sarah Palin (of course, it's a simplification to blame any one person).  Still, Ronald Reagan did more to dismantle America's mental health system than anyone else.  Although he promised adequate "community care" in its place, a system of outpatient facilities capable of handling the country's mental health burden never materialized. 

 

In my opinion, at least two things necessary for adequate reform:  

1) A bigger budget for mental health care services.  This is probably unrealistic given the deficit and the economy. But I wonder if teaching children emotional resilience at an early age could help reduce the burden (and expense) of treating mental illness later on. Also, families need to get sick loved ones into care much sooner, since early intervention improves the prognosis of most mental illnesses. A great example of a program teaching kids emotional resilience skills is Project Happiness.

2) Changes to the legal criteria for involuntary treatment or commitment.  There's a fine line between providing psychiatric treatment and harming civil liberties, but it's a line that we need to look at more closely. In the following MSNBC interview a forensic psychologist discusses the need to loosen the legal criteria for involuntary commitment. Currently, only people who are seriously at risk of harming themselves or others (for instance, as he notes, people who have waived a gun at someone over the last 24 hours) can be held. He thinks that courts should also consider what doctors call "insight" when deciding whether to commit someone. Those patients who lack insight into their illness (i.e don't believe they are sick) should be easier to commit. 

  MSNBC forensic psychologist interview

The Dr. also makes the point that the main reason for getting the mentally ill into treatment is because they are suffering, not because they are dangerous. This suffering is undeserved and thwarts many people with mental illness from reaching their full potential.

Plus, as one commentator points out, a higher percentage of intoxicated people commit violent acts than people with mental illness. In fact, the mentally ill are far more likely to be victims of crime (given their vulnerability) than perpetrators of crime.