Have you noticed the lack of attention about the Wafflehouse Shooting? There is scant media attention for the wonderfully brave James Shaw Jr., who stopped the shooter before the death toll rose and has raised money to help bury the victims. And I’ve seen almost no new clamor for changes needed–gun control and/or mental illness care–to prevent the next shooting. I think we’re becoming numb to mass shootings. The police captured Travis Reinking, the mentally ill young man behind this shooting, at the Wafflehouse in Tennessee, pretty quickly. I feel so bad for the four young men who were killed, and for their grieving families.
You may wonder, how could Reinking, the shooter, have been arrested last year, identified as seriously mentally ill, and be walking around a year later with four guns? I am not surprised. After my family’s connection to serious mental illness, I know that our system of mental healthcare is more confused than the people it is supposed to help. Also, it is pretty obvious that the 300 plus million guns floating around our population are out of anyone’s control. They are like the terrible virus spreading in a disaster movie, and it may be too late to eliminate the threat.
But there are ways to help contain it.
Obviously one way to reduce shootings is to make it more difficult for people to get guns. And I hope Congress will put forward and enforce legislation on gun control. Here, though, I want to focus on serious mental illness (SMI). These are people with schizophrenia and serious bi-polar disorder and the like. People with SMI make up about 4% of our population, but are behind about half of mass shootings.
Our care systems for mentally ill people do not take into account the fact that SMI is a chronic, and usually worsening condition. Someone who is mentally ill needs not only emergency care in an ER when they are having a psychotic episode, but also long term follow up care for the duration of their life. There is often an ebb and flow to the illness, and without monitoring and intervention when necessary, it can quickly escalate. Think of diabetes. A shot of insulin helps for today, but tomorrow someone with diabetes needs another dose, and the next day, and the next.
My brother had his first psychotic episode when he was sixteen. Over the next thirty plus years, he got worse and worse, despite all the hospitalizations, consultations, and medications he was given. Sometimes manifestations of his schizophrenia lessened, and if he didn’t talk, you might think he was OK. And then he’d speak, and within ten words you were well aware there was something really wrong with this man. Yet our psychiatric hospitals refused to keep him in their care; he was assigned to live in a so-called adult home–a terrible place that was like a mental hospital without any medical personnel–and told to show up at some clinic for help if he thought he needed it (which he never thought he did). He wandered around on his own recognizance, often scaring people in the streets and stores he frequented. Others like him live with their families, who may be terrorized and not know what to do.
As I wrote in the book about trying to take care of him (Shot in the Head, a Sister’s Memoir, a Brother’s Struggle) families are simply not equipped to care for someone who is delusional, ranting and raving, refusing to bathe, perhaps, or bathing 25 times a day. My brother was afraid of the people he saw in the streets or in restaurants; he was sure that anyone who caught his gaze for more than a second was trying to steal his soul. He would shift his eyes constantly, so that no one could succeed. He lost all his teeth in his thirties, his hair varied between shaved (in which case he usually thought he’d been scalped) or long and dirty. His thrift store clothes seldom fit and were even less seldom washed. But hospitals would not keep him more than two or three days, as there is no public mechanism for them to be paid for more than that.
People like my brother–and this shooter– need long term followup care after a hospitalization such as Reinking’s last year, after he was caught trying to climb over the White House fence with an AR-15. Luckily, my brother never developed any delusions about a need to kill a bunch of people. But I often cringe at incidents like the Waffle House or Parkland shootings, knowing that if he’d had access to an AR-15 when he was in one of his delusional states, I don’t know what would have happened.
What to do about it
My sister, Ilene Flannery Wells, has put together a concise list of what needs to be done to improve the treatment of people with serious mental illness in the U. S. (which I have amplified with suggestions from another mental illness care advocate, Kathy Day)
If you are part of an advocacy group, or if you would like to learn more about this issue or would like someone to speak to your group, please contact me. See also the wonderful work being done by the Treatment Advocacy Center, and the educational efforts of the Mental Illness Policy Org.
10 ways to improve care for people with serious mental illnesses
1. Repeal the Medicaid IMD Exclusion, which prevents Medicaid funds from being used at “institutions for mental disease.” It is discriminatory and is behind much of our failure to care properly for people with SMI.
2. Modify commitment laws to include grave disability instead of dangerousness. Treat people before there’s a tragedy. Recognize that the sufferer’s own need for treatment is as valid as the danger he might pose to others. This is especially true for those who lack insight and therefore can’t/won’t seek treatment voluntarily.
3. Reform use of HIPAA privacy laws so that valuable family care givers aren’t left out of treatment plans.
4. Implement nationally the RAISE program, an early intervention program with wrap around services that is now in use in some parts of the country.
5. Use Clozapine earlier in treatment rather than having a person wait until they’ve failed on other drugs…it works! (Not for everyone, but it isn’t used enough and lives are being ruined because if it.)
6. Use cognitive enhancement therapies as soon as possible. Get it covered by insurance. Most of the difficulties a long-term sufferer of serious mental illness encounters, even after psychosis has subsided, is due to cognitive damage. CET may help them recover.
7. LEAP training for all medical and police personnel, to prevent tragedies when they are called to help.
8. Permanent supportive housing–not just once a week social worker visits–for those most seriously disabled from mental illness.
9. Use telehealth for those who can’t get in to see a psychiatrist. First line care providers should link families to this source of information and counseling.
10. Funding for more neuropsychiatrists! This could include straight out funding and/or school loan debt subsidies. Often families can’t find a therapist who can take on another patient.
Be aware. Tell your representative you want them to do something to fix this. Call your members of Congress. Click here: Link to find your representative’s contact info
We can all make a difference. Advocate. Lobby your state and federal representatives. If each of us does one little thing, all the little things will add up.