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How The Mental Health System Struggles To Prevent Mass Shootings


It seems that with every mass shooting, two debates reliably spring up - how the country should deal with guns and how it should deal with mental illness.


UNIDENTIFIED MAN #1: People pulling the triggers have turned out to be severely mentally ill.

KATIE COURIC: ...Linked to a gunmen believed to be mentally ill.

UNIDENTIFIED MAN #2: ...Suspect's said to have mental or emotional issues.

RATH: But when it comes to what could actually be done, Dr. Matthew Goldenberg says the mental health system is ill-equipped to prevent people from committing these acts. He wrote about this in the LA Times recently. And when we spoke, I asked him why we shouldn't look to the mental health system in the wake of these tragedies.

DR. MATTHEW GOLDENBERG: It's tempting to do so because sometimes mental health of the perpetrator seems prominent. I think the challenge is that we actually, ahead of time, are not very good - we being the mental health community - are not very good at predicting who, among a large population of mentally ill people, are likely to perpetrate such crimes. A lot of these folks have not been identified previously as mentally ill and actually even in retrospect don't have a classic mental illness that's treatable. And so focusing on the mental illness aspect of this violence, in some cases, perpetuates a negative stereotype about mentally ill people being violent.

RATH: And can you talk about that a little bit? As a psychiatrist, how difficult is it to distinguish between people who have a severe mental illness and - separate those from ones who might pose a threat to other people, who might commit horrible violence?

GOLDENBERG: First of all, let me just say that although the episodes are extremely horrific and tragic, they're actually statistically relatively rare. The FBI estimates that there are 10 and 20 such episodes a year in a country of about 300 million people. So the number of people committing these crimes is actually pretty low, and the number of mentally ill people in the country is extremely high. There are about 40 million people in the United States with a mental illness. So picking the one person out of that huge population who's going to perpetrate such crimes is extremely rare - or extremely difficult.

RATH: Does it make sense to talk about treatment options that are available? I mean, are there ways in which the mental health services can be used in some broad way to help with this problem?

GOLDENBERG: Well, I think mental health treatment services are important and generally underfunded in this country. And so I think mental health services are an extremely important part of a health care system and a social good. That said, I don't think that we can say ahead of time that increasing mental health services will stop these crimes. And I think that's not what the mental health system is good at. So I do think that mental health care and access to mental health care is an extremely important issue in our society. I just think that the metric used to measure the effectiveness of such mental health care should not be the prevention of these rare, tragic episodes of mass violence.

RATH: In a piece that you wrote, you talked about institutionalization of people and the problems that would present. Can you talk about that?

GOLDENBERG: Absolutely. So when we talk about a mental health solution, there's no medication or outpatient therapy that I can provide that would surely prevent someone from going out and committing an episode of mass violence. And so in order to prevent one of these, we would have to potentially institutionalize thousands or millions of people. And then the question becomes a little bit farfetched to be quite honest - but how many people would we feel comfortable institutionalizing in order to prevent one of these episodes? Although there is this notion that psychiatrists - myself included - have these powers of mind reading or prediction, we're actually quite limited in our ability to predict what we don't hear from either the patient or from family or friends or other folks in the community.

RATH: That's Matthew Goldenberg, an assistant professor of psychiatry at the Yale University School of Medicine. Dr. Goldenberg, very interesting. Thank you so much.

GOLDENBERG: Thank you. Transcript provided by NPR, Copyright NPR.