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By now, mental health experts have performed extensive post-mortems on
whether Arizona had adequate involuntary treatment laws for people like
Jared Lee Loughner, the alleged gunman in the recent shootings.
The answer is yes.
Arizona, it turns out, has admirably progressive mental health
statutes that permit involuntary evaluation and treatment of someone
who desperately needs it. Loughner, 22, whose delusions of mind
control, agitated outbursts, bizarre preoccupations, and paranoia are
highly consistent with a diagnosis of schizophrenia, fit that
In fact, under Arizona law, any concerned party can petition the
court for an Order for Treatment. If Loughner had been found
“persistently and acutely disabled” by severe mental illness and
“likely to benefit from treatment”–regardless of whether he had a
weapon or was suicidal–an evaluation and subsequent care could have
been court mandated.
Of course, hindsight is perfect. As incidents unfold in real time,
most people are rightly skittish about infringing on a person’s
freedom. But given Loughner’s troubling track record–the number of
times the campus police were called to intervene; the pressing
concerns of his teacher and of other students; and the very fact that
the college would not re-admit him after his suspension without
psychiatric clearance–it seems that a court petition could have been
Good laws only work when applied, of course. And when Loughner did
not return to school, Pima Community College was rid of a very
troubled young man and his problems. It did what so many colleges,
universities and businesses have done before: passed the problem
This brings us to a no-man’s land where even strong commitment
laws, when they mercifully exist, are not enough. What responsibility
does an institution have to the wider community when it has identified
a deeply disturbed individual?
Mental health organizations are no place to look for solutions.
Their job includes raising public awareness of mental illness;
championing the virtue of treatment and implementation of commitment
laws; and lobbying for more desperately needed treatment resources.
Excellent causes all. As for psychiatric facilities, they can only
treat those who have already come through their doors.
Even commitment statutes are, in a sense, permissive–that is they
give concerned parties and the courts the authority to do something
but do not require anyone to do anything.
Perhaps it is time to require action. When a school or business
feels the need to protect itself from someone who is mentally ill,
perhaps it should be required to try to protect others, too.
Thus, if a school or a business ejects or otherwise removes a
student or employee out of concern about behavior and dangerousness,
the principal, dean, or head of the Human Resources department would
be required, under a mandatory reporting law, to inform the medical
director of the appropriate public health jurisdiction. This public
official would then have to initiate an evaluation which might lead to
a face-to-face evaluation and, depending upon its outcome, possibly
When to break confidentiality
Precedents exist. There are mandatory reporting laws for child
abuse. Teachers and medical professionals cannot just look the other
way when they see a child with multiple, suspicious bruises. The same
logic applies here: a severely ill person battered by psychosis should
not be left at the mercy of a condition that causes others to be
worried for their safety.
As for the legality of breaking professional confidentiality, a 1976 Supreme Court decision (Tarasoff v. Regents of the University of California)
allows a doctor to warn intended victims of a patient’s planned
attack with no fear of breaking confidentiality. A school or business
could be similarly insulated, especially since there is no clearly
defined right to confidentiality in these situations.
Weighing individual rights against protection of the general
population invokes a vexing social calculus, indeed. Preventing
extremely low base rate behavior like the Tucson tragedy is always
difficult–many people seem at risk for violence toward others, but so
few actually are. And once a reporting requirement exists, will newly
accountable institutions inevitably become more cautious and
conservative than they need to be?
Then again, if a school or business community is so fearful for its
safety that it evicts one of its own, it is clear that a serious
threshold of concern has already been reached. A requirement for
mandatory reporting at that stage might prevent some tragedies with
only minimally greater intrusion on an individual’s rights than is now
Jeffrey Geller is Director of Public Sector Psychiatry at the University of Massachusetts Medical School. Dr. Sally Satel is a resident scholar at AEI.
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