Tragically, too many lives have been lost over the past years to too many shootings and acts of domestic violence. The disclosures of the Florida shooter Nikolas Cruz have uncovered undeniable shortfalls across the health and social agencies in contact with him.
The string of deaths from Virginia Tech to Marjory Stoneman Douglas High repeatedly spotlight glaring deficiencies in community mental health and prevention. No doubt, less is known about the Texas bomber Mark Conditt, but authorities labeled him as “a challenged young man,” and he called himself a “remorseless psychopath.”
I was engaged in 2012 to advise on legislation in the National Defense Authorization Act (NDAA). The law prohibited military commanders and healthcare providers from asking service members that lived off post if they had guns in the home. I was appalled and adamantly opposed it. Asking potentially suicidal soldiers about weapons in the home is basic to protecting them, and failing to ask is malpractice.
As I became more engaged on the problems of gun violence, I learned that the lobbyists deflected attention from automatic weapons to fixing their sites on mental illness. That tactic fired up the patient rights activists. They retorted that focusing on mental illness stigmatizes patients and imposes greater burdens and complicates their lives.
The debates got muddier as supporters of the 2nd amendment stiff armed any legislation possibly infringing on individual rights. A team of retired generals and admirals were able to influence reversing the legislation in the NDAA, but I am pessimistic of finding any political solution today and fear that we will be exposed to more violence.
Any solution in this political environment has to start at the local level, and be reinforced by Executive Action. Effective programs for identifying and monitoring potentially violent young offenders are grounded in community mental health systems and involve community social agencies, the police, and the FBI.
As a career military psychiatrist and former Army general, I have learned that a complex system needs a senior commander in charge to build a strategy and coordinate the operations, particularly when the politics are dysfunctional. We need a high level campaign to mitigate violence and keep our homes and communities safe.
If we cannot get better legislation, then it is time to identify a visionary leader adept at “working the system” to take action. The strongest provision in former Rep. Tim MurphyTim MurphyOur approach to schizophrenia is failing Conor Lamb defeats Trump-backed challenger for reelection in Pennsylvania Biden receives endorsements from three swing-district Democrats MORE’s (R-Pa.) “Helping Families in Mental Health Crisis Act” was setting up the Office of the Assistant Secretary for Mental Health. An empowered Assistant Secretary can design and implement programs to strength community mental health and prevent future tragedies. And, paradoxically, I believe that better programs would be get broad support as long as the publicity does not backfire politically.
The field of mental health differs fundamentally from the rest of medicine that is compartmentalized and narrow. Mental health issues and problems are more generalized and show up in multiple sectors across American society. They are linked to prisons and criminal conduct, education, employment and productivity, veterans, national defense, social concerns (bias and prejudice), and many more.
No other medical specialty has such a wide and diverse impact, and begs for coordination and collaboration. An important goal of the inaugural assistant secretary is laying the groundwork for a strategic vision that recognizes the broad span of mental health issues and important trends we see today. A clear priority needs to tackle political and social concerns over violence, suicide, opioid abuse, and especially identifying potentially dangerous individuals so that communities, agencies, and professionals are empowered to intervene.
The tragic record of shootings and killings threaten our national security from within the borders of our cities and states as foreign terrorist organizations threaten our security beyond the shores. These killings undercut the stability and social fabric of our communities. The country needs a national campaign with coordination across diverse groups — mental health practitioners, educators, employers, and law-enforcement — and can manage the competing funding streams.
Nikolas Cruz is a teaching case on violence and mental health, and the failure of our society to care for handicapped and disadvantaged young people like him. Cruz’s problems were out in the open for years. Social services were aware of his depression, attention deficit, and autism. His parents died when he was a young child. He frightened his adoptive mother, and she had asked the police repeatedly to intervene.
Sadly, her death in November from the flu undoubtedly destabilized him, as she was not around to contain his threats and scary conduct. Nor was his adoptive father who had died six years before. Everyone knew that Cruz was fascinated with weapons, collected knives and guns, and bragged about killing animals. Cruelty to animals is a glaring alert for dangerousness. Adolescents like Nikolas Cruz suffer deeply and have swings in mental state that require close monitoring and expert mental health services.
The social service agencies, police, and FBI failed to act on Cruz’s threats and the dangers he obviously presented. No doubt there are many obstacles in the current environment, but excuses should not be tolerated. The case illustrates a pervasive lack of commitment to mental health treatment, inability to prioritize threats, and failures in strategy, planning, and coordination.
The politics over guns and mental health have hurt our communities and citizens for far too long. The real challenge for protecting against gun violence and domestic terrorism will be to apply leadership and build comprehensive mental health programs. This tragedy could have been avoided, and we would all feel less vulnerable today and have fewer regrets if it had.
Stephen N. Xenakis is a child and adolescent psychiatrist and a retired Army brigadier general. He is the Founder of the Center for Translational Medicine, a nonprofit serving soldiers and veterans. Follow on Twitter @SteveXen.