Sandy Hook and Beyond: How More Help for the Mentally Ill Could Prevent Mass Shootings

The anniversary of the shooting at Sandy Hook Elementary School is upon us this week. It’s been five years since 12 girls, eight boys, and seven adult women were killed. Much was promised in the aftermath. Politicians wept, gun-control bills flooded statehouses, and the state of Connecticut set out to examine how Adam Lanza transformed from a socially awkward child to a 20-year-old gunman.

It took almost two years for Connecticut’s panel of clinicians and education experts to carefully compile the 114-page report and in that time the fervor dwindled. Various news outlets gave their own short summaries, often highlighting more sensationalistic elements, like the comic book Lanza co-wrote when he was 10-years-old, The Big Book of Granny, which involved “child murder, cannibalism, and taxidermy.” Sadly, far more information lies within that report, but too often linking mental illness to mass shootings is met with derision.

Last month after Devin Kelley killed 25 adults and children in a Baptist Church in Texas, Bethany Lilly of the Bazelon Center for Mental Health Law told NPR, “There is no real connection between an individual with a mental health diagnosis and mass shootings. That connection according to all experts doesn’t exist.”

Days later, after Kevin Neal killed five people, wounded seven children, and attempted to attack Rancho Tehama Elementary School in California, Dr. James Fox, an author and expert on gun violence, told NBC news, “We like to think that these people are different from the rest of us. We want a simple explanation.” He went on to say that “because of how fearful, dangerous, and deadly” these gunmen are, “we really want to distance ourselves from it and relegate it to illness.”

Dr. Fox’s sentiment is problematic. And while it’s understandable that an organization like the Bazelon Center for Mental Health Law might not want mental illness to be associated with mass shootings because it could make it harder for them to protect the vast majority of the mentally ill, who are non-violent, it’s somewhat dismissive.

If we revisit some of the deadliest mass shootings in the past 10 years — Virginia Tech in 2007; Aurora, Colorado in 2012; Sandy Hook Elementary School also in 2012; Washington Navy Yard in 2013; and Isla Vista (or UC-Santa Barbara) in 2014 — there are reoccurring patterns. Firstly, yes, each perpetrator had a gun, or a stockpile of guns, which he obtained through legal means or with great ease illegally. Prior to the gun purchases, though, each gunman attended sessions with a mental-health provider and in three of the five cases the police were also involved. The duration of time between therapy sessions / police visits and the attacks varies, from three weeks to six years. But in every instance there was ample time to intervene, but no one did. Or no one could.

In the case of James Holmes, the University of Colorado graduate student who killed 12 and wounded 70 in an Aurora movie theater, he told his psychiatrist, Dr. Lynne Fenton, four months before his attack in March 2012, that he was having homicidal thoughts three to four times a day. Further in his treatment, he admitted his obsession with killing was only getting worse. Long after the shooting, an MRI showed that the part of Holmes’s brain that controlled emotions, empathy, and impulse control was abnormal. He was given a multitude of diagnoses on the schizophrenia spectrum — schizophrenia, schizoaffective disorder, and schizotypal disorder.

Prior to Holmes’s attack, his psychiatrist did alert the University of Colorado’s Threat Assessment Committee but testified in court that she couldn’t place Holmes under psychiatric hold, meaning hospitalize him involuntarily, because he never overtly said he planned to kill and he never named specifics, like a locale or target.

Such narrow criterion is nothing new. Every state creates its own requirements for involuntary commitment and these laws often revolve around the words danger or harm. Namely, is the individual a danger or harm to himself or others? But such danger or harm is always measured in the present moment, rarely for future’s sake. (The phrase imminent danger is frequently used as a means of qualifying how visibly dangerous a person must be in the here and now.) Beyond the actual wording, the degree of danger or harm is open to interpretation, even among the most trained professionals, sometimes even dealing with the same patient.

Candlelight vigil at Virgina Tech.

Seung-Hui Cho, for example, was almost involuntarily committed the semester before he shot and killed 32 people and wounded 17 at Virginia Tech on April 16, 2007. That particular year, his behavior had become increasingly unsettling. In class, he wore reflector glasses with his hat pulled low and read aloud in a whisper when called upon to read. Sometimes he called his roommates from another room, claiming he was his own twin brother, who went by the name of “Question Mark.” He also stalked a female in his dormitory, intimidated his fellow poetry students to the point that some stopped attending, and submitted writing to his independent study that involved “shooting and harming people.”

The Virginia Tech Police Department visited Cho several times, but it wasn’t until December 13, 2006 that he was taken into custody after admitting to his roommates that he wanted to kill himself. An emergency evaluation ensued and a licensed social worker found that he met these three criteria: a) he was mentally ill, b) a danger to himself and others, and c) not willing to be hospitalized voluntarily. He was then sent to St. Albans Behavioral Health Center of the Carilion New River Valley Medical Center, where a separate evaluator felt he was mentally ill but not in imminent danger. Another psychiatrist agreed. The first evaluator had spoken to the police and Cho’s roommates while the latter two had not.

Cho was subsequently released and an appointment was made for him at the Cook Counseling Center, the mental health facility at Virginia Tech. He attended one session in person and spoke to the same therapist twice on the phone. The last time the therapist spoke to Cho he said he couldn’t make another appointment because he didn’t “know his schedule.”

Long later in an inquiry as to how authorities had failed to intervene, panelist authors suggested that Virginia’s criteria for involuntary commitment be revised. They felt that the term “imminent danger” should be replaced with more explicit language and broadened so that if there was “a substantial likelihood” or “significant risk” that an individual might cause serious injury to himself or others “in the near future,” he be treated.

Virginia’s commitment laws now contain this exact language and other states have made similar changes. But the problem of interpretation remains.

In the last 2 minutes of Elliot Rodger’s video, if not its entirety, there are clear suggestions of loneliness, vengefulness, and suicide.

Elliot Rodger’s mother called police on April 30, 2014, three weeks before her son killed himself and six people at UC-Santa Barbara. Rodger had posted a series of YouTube videos (one of which is above) that gave the clear sense that he was incredibly lonely, wanted to “leave” his life, and held a desire for revenge. Rodger’s life coach had initially alerted Rodger’s mother regarding the YouTube posts and she, in turn, called the police, in effort to have Rodger evaluated and possibly hospitalized involuntarily.

If the police had searched Rodger’s room, they would’ve found ammunition, three handguns, and a manifesto entitled My Twisted World, which described his plan to kill others and himself. According to Rodger’s manifesto, which serves in part as a diary, the police interrogated Rodger “for a few minutes,” asking if he had suicidal thoughts, and left. According to Santa Barbara Country Sheriff Bill Brown, this short intervention offered “a very convincing story that there was no problem, that he wasn’t going to hurt himself or anyone else, and he just didn’t meet the criteria for any further intervention at that point.”

As a rule, the police are often the first responders to similar situations and they often lack the training and insight to evaluate harm or danger, unless it’s overt and obvious. If a mental-health professional had accompanied the Santa Barbara police, he or she may have asked more open-ended questions such as: What’s the worst thing that’s happened to you in the last month? If you were to kill yourself, how would you do it? And considering Rodger’s interest in sharing his feelings on YouTube, he may have responded less tactfully.

Aron Alexis, who killed 12 people and wounded three others at the Washington Navy Yard, also called and the police 40 days before his attack. He was traveling for work and staying in a Marriott hotel room in Newport, Rhode Island. He complained of hearing voices that were keeping him up, voices that were sent to follow him, voices who were using “some sort of microwave machine” to send vibrations into his body. Upon arrival, the police heard no such noise. In the incident report, the police describe the voices Alexis heard to be “coming from the walls, floor, and ceiling,” and in turn they suggested he “stay away from the individuals” following him. They also asked if he had ever had “any kind of mental episode.”

Again, if a mental health professional had accompanied the Newport police, more thorough, open-ended questions may have been asked: How are the these voices making you feel? If the voices were to tell you to do something, what would you do?

After the Washington Navy Yard shooting, Newport police Lieutenant William Fitzgerald, insisted that there had been no legal justification for taking Alexis in for evaluation and concluded, “People make complaints like this to us all the time.”

Statement from Aaron Alexis’s mother.

In many ways these examples of failed interventions reflect how difficult it is to find meaningful support and resources for the mentally ill. From a legal standpoint mental illness is often deemed a domestic matter for which parents, siblings, and spouses are solely responsible, putting tremendous strain on family members and making the false assumption that such caregivers cannot fall ill themselves. Such thinking also presumes that family members can recognize illness and make the best choices.

And lastly, in the case of Adam Lanza, who shot his mother first before killing 20 children and six adults, the last two years of his life were spent in seclusion. Unlike Holmes, Cho, Rodger, and Alexis, he did not attend college regularly or work, or even go to the grocery store. Black trash bags covered his bedroom windows and his door remained locked. Although living alone with his mother, he mainly communicated with her via email.

At six feet tall, Lanza weighed 112 pounds when he died, confirming a diagnosis of Anorexia. According to the coroner report, he was so severely malnourished that he exhibited “resultant brain damage.” Why his mother allowed him to live in this manner raises questions about her own mental health.

Yet within the report Connecticut’s Office of the Child Advocate compiled regarding Lanza’s life, there’s substantial evidence that the Lanzas did make numerous efforts to acquire special educational services as well as both medical and psychiatric evaluations for their son. Like Cho, Lanza struggled significantly with language acquisition and expressing himself in his early years, both of which are believed to contribute to social-emotional problems later in life — if not resolved as early as possible. Like Cho and Rodger,Lanza had Autism, although it went undiagnosed in his early years. By age five, Lanza refused to dress and had made up his own language. In class he had such difficulty communicating that he had another student talk for him. During this time, his parents had to seek evaluations outside the school system to keep their son in special education programs.

Still, Connecticut’s report does suggest that his parents and the professionals involved did not persevere enough early in his life and long later, Mrs. Lanza often refused certain therapies or medication, at the bequest of her son.

“When systems aren’t created in a way that fosters communication between professionals and families,” the report’s authors explain, “those systems are left to make ill-informed, albeit well-intentioned, decisions that may miss critical opportunities to help...”

Like James Holmes, Lanza’s mental heath began to deteriorate significantly in middle school. Although Lanza was already seeing a local psychiatrist, Lanza’s parents brought him to the Yale Child Study Center, six years before the shootings at Sandyhook took place. “If there is a single document that is most prescient regarding Adam Lanza’s deterioration,” the report concludes, “it is the October 2006 report from the Yale Child Study Center — an evaluation that so dramatically states the high stakes presented by his disabilities and the need for meaningful and immediate intervention.”

At the core of the Yale evaluation great urgency was placed on Lanza’s diagnosis of anxiety and social-emotional problems — diagnoses that Cho, Holmes, and Rodger also received from their own doctors. The Yale evaluation does not predict violence but spoke of a future Adam Lanza without treatment: a “homebound recluse,” without friends, unable “to work productively into his twenties and thirties,” living with a mother who would become “ increasingly isolated and burdened.”

As David Kaczynski, the brother of Ted Kaczynski (the “Unabomber”), once wrote, “By ignoring the reality of mental illness — by assuming as a matter of ideology that just about everyone is a free, autonomous actor entirely responsible for their own actions — we effectively absolve ourselves from any responsibility to the next group of victims.”

As a matter of responsibility to others, including the mentally ill, there are basic steps to be taken: commitment laws should focus on precluding danger instead of imminent danger; mental-health providers should consider multiple credible sources in their evaluations, not just the words of the patients themselves; the police should never assess the suffering of the mentally ill without a trained mental-health provider present; and children with social-emotional challenges should receive support and resources as early as possible.

In the meantime, another mass shooting is likely to occur. When it does, we will learn the gunman’s name and age. Information from his Facebook and/or dating profiles will be offered, like pieces to a puzzle. Days later, police and hospital records will surface and a relative will speak. Some gun enthusiasts will blame it on a cartoonish force known as “evil” or an isolated case of mental illness. Many advocates for the mentally ill will balk. And most gun-control proponents will insist that if guns were illegal, none of this would happen — suggesting that Seung-Hui Cho, Elliot Rodger, and Adam Lanza, could still be here today, untreated and perfectly benign.

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