The consequences of not treating the dangerously mentally ill

The details now emerging about accused airport gunman Esteban Santiago sound like the same, infuriating loop we have heard for years.

Here was an otherwise unremarkable young man who returned home from war oddly changed. In due course he became combative, violent, and ultimately turned up in an Anchorage FBI office complaining of voices telling him to join ISIS.

A pro forma mental health referral was followed by his release; then, the return of voices in his head, culminating in a flight to Fort Lauderdale, and a mass shooting.

At the time, federal authorities found no evidence of any communications between Santiago and any terrorist group. But there is plenty to argue that this case is about mental illness, not international terrorism.

In retrospect, it all seems clear. But retrospect won’t bring back the dead, heal the wounds, or restore the scores of lives broken or damaged in yet another tragedy born of a mental health system failure.

My role as a member of Congress and a practicing psychologist in the Navy Reserve has given me a unique window into the recurring failures of our crisis mental health dilemma: a system fraught with cracks, hobbled by bureaucratic red tape, underfunded, with too few providers, and seemingly more supportive of an ill person’s “right” to be mentally ill than their right to be well and the public to be safe.

The small details sometimes change, but the pattern is unmistakable and too often written in blood: our mental health system too often trades treatment for tragedy.

As the author of the recently enacted Helping Families in Mental Health Crisis Act, I presided over numerous hearings during which struggling family members told of their frustration when trying to get a clearly ill member into treatment. Because mental illness, almost by definition, clouds the judgment of the sufferer, the ill are often strongly resistant to treatment and require intervention by family or caregivers.

Opposition, primarily from the Democrats but to be sure Republicans as well, caused the removal of language from my bill that would have reformed Health Insurance Portability and Accountability Act (HIPAA) privacy regulations to allow families more knowledge about a loved one’s treatment and whether they pose a danger. Santiago was being prosecuted for domestic violence, and was clearly mentally disturbed. Yet the family had no real window into his mental illness or how to handle it.

Yet he sailed through an evaluation, was allowed to obtain a gun because he had not been involuntarily committed, and Anchorage police and family were powerless to force him into treatment. Keep in mind that a seriously mentally ill person with history of violence and not in treatment is 15 times more likely to engage in violence.

This is another case of system failure and our failure to pass stronger laws.

Under current law, a person has to wave a gun in public and vow murder before they can be declared a danger to themselves and others. And in cases like Fort Lauderdale, that’s when it’s too late.

Even when an ill person agrees to treatment, the available pool of mental health professionals is too small to provide meaningful service. Between the cost of treatment and misguided advocates who resist the idea of empowering families to guide a member into treatment, it is little wonder how the Esteban Santiagos of our world emerge.

As federal agencies begin to implement reforms enacted in the Helping Families in Mental Health Crisis Act, we cannot retreat from the investment needed to make these reforms work. We must remain steadfast in our fight to deliver treatment before tragedy. That’s why I will be introducing new legislation in the House that will work with the new reforms to close the gaps in our mental health system. Specifically, it will increase the number of psychiatric beds across the nation, allow families to become part of the treatment delivery team, and requires hospitals to follow through in ensuring a person with mental illness continues to receive the care they need after they’ve been discharged.

We owe it to the travelers cut down in Fort Lauderdale, the children of Sandy Hook, and to generations yet to come. All deserve better. I pledge to continue my effort and keep moving forward with stronger reforms for the most seriously and dangerously mentally ill.

The pattern is unmistakable and too often written in blood: our mental health system too often trades treatment for tragedy.