An uptick in violent attacks by individuals with a history of mental illness reopens the debate on involuntary, institutional care.
The murder of an 18-year-old college student taking a walk near her campus in Nashville, Tennessee by a man with a long history of mental disorders has renewed discussion on whether the chronically mentally ill, especially those with violent tendencies, should be involuntarily institutionalized.
Jillian Ludwig, an 18-year-old freshman at Belmont University, was struck in the head on November 9 by a stray bullet allegedly fired by a career criminal who had been released from custody earlier in the year because he had been deemed too mentally incompetent to stand trial, the New York Post reported.
The young woman’s death came two weeks after a man opened fire at two locations in Lewiston, Maine, killing 18 people. Like the suspect in Nashville, the shooter in Maine had mental health issues that included “hearing voices and threats to shoot up the National Guard Base in Saco, ME,” a law enforcement bulletin said. “[The shooter] was also reported to have been committed to a mental health facility for two weeks during summer 2023 and subsequently released,” The Daily Wire reported.
While these killings, along with mass shootings at schools, nightclubs, and other venues, have renewed calls for stricter gun control laws, others believe random violence reflects serious inadequacies in the nation’s mental health system. Former President Donald Trump said he would bring back institutional care for dealing with the “deeply disturbed” if he is elected to a second term.
‘Failed Mental Health Policy’
“Fifty years of failed mental health policy have placed law enforcement on the front lines of mental health crisis response and turned jails and prisons into new asylums,” the Treatment Advocacy Center (TAC), based in Arlington, Virginia, notes on its website.
“Deinstitutionalization, outdated treatment laws demanding a person become violent before intervention, discriminatory federal Medicaid funding practices and the prolonged failure by states to adequately fund their mental health systems drive those in need of care into the criminal justice and corrections systems, rather than into public health systems where they belong.
“Most individuals with serious mental illness are not dangerous, most acts of violence are committed by individuals who are not mentally ill, and people with mental illness are more likely to be victims than perpetrators of violent acts,” states the TAC website. “It is also true, however, that violence is more common in people with serious mental illness, especially when psychosis with paranoia and ‘command hallucinations’ are present.”
“The human, social, and economic impacts of not treating serious mental illness are beyond calculation,” states TAC.
Lisa Daily, executive director of TAC, says consistent treatment is the key factor in neutralizing the risk of violence for those with severe mental illness. “You should not equate mental illness with violence, though failure to treat psychosis can increase the potential for harm,” Daily told Health Care News. “The focus must be on ensuring that those who need it are receiving the treatment they require, both to prevent violence and to protect against victimization.”
Homelessness an Issue
Widespread homelessness in urban areas across the country has been linked to the growing number of mentally ill people living in tent cities. “Recent random attacks by homeless people have left many people concerned about their safety on the streets of Southern California,” KTLA5 in Los Angeles reported in October 2022.
The TV station reported that “the City of Long Beach closed the Billie Jean King Main Library due to ongoing threats and attacks on library staff by mentally unstable homeless individuals.”
The following month, New York City Mayor Eric Adams directed the police and emergency medical workers to hospitalize severely mentally ill people unable to care for themselves, The New York Times reported.
In their 2016 book, Committed: The Battle over Involuntary Psychiatric Care, psychiatrists Dinah Miller, M.D., and Annette Hanson, M.D., explored the question of whether involuntary treatment has a role in preventing violence, suicide, and mass murder.
The authors delved into such issues as court-ordered outpatient treatment, mental health courts, crisis intervention training, and pretrial diversion—all of which are intended to keep the mentally ill from falling into repeated cycles of hospitalization and incarceration, and possibly prevent violent acts from occurring.
No Crystal Balls
“Our book is on civil commitment, the issues for forensic commitment are much different, and while the average length of stay in a psychiatric unit is 7-10 days, the average length of stay in a forensic hospital is three years,” Miller, an assistant professor at Johns Hopkins University, told Health Care News. “Psychiatrists don’t have crystal balls.”
Miller cautions against increasing institutional care as a means of preventing mass murder or violence by people with mental illness.
“For one thing, we don’t have a good definition of mental illness, there is no specific mental illness associated with violence, lots of people have mental disorders—one in five in any given six-month period and one in two in the course of a lifetime,” said Miller.
“Half of mass murderers have had mental illnesses, but most are able to buy their guns legally. Substance abuse is likely a higher predictor of violence,” Miller said. “Many people who commit violent crimes have had no history of violence, so the idea of institutionalizing people because they might commit a crime seems misguided.”
Bonner Russell Cohen, Ph.D. (bcohen@nationalcenter.org) is a senior fellow at the National Center for Public Policy Research.
