Washington – Existing U.S. laws relating to determining dangerousness must be changed to prevent tragedies such as the Newtown massacre, asserted forensic psychiatrist Dr. Michael Welner, in testimony this week to a U.S. House Subcommittee on Oversight and Investigations studying how the mental health system treats the acutely ill. The remarks came at a Congressional forum of doctors and leaders in mental health advocacy and psychiatry, along with parents of teenagers and young adults whose lives were endangered and lost because of their untreated illness. Liza Long told the story of her violent developmentally disabled son, popularized in a blog post, “I am Adam Lanza’s Mother,” and the day to day challenges of his unpredictable outbursts as he outgrows her; Pete Early, best-selling author, spoke of how difficult he found securing acute care for his psychotic and actively suicidal son; and Pat Milam spoke of how his son was discharged home according to an insurance reimbursement timetable with signs that his father found obviously reflected dangerousness; his son killed himself shortly afterward as his parents helplessly stood at the bedroom door.
Dr. Welner cited the gripping stories of these three families for the commonality of the parents’ helplessness even as they try to get help for the children they know, and know to be frightening. Current commitment law requires a determination by physicians that the person is dangerous to one’s self or others in order to be hospitalized for acute care. Once admitted, reimbursement and length of stay restrictions return inpatients quickly to the homes from which they came, with bewildered parents feeling uninformed and without direction because of HIPAA privacy laws. “The most relevant psychiatric symptom to mass killing is paranoia. If you are a mental health professional examining someone who is paranoid, what kind of history are you going to get in your interview? Why is it that parents are not empowered to impact decisions about dangerousness?” He added, “A parent says, I’m caring for this child, I’m the person who may one day, god forbid, bury this child, and I think my child is dangerous, and I’m frightened. And the law says, that’s not good enough. A mental health professional, even of the best training, has the power to define, rather than the parent who can give stories like what we heard, which are more detailed than any clinical history that we will ever get in an emergency room or a consultation setting.” Dr. Welner called on legislators to “Change that law… to allow for caregivers to have say in who defines dangerousness.”
Among other testimony, Dr. Welner called attention to the important distinctions of mass killers from other patients with acute psychotic illness, especially those who fall in the cracks of a system to which commitment is difficult. Those intending mass killing are invested in destruction as a masculine ideal and crawl into the cracks and resist help, Dr. Welner explained, and require outreach even if programs and institutions are available. He expressed opposition to allowing responsibilities for community mental health needs to be opened up to a range of paraprofessionals. These are the toughest of patients, he noted, and recommended incentives to attract the most talented and sensitive mental health professionals to positions in which they would defuse those at risk for mass killing, which he terms “Mental Health Seals.”
Dr. Welner has been outspoken in asserting that mass killing can be eliminated – but requires efforts across all sectors of society to do so. He is at work on such a prescriptive book, “The End of Mass Killing,” in which he enumerates a range if prescriptions, informed by his experience examining numerous mass killers and attempted mass killers who survived their homicidal efforts, his work on complex homicides with cultural overtones, and his research in criminal and everyday depravity. In his Congressional testimony, Dr. Welner compared the challenge of remedying the crisis of care for the acutely psychotic to recent history that inspired rapid development in sex offender alternatives and homeland security infrastructure, which developed only within a few years. “I don’t think we have any reason to feel futile, and that’s why we’re all here.” Dr. Welner vowed to continue to work to change mental health and other laws that would prevent future mass killings, including “engaging the social responsibilities of the news media and violent entertainment industry as we did the tobacco industry. Culture matters.”
To view the proceedings, watch here.
