January 05, 2012

This week marks a sad anniversary. On January 8, 2011, U.S. Representative Gabrielle Giffords and 13 other people were gravely wounded—and six persons killed—in a shooting attack in Tucson, Arizona.

Charged in the attack was Jared Lee Laughner, 23, who has since been diagnosed with schizophrenia, which had largely gone untreated. His photo appeared in news media across the country reinforcing misconceptions of mental illness and linkage to violence.

But something else also happened. In the immediate aftermath of the attack, 50 percent of Americans saw it as the result of failure in the mental care system, not simply mental illness. That recognition fueled a national debate over cuts in mental health services.

The U.S. Surgeon General has reported that the likelihood of violence from people with mental illness is low. In fact, “the overall contribution of mental disorders to the total level of violence in society is exceptionally small.”

Despite perceptions that result from tragedies like that in Tucson, acts of violence are rare. They are a sign that something has gone terribly wrong, usually in the mental healthcare system.

When tragedies involving mental illness occur, it is essential to understand the reality of mental illness—and to find out what is wrong and what is right in the treatment system.

In Arizona, the Phoenix New Times has published an on-going series that has sought to do exactly that. The paper has noted that six months before the tragedy 3,000 seriously mentally ill people in Tucson’s Pima County alone ”lost almost all their services, including access to non-generic medication and caseworker supervision.” Thousands classified as "generally mentally ill" also lost funding.

“What's the one image [readers] took away from the Tucson shootings?” the paper asked.

“We thought so.”

“That mug shot of Jared Loughner is haunting. And for the world, it has become the face of mental illness in Arizona. Here, we know that's not true. A picture may be worth a thousand words, but the story of what it's like to be mentally ill in this place cannot be told in a single photograph.”

“Tens of thousands of seriously mentally ill people live in Arizona. Some of them look just like you.”

The series has included stories about a doctor and a boxing historian who have overcome the worst of mental illness, as well as a man who is homeless but retains a sense of community. The reporters responsible for the series are Paul Rubin and Amy Silverman. Kudos to them! Read the series and if you want to send comments you can via, via the paper's website.

Meanwhile, Jared Laughner is in federal prison where because of his illness he is considered incompetent for trial. The prosecution y is fighting to medicate him to improve his condition so that he can be put on trial and—potentially—receive the death penalty

From a legal perspective, “competence” means that Laughner will need to be able to understand charges against him and assist in his defense at the time a trial begins. It’s not the same as the legal standard for an insanity defense, which would require that he have known the difference between right and wrong at the time of the attack. Definitions in the law are not the same as medical definitions.

So, this is a sad week of remembrance.

Looking beyond the tragedy of six lives lost and 14 others wounded, many serious issues in the case that will still be with us in the coming year—and years ahead.

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