Monday, November 20, 2017

Laura's Law (outpatient commitment): The Answer to Preventing Mass Murder?

2017 has broken the record for the most mass murders in a single year -- not something to be proud of, my fellow Americans.

After the latest mass shooting in Tehama, California, John Snook, the executive director of the Treatment Advocacy Center had an op ed piece in the The Sacramento Bee titled
"Tehama Country had a tool to Get the Shooter Into Treatment.  It Just Didn't Use it and the System Failed."  The article notes that Laura's Law, where a judge orders a patient to get outpatient treatment, exists in many California counties, but not the one where the shooter lived.  If only, if only.

We know little about this shooter.  He was a violent man with a history of stabbing a woman (he was out on bail) and of shooting at neighbors.  His sister has stated that he had a long mental health and he was paranoid, and anti-government.  Prior to his shooting spree, he killed his wife and buried her in the floors.   The shooter worked as a marijuana farmer, we know nothing about his drug use or his treatment history.  He was known to the police, and clearly repeatedly dangerous, but the judicial system saw fit to let him remain out of jail on bail, which his mother in North Carolina posted, while he awaited trial. His guns were made by the shooter with pieces he had ordered and assembled, other guns were registered to someone else (?stolen).  He had a history of violence, and this crime does not sound to have been a surprise to the neighbors who feared him; one of the victims was the woman he had previously stabbed.

So would this mass shooting have been prevented if Laura's Law was implemented in his country?
First off, we don't know about the shooter's mental health history.  Oddly enough, while Tehama does not have outpatient commitment, the shooter could have been confined on an inpatient unit if a "5150" had been filed to detain him for an evaluation on an inpatient   Also, the shooter had multiple charges for violent crimes -- he could have been diverted to a mental health court and mandated into treatment through the legal system.  That also didn't happen-- or at least we haven't heard about any of those actions happening.  I suspect that the shooter fell through the mental health system  cracks, but it's clear he fell through the cracks in the legal system.  

So would Laura's Law have prevented THIS mass shooting?  Perhaps, if the following list of stimpulations were met:
~If the shooter's violence was a product of his mental illness.  People without mental illness are violent, and people with mental illness are violent for reasons unrelated to their psychiatric disorders.
~If the shooter's symptoms that caused him to kill people were eliminated by the use of psychiatric medications.  Not everyone has a good response to medications and so far, we haven't heard that he was so much better when he took medications.   Forcing people to take medications doesn't fix/prevent everything, and the average length of stay in a forensic facility for people who have committed violent crimes due to their mental disorders is YEARS.  Sick, violent people don't magically get better with a judge's order. 
~If the perpetrator was ordered to treatment and if he complied with the order to go to treatment and to take medications.  Not everyone does, and from what we know, this man broke laws, both with his violent behaviors, and with his planned and purposeful assembly of illegal weapons.
~If services were available for the perpetrator to receive them. In half the counties in this country, there are no mental health professionals.
~Does Assisted Outpatient Treatment prevent gun violence?  We don't know.  In New York, where AOT has been studied, one large study showed AOT, with partner services including case management and housing prioritization, AOT reduced hospitalizations and incarcerations, but people with a history of violence were  excluded from the AOT study.  We don't know that outpatient commitment reduces violence or gun violence.

Just a thought: other countries have mental illness illness.   Other countries don't have mass shootings.  What else they don't have?  One gun for every citizen. 


Joel Hassman, MD said...

Just curious, suppose we admitted this shooter before he acted to a psych unit and then he kills a patient on the unit?

Then what have we learned, that psych units do not really act as substitutes for Correctional Facilities because there are some people who were just antisocial creatures Who belongs in prisons.

You can continue to have this debate about who belongs in jails versus psych units, but when it touches people personally, then it suddenly becomes a different issue, true?

Whether it be Laura's law, Kate's law, or any other law based on someone who was horrendously injured or murdered because of frank antisocial behavior, maybe it's time to have a better law, like the common sense law?!

Maybe it's time to step back and look at our tolerance, our enabling our defending, and even at times validating frank inappropriate behavior that needs to be marginalized, ostracized, and reputed!

Case and point how Al Franken and Judge Moore in Alabama have pathetic people saying they would vote or support these abusers staying in office.

And people wonder why shooters continue to find ways to end up killing lots of people...

Joel Hassman MD

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