SPRINGFIELD, MA - The reality of living in a free nation is that we are subject to the will of others who may not have the same regard for human life. That’s a politically correct way of saying that there are evil and mentally compromised individuals that will seek to cause grave harm any way possible.
When we witness incidents of violence it seems everyone who knows the assailant can all of the sudden recall multiple incidents of concern prior to the violence. Neighbors detailing a domestic conflict they witnessed, family recounting bizarre behavior during the last holiday gathering, law enforcement revealing a history of calls or responses to the individual’s home, etc. When the often very public “red flags” are ignored by those closest to a potentially violent person, what can we as a society do? How do we compete with apathy and incompetence?
That question is something that has and will be debated by the decision makers in government. What I would like to address is the mental health crisis response system. I work in Massachusetts as a licensed mental health counselor, which makes me a mandated reporter for evidence of abuse. Another responsibility I have to my clients and the public is reporting the potential for danger to oneself or others to the local crisis response team. Their function is to assess an identified individual’s psychological state and provide a higher level of care, which could mean transportation to a hospital for further evaluation or being “sectioned” and legally held for 72 hours against their will pending more evaluations. If the latter happens, often the responsible entity could then petition a judge to hold the individual longer if it's medically appropriate.
This process is supposed to be simpler than it actually is: If I am concerned for the safety of my client or for the safety of others, I would call the local crisis response team. On the phone they ask me a series of demographic and background questions about the client and then ask my reason for concern. The response team will then send a crisis clinician to the location of the client (usually with me in my office) to evaluate on site and decide the next step. That is how it is supposed to work. The problem is the journey from my initial phone call to a crisis clinician responding is extremely difficult.
The first barrier to getting the required support is simply the phone call itself. Most often when I have needed to call the crisis response unit, the phone would ring and ring for 5 minutes without answer. I’d have to call back multiple times. (You want to heighten the stress and desperation of a potentially dangerous situation? Don’t pick up the phone.) After repeated calls, I finally get someone on the phone (It’s taken 45 minutes for me at times), then I’m faced with another barrier.
The verbal gymnastics that a mental health clinician has to engage in to meet the narrow threshold of need is an art. Crisis will not come to provide support if the client is actively violent. They will instruct you to call the police. That’s reasonable, especially considering if a client is actively aggressive, waiting 45 minutes for someone to answer the phone isn’t very smart. On the other end, if the client is not in immediate danger (meaning there is no plan or reported intent by the client to do harm to self or others in the immediate future.) the crisis response team will say “call back when there is an immediate need.” This is not a joke. Your client has to be dangerous enough yet not too dangerous in order to get help.
There is no wonder why the recent shooter in Thousand Oaks, CA did not get the higher level of care obviously needed when the police responded earlier this year to his home. The now deceased shooter was “holed up inside; furniture was thrown around”, neighbors said, and a bullet had been fired through the wall. The street was blocked off, and police spent hours trying to get the individual to peacefully come outside. “They couldn’t get him out for a long time, like half the day,” said another neighbor. The Ventura County sheriff said in a briefing that deputies responded to a disturbance at the home in April and mental health specialists were dispatched. They determined that he wasn’t a threat and didn’t qualify for an involuntary psychiatric hold.
We have a problem. That problem is a huge hole that mentally compromised and evil people can easily walk through. It’s easy to know the words not to say and the actions not to take in order to avoid involuntary psychological intervention. If we don’t reform and simplify the process, we will have more ignored red flags that lead to tragedy. I and my clinical mental health colleagues are the first line of defense to preventing some of these violent expressions of rage. Regardless of our efforts to get the needed help; when they are ignored, we will be blamed for the violent actions of one person and for the lack of action by the system.