Jared Loughner, Schizophrenia, and Mental Health Care in America

We still don't know what Jared Loughner's motives were, but the media's preferred adjective to describe him, "troubled," certainly seems apt. From his YouTube videos, filled as they are with nonsensical, vaguely paranoid syllogisms, he comes off as a cross between Glenn Beck and Ludwig Wittgenstein.

Many in the media have speculated that he might suffer from schizophrenia. While it's certainly too early to make any real diagnoses, the Arizona shooting does raise questions about mental health, violence, and health care in America.

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Are people with serious mental health conditions more likely to be violent?

In short, no. Unless, that is, they also abuse alcohol or drugs. Dr. Seena Fazel, an Oxford University psychiatrist, has produced one of the most comprehensive studies on mental health problems and violence.

He said rates of violent crime among people who were mentally ill and abused substances were no different from those among other people who abused substances. People with mental illnesses who abuse substances have violent crime rates which are six to seven times higher than the general population – as do people with no mental health issues who have similar drink or drugs problems. Dr Fazel said data also showed that those who were mentally ill but did not abuse substances were only at "minimally increased risk" of committing violent crime.

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It is also the case, however, that people with serious mental health problems are more likely than the general population to abuse alcohol or drugs. A U.K. study found that five percent of homicides were committed by people with schizophrenia.

How good is mental health care in America?

It isn't good at all.

In 2009, the National Alliance on Mental Illness gave the country's mental health care system an overall grade of D. Arizona, it reported, had an urgent workforce shortage, among other problems.

A 2008 article in The American Prospect details how state budget cuts, a convoluted bureaucracy, and pharmaceutical industry lobbying have created an ineffective, expensive system.

On virtually every front, Medicaid and other government agencies, the drug industry, and health-care providers all play a part in a fragmented system that uses taxpayers' dollars to pay for treatments and drugs that too often don't work. At the same time, wholesale budget cuts, convoluted reimbursement rules, and conflicting funding agencies have helped create a perfect storm of waste, needless deaths, and ineffectiveness. Tragically, this has diverted scarce resources from proven, recovery-oriented programs such as "supported employment" that promotes a guided return to work, or integrated "dual diagnosis" treatment for the 50 percent or more of seriously mentally ill people who are also substance abusers.

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More and more of Medicaid's money has been going to expensive new drugs, aggressively promoted by the pharmaceutical industry, that may not be any better than their cheaper alternatives. At the same time, programs to treat mentally ill people with substance abuse problems—the ones most at risk for violent behavior—have been cut.

Will the health care reform bill change things?

A March 2010 article in The New York Times described the mental health care community's enthusiastic support for health-care reform bill. The biggest improvement, from the perspective of mental health advocates, is the new law's "parity" requirement—insurance companies must provide the same deductibles, co-payments, and coverage limits for mental health problems as they do for physical health problems.

The law signed by President Obama last week expands parity to a much wider pool, making it possible for millions more people to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression and schizophrenia as they would for, say, diabetes or cancer.

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Michael J. Fitzpatrick, the executive director of NAMI, said the health care reform bill could "give families and individuals an opportunity to get a level of access to care we could only fantasize about before this became law."

It is too early for an informed diagnosis of Loughner, and we're not the ones to make it anyway. But regardless of his motives, we should take better care of people with serious mental health conditions—both to help prevent needless violence and, of course, just to help ease their considerable suffering.