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Help the mentally ill get help

By Gerald Landsberg, Special to CNN
  • Gerald Landsberg says Tucson shootings show failing of mental health system facing cuts
  • Research shows link, though tenuous, between untreated mental illness, violent behavior
  • Acknowledging this and providing funds and system-wide attention is crucial, he says
  • Landsberg: It's cheaper to treat mental illness than to pay for prison

Editor's note: Gerald Landsberg is a professor at the Silver School of Social Work at New York University and director of the Institute Against Violence, which conducts research and provides training and technical assistance in forensic mental health, youth violence prevention and family violence prevention and intervention.

(CNN) -- The shooting Saturday in Tucson, Arizona, demonstrates once again that mental health systems in the United States are seriously flawed and, as a result of continuing budget cuts, are becoming even less comprehensive and effective.

Jared Loughner, who is accused in the shooting, displays symptoms of young-onset schizophrenia with delusions that apparently was not treated but in fact may have led to his alleged act.

There is some debate, but recent research suggests that there is a link, although tenuous, between mental illness and violence, especially when an individual has schizophrenia and the disease goes untreated or undetected (and in general, research shows, fewer than 25% of the mentally ill receive needed services).

The concern, voiced by both advocates for expanded mental health services and consumers, is that highlighting the link would increase the stigmatization of emotionally disturbed by the public, the vast majority of whom are not violent people.

Yet, by not acknowledging and addressing the connection, an important opportunity for frank discussion and action is lost. In my research on victims of mentally ill offenders, which was funded by the United States Department of Justice in 2001, I found that the violence that is committed by the mentally ill, while rare, is overwhelmingly directed toward family members, usually elderly parents, and close friends -- not strangers.

However, what is occurring is that with the shrinkage of mental health services as states tighten their budgets (in the past few years in Arizona, for example, mental health funding has seen deep cuts), we have witnessed the continued growth of the criminalization of mental illness for both adults and youth.

Moment of silence at site of AZ shooting
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Playing politics with tragedy
What to do if confronted by a gunman

Among adults abandoned to county jails and state prisons, nearly 25% may be seriously mentally ill, and for youth sent to juvenile detention facilities, the rate is 75%. Keeping the mentally ill in these facilities costs taxpayers substantially more (three or four times, typically) than effective community based housing and services.

Further, with respect to young people, such as the accused in Tucson and in the Virginia Tech shootings, communities' intervention systems are totally inadequate. To be effective, mental health intervention systems and services need to coordinate their activities across schools, after-school programs and the criminal justice system, but this seldom occurs.

Additionally, the availability of those services is not well communicated to the public, so individuals, family members and organizations do not know where to turn for assistance when confronted with a person who appears depressed, delusional, violent or potentially violent. There are few hot lines or public education campaigns.

Contrast this with the federal government's investment in and public promotion of a major national initiative, No Child Left Behind. Great public awareness of that program suggests what is possible in public education and publicity campaigns when the government really gets behind it. It shows by comparison the severe lack of federal, state and local action when it comes to the widespread existence of mental illness and what to do about it.

After the attacks of September 11, victims and communities were traumatized by the events, but few mental health providers could effectively help, since most of their staff members did not have the required training in crisis and traumatic interventions. As a result, at the federal and state levels and in some local communities, substantial attention was devoted to developing needed training, and significant amounts of funding were provided to enable mental health staffs to become effective responders to crises.

With concerted effort, we can move expeditiously -- without the distracting debates about free speech and gun control -- to develop comprehensive strategies that take the first long but difficult steps needed to reduce America's mental health deficit.

The opinions expressed in this commentary are solely those of Gerald Landsberg.