Preventing crimes by mentally ill offenders: The role of health reform

We can’t specifically predict atrocities such as occurred in Sandy Hook. Yet the Medicaid expansion in health reform is an important step in addressing violence by mentally-ill offenders.

Me with a long piece in the Washington Monthly:

It’s a strange thing. Newtown was an atypical crime, committed by an atypical offender, using a murder weapon that I hope will be outlawed but that remains pretty atypical for gun homicides. Even though we may not be able to stop an event like Newtown from happening again, it seems to be moving public policy more than the routine smaller scale tragedies that we could more easily prevent. Newtown has provided a genuine occasion for Americans to think seriously about gun policy, and to consider the very real challenges to our mental health system. We should make the most of this moment.

It’s naive to believe that we could specifically identify someone such as Adam Lanza before he goes on a rampage, but improved policies could still prevent an unknown, maybe unknowable number of violent deaths. No one policy will dramatically reduce homicides, and the politics and administration of effective mental health policy are both daunting. But making these policies work would provide a fitting memorial to the victims of needless violence across America. While we may not be able to entirely solve the tragedies that occur at the intersection of mental illness and gun violence, surely we can do better than we’re doing now.

More here.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

11 thoughts on “Preventing crimes by mentally ill offenders: The role of health reform”

  1. No one policy will dramatically reduce homicides

    I’m pretty sure across-the-board drug legalization would dramatically reduce homicides but no one wants to listen to “the crazy libertarian” who thinks that letting people poison themselves to death is morally preferable to having criminal gangs’ violent competition control and destroy our center-cities.

    Milton Friedman, a minor economist at the obscure University of Chicago, said we could lower homicides by 10,000 per year if we legalized drugs. Thank God no one listens to that lunatic.

    1. I tend to sympathize with the legalization side, but I’m not sure it would solve our gang problems. I’m sorry to say it, but I think there’s a lot more going on there than just money. There seems to be a lot more we could be doing. Early childhood ed, parenting classes, smaller class sizes and smaller schools within schools (to prevent dropouts), jobs programs, mentoring, … oops did I forget to mention living wage jobs, so parents can see what their kids look like in daylight? Iron John drumming groups, whatever it takes! If I have to agree with Friedman about something, I guess I can bear up under the strain. The question is whether as a society, we think young men of color are worth saving, and the answer ought to be, “yes!”

      Of course, the post was mostly about the need to address substance abuse issues along with mental health. I can’t see any argument against it. It didn’t seem like a pro-prison industrial complex article to me, but hey, what do I know?

      1. Oh, and while we’re talking about violence, here are my half-baked, could-never-get-enacted ideas about gun control.

        1) You have to have 3 references to buy a guy. Three people with clean records have to sign a statement that you are okay to be a gun owner. Heck, it would slow people down a little. You could have exemptions for emergency situations. Speaking of which, I’ve always thought it was a little unfair that ex-cons can’t own guns, as I would think they are the most likely to live in bad neighborhoods and have violent people mad at them. Meanwhile, there is this supposedly sacred right to self-defense. I’m just saying.

        2) A friend is reading a book about LAPD history. To make a long story short, at one point they had sort of pre-tested certain guns for the ballistics info, in the hope? that the owner would subsequently shoot someone. Now, isn’t this information probably already in the hands of mfrs? Seems to me, it should be. And it might be useful.

        1. 2) This is the sort of proposal that’s always coming up, from people who are basically ignorant of firearms.

          Ballistic identification works by comparing the pattern of scratches in the barrel of the gun, to the deformations on the bullet. If you have a shooting, recover a bullet, and find a gun thrown in the bushes nearby, it’s a very effective way of proving the bullet came from the gun.

          But the pattern of scratches is ephemeral. It changes fairly rapidly over time, is completely changed if you clean the gun, and isn’t nearly as uniquely identifiable as fingerprints.

          So samples taken at the time of manufacture cease to be of any use after 40-50 shots have been fired through the gun, or it’s been cleaned, whichever comes first.

          And if you have, say, 100,000 guns in your database, you’ll get multiple false positives every time you do a search. And because of the fact they change, almost certainly there won’t be any genuine positives.

          Now, none of this is recent news, or any secret. The fact that ballistic matching is utterly useless on a large scale, or involving a database over time, was well established decades ago. So, why does it keep getting seriously proposed?

          Two reasons:

          1. The people proposing it are stone cold ignorant about firearms, and often militantly so.

          2. The fact that it inconveniences gun owners, and makes guns more expensive, is justification enough even if it’s utterly useless.

          1. Brett: you’re right, I don’t know anything about guns. And this doesn’t embarrass me one bit. If one had lots of extra time and money to go to shooting ranges, maybe that would be fun, but I don’t, so I haven’t.

            But I’m glad you wrote in, I didn’t know that these patterns changed so much. Someone should do something about that… ; > You learn something new every day.

  2. That “drug war” thing’s certainly a shiny symbol of success, right? I agree we’d be better off as a society with easier access to cannabis (definitely NOT poisonous, whatever else it is) and more limited access to firearms. I realize policy wonks have a natural inclination to try to suppress both, but let’s be realistic…

    While Pollack issues the standard disclaimers of those promoting better mental healthcare through imprisonment — that one shouldn’t jump to the conclusion that the mentally ill are more violent than the legally sane, because they’re not — we’d be better off trying to separate the mentally ill from the legal system than finding them a cozy place within it. That’s the same line taken by so many who still aren’t willing to say we need to have a serious discussion about our national political tendency to build jails and fill them with people in order to solve social problems.

    A sane criminal can get plenty of state investment in his future — and probably should — but we dump the ill outta sight and outta mind as cheaply as possible. Been doing that since the 60s, because that’s “good” for them and after all, we take care of our own in this country, right?

    We don’t have a policy problem, we have a political problem that ensures we’ll never have sane policy on this issue until we eliminate the unfortunate tendency of politicians to get re-elected by locking up those they are unwilling to fund community services for. Pouring additional money into a system of mass incarceration that only enables the delusional tendency that we need to make people criminals before we’re willing to treat them effectively as patients is, as they say, repeating the same thing and expecting different results.

    1. “that one shouldn’t jump to the conclusion that the mentally ill are more violent than the legally sane, because they’re not”

      I suppose that’s true if you lump all forms of mental illness together, but it’s hardly true of all forms of mental illness.

      1. Let’s at least try to agree on the facts.

        If you want to discuss specific examples, go right ahead. Otherwise you’re just insisting on dipping your broadbrush into the tar again. The fact remains that incarceration of the mentally ill, with treatment as a decidedly secondary goal, creates more problems than it allegedly resolves.

        Thanks for proving how beating up on the politically powerless mentally ill remains a powerful force for ill in our society.

  3. Some people think all people who have ever received treatment for a mental illness should be forever barred from purchasing a gun legally. That would include people who went to their GP for depression and were prescribed a low dose of an SSRI inhibitor such as Prozac, which cleared up the problem. This seems unfair. I’m a lot more concerned with people who have NOT been treated for a mental illness but who nonetheless have one.

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