Donna Sabella, PhD, MSN, PMHNP-BC, is a mental health nurse and assistant clinical professor and director of global studies at the Drexel University College of Nursing and Health Professions in Philadelphia. She also coordinates the AJN column Mental Health Matters.
Who’s next? On May 23rd, we were once again forced to witness a scene of senseless violence. Elliot Rodger stabbed to death three men in his apartment, after which he gunned down two women and a man. Aside from the six murders, he injured 13 people, shooting some of them and hitting others with his car, before apparently shooting himself in his car.
All of this carnage from one lonely, angry, troubled 22-year-old raised in a world of relative privilege—we feel for the victims and their families, and we feel for the Rodger family as well, who appear to have done everything they could to help their son find help for his mental instability and prevent this latest tragedy from unfolding.
While perhaps comforting to family and friends of the slain, our grief and prayers for all involved and our dismay at the other horrific events preceding this one mean little when it comes to preventing the attacks of the next Elliot Rodger.
But I believe we are wrong if we think our outrage and sadness are all we have to offer. As we wring our hands and wonder what could have been done to prevent this, some answers seem clear. Elliot Rodger, like many of those on the list that he now joins, did not suddenly become what he was on the day he carried out his plans.
There was, as there almost always is, a process involved, with numerous warning signs. People often—as was the case with Seung-Hui Cho, Jared Lee Loughner, and James Eagan Holmes—leave hints and clues as they descend into alienation and begin laying their plans. (See my article “Mental Illness and Violence” in the January issue). So too, Rodger did not keep it all to himself. He had a troubled history and contact with therapists, as well as parents who were so concerned that they asked the police to step in at a critical juncture not long before the rampage. But the police are hardly qualified to make mental health assessments. That Elliot Rodger outsmarted them makes that clear.
Most people with mental illness are not violent, and rarely do those experiencing behavioral issues commit such atrocities. We rightly pride ourselves on honoring the rights of all those with mental health issues, and that is how it should be—we don’t want to return to the days when people could be involuntarily committed and locked up for months at a time, even folks who had no history of mental health problems, at the word of cheating spouses or money-hungry heirs.
But as Richard Martinez, whose agony and grief were palpable upon learning of the murder of his only son and only child Christopher, asked, what about the rights of my son to live? What about the rights of all the others murdered and maimed that day?
And let’s not stop there. How about the rights of those who have preceded and those who will surely follow in their footsteps as the next round of victims? There are many requirements for the use of involuntary commitment. These exist in order to prevent people from being wrongly hospitalized and kept for indeterminate amounts of time. The first of these is than an individual must be seen as a threat to himself or others.
While Elliot Rodger largely avoided making overt threats to himself or others in his social media postings until just before his rampage, and has been described in many accounts as a very skillful liar, the concerns of his parents should have been more clearly listened to and heard. I believe that there were enough warning signs that Elliot Rodger should have been taken into such care by the police, giving mental health professionals the opportunity to make a thorough and complete assessment, including the opportunity to view his videos and review his history of mental health treatment.
We need to find a way to develop a new, more nuanced kind of policy that neither stigmatizes those with mental illness nor infringes on individual rights, but that still allows people who pose even probable—if not always overtly stated—threats to themselves and/or others to be taken into what I call protective care, with the focus on protecting and caring for them as well as protecting and caring for the public that they live among. And we should have the option of keeping people in protective care until it is safe to let them return to the community.
Such a protective care approach needs to be understood not as chaining someone’s hands together but as holding their hand until they can get to where they need to be on their own and do so safely. The time has come to rethink some of our mental health policies that have been shown time and again to be ineffective.
But being freer to implement humane protective mental health care for those who need it is not the only problem that needs attention. While Rodger was able to stab three of his victims to death, he also had access to semiautomatic handguns that he used to kill. While California has some of the strictest gun control laws in the country, we need to do more toward preventing people with a history of troubled behavior from purchasing such weapons.
We can’t wait any longer to take care of business. Vigils and memorials don’t get the job done. I challenge all of us to take a stand and be proactive in demanding that we do what is necessary to enact new laws, procedures, and policies on both the mental health and gun front to protect the greater good. Unless we make ourselves heard, who knows for whom it’ll be too late next time. Mr. Martinez, if you decide to take on becoming the voice that calls for change, let me know. I’ll be happy to add my voice to yours.
One last thing: how can media outlets justify making Eliot Rodger’s disturbing YouTube video, released shortly before his rampage, available? What is wrong with this picture?
As someone who worked in mental health, albeit ages ago, one of my personal frustrations with the system was the “revolving door” rather than real care of the patient.
I don’t know about insurance and the comments above but it makes perfect sense based on all the other issues in the US Healthcare System.
This blog’s message is excellent and needs to be shared far and wide until something is changed.
have been a psychiatric nurse for 30 years. A protective care unit will never exist unless someone in government’s child, spouse, etc. is tragically affected by the inadequate mental health system AND is not tied to the insurance industry’s purse strings. The shift in mental healthcare over the last 30 years to keep length of stays short as well as avoid hospitalization were not because of abuses in the system. It was primarily because of the power to “yay or nay” the insurance companies gained politically which deregulated any mandates (physically and ethically) they had to pay benefits. The outcome has been, literally, a “get ’em out” system where our patients who would have had a length of stay of 7 weeks 15 – 20 years ago are now staying 7 days! There is mention in Ms. Sabella’s blog that doctors were not alerted to Elliot’s writings or rantings and maybe if they were this massacre wouldn’t have happened; I can tell you with all certainty that most doctors would not have the time or inclination to read or watch them. (That’s another subject I won’t go into here!) Hospitals need to make money to stay open. Insurance companies need to save money to stay open. Gee I wonder what’s wrong with that?