We need better involuntary commitment rules for mentally ill

Tomorrow will mark three weeks since the Newtown, Conn., school massacre. The wretchedness of that day has touched off a national debate about preventing mass murders -- as it should. But lately the conversation has narrowed to gun control.

In a year-end interview, responding to a question about the political fights ahead, President Barack Obama voiced his support for banning assault rifles and high-capacity clips, and for better background checks for gun buyers. What I didn't hear from the president was a vow to strengthen our mental health system to treat people like Adam Lanza before they descend into madness. Whatever Lanza's technical diagnosis -- schizophrenia? -- executing two classrooms of first-graders is by definition mad.

Gun control is easier to discuss, because there is an identifiable, organized opposition in the National Rifle Association. But mental illness is harder to recognize, reach and heal.

Consider the divergent responses I received to a column that ran right after the Sandy Hook killings. I wrote that in New York, as in most states, the law allows for involuntary commitments of those who are mentally ill. What's more, New York permits someone to alert the authorities to dangerous behavior while remaining anonymous.

Some readers wondered about the potential for abuse of involuntary commitment -- also called civil commitment. "How do [the authorities] know that you are just not furthering a neighborly feud or personal vendetta?" one man emailed.

Others said that even though such laws exist, they are almost unenforceable in practice. A mental-health group home administrator said he has often been frustrated when calling for help: "There is no mechanism for involuntary admission unless the person is either violent or expresses violent ideas in front of a psychiatrist or police."

And so there is the conundrum. The problem isn't the law, exactly, but the judgment, resources and political will to enforce it.

We have yet to find the place where the pendulum should rest since deinstitutionalization began in the 1960s. The idea was to wipe out the abuse of mentally ill people, to respect their civil rights by closing psychiatric hospitals and moving toward community-based care, such as group homes and outpatient treatment. But the system that was supposed to take the place of psychiatric hospitals has never been adequately funded or built out.

The results are cruelly inadequate. Twenty percent of prison inmates, and at least one-third of the homeless, are seriously mentally ill, according to the national Treatment Advocacy Center. Mostly, they are not receiving the care they need to heal, stabilize and lead full lives.

And, as appears to be the case with Lanza, responsibility for care falls to individual families -- sometimes with disastrous results. In two other recent mass murders -- the killing of 12 people and injuring 58 at a Colorado movie theater in July, and the wounding of Rep. Gabrielle Giffords and killing of six others in Tucson two years ago -- family, acquaintances and school officials had been alarmed about the behavior of the two men who became suspects. Yet no one stopped them.

Most mentally ill people are not violent, but statistics favor stronger civil commitment laws. According to a 2011 study by the University of California, Berkeley, states with stronger laws have homicide rates about one-third lower.

Vice President Joe Biden is preparing a report on preventing mass shootings. If he wants a place to start, he might consider our patchwork of state civil commitment laws -- both how they are written and how they work in practice.

This essay was first published in Newsday.

Reasons to shoo away the humbuggers

It's been a Scrooge of a year, wouldn't you say? Ebenezer Scrooge - whom I caught on television the other night looking a lot like the actor George C. Scott - was a man who refused to share any of his wealth with the world around him. The year 2012 bears a resemblance.

This year, we endured a divisive battle for the presidency, which was fought at times as though the only thing that mattered was how much money either side could raise. That's a sad statement for a country that stands for democracy.

Thousands were wiped out financially and emotionally by superstorm Sandy. Many innocents were lost to deranged gunmen in Aurora, Colo., and Newtown, Conn.

The economy refused to rebound, and Washington wouldn't come to agreement over anything.

And so the year 2012 was stingy like Scrooge. But in "A Christmas Carol," Charles Dickens thankfully gives us examples of two people who don't lose faith in the old miser: his long-suffering clerk Bob Cratchit and his nephew, Fred.

Cratchit raises a glass to Scrooge over the family's meager Christmas dinner - and over Mrs. Cratchit's objections. And Fred continues to invite his uncle to dine, year after year, even though the old man riddles him with insults.

We all know the end of the story. After his ghostly visitations, Scrooge accepts dinner with Fred and becomes a generous benefactor to the Cratchits. And so, neither should we close our hearts to hope for the 21st century.

Taking a wide look around, here are a few silver linings that emerged in 2012.

*Apple announced that it is bringing back some of its manufacturing to the United States. In interviews, Apple's chief executive, Tim Cook, said the company would spend about $100 million on U.S. manufacturing operations in 2013.

*Several cities, including New York, are reporting declines in childhood obesity - perhaps showing that public health campaigns can be effective. Obesity is a significant factor in health care costs.

*The years-long deployment of soldiers to Iraq and Afghanistan resulted in an unexpected gain for quality child care in this country. When parents began shipping out, the Department of Defense realized that there weren't enough approved, private child care slots. So the military worked with a national organization, Child Care Aware, to train and certify child care providers, greatly expanding the supply of quality programs.

*Here's another unexpected gain. During the economic downturn that began in 2008, even as people are hurting financially, they are demonstrating more compassion. The Corporation for National and Community Service reports a rise in volunteerism - exactly the opposite of what happened during hard economic times in the past.

There are many more bright spots; we see them in our personal lives every day. Let's hold a hope in our hearts for rebirth in our public life as well.

This essay was first published in Newsday.

We can no longer ignore need for gun control, care for mentally ill

Make it stop.

That's how I react to yet another horrible mass killing. Like the third-grade class at Sandy Hook Elementary School that huddled into a corner - "squished," as one student described it - and the gym students hidden in a closet, I just want to shrink into a defensive posture. Don't tell me any more.

Don't offer any explanations or reasons. We've heard too many. There is no good reason why, when I talk to my children about mass murder, they've heard it all before in their 14- and 15-year lifetimes. As a country, we should not be resigning ourselves to this reality.

We need to face up to two facts we've been avoiding: that we have permitted an outrageous access to guns and level of gun violence. And we are pitifully inadequate at dealing with people in mental and emotional crisis.

It pains me to say this, but we have gone too far in protecting individual rights, and we must pull back and make this society safer. Get the guns out of madmen's hands, even if it means some hunters and self-defense advocates have to put up with more bureaucracy. The cost is worth it.

Strong and savvy voices - those of Rep. Carolyn McCarthy (D-Mineola) and New York City Mayor Michael Bloomberg among them - are raised now on gun control. Let's hope they are not muffled by politics yet again.

And what about the mentally ill? We always seem to find out after the fact that someone suspected this person was about to snap. A college mental-health counselor, or a parent, or a friend.

Does it seem at all likely that no one around Adam Lanza - whom officials have named as the shooter - recognized his potential to break? If someone in your home were about to murder 27 people, wouldn't you have some hint? Wouldn't something feel wrong?

It's not that we need stronger laws on involuntary commitment. For the most part, we already have them. We just don't use them.

Such laws vary by state. In New York, a person can alert the authorities that someone is dangerously askew, and that person will be taken in for observation and evaluation by a psychiatrist within 48 to 72 hours. The person making the report can remain anonymous.

One ready place to research the commitment laws is on each state's department of mental health website. The New York State Office of Mental Health has hotline emergency numbers on its home page. Police and other first-responders also know where to direct people.

I don't know how often involuntary commitment is used. But it needs to be more widely known-about. The symptoms of someone in mental crisis are most times not subtle: mood swings, abusive behavior, isolation, inability to cope with daily tasks like bathing, loss of touch with reality.

Perhaps it's often just too hard to admit that someone you love is so far gone. I wonder what Nancy Lanza - Adam's mother, who was also killed - was going through.

Too often, we look for a history of mental illness and treatment before we act. We want a diagnosis, some proof - someone who has "gone off his meds" or tried suicide.

But a person who is about to snap for the first time slips out of this net. These are the ones who design and execute elaborate schemes to go out in a blaze. It must satisfy something that's gone wrong inside them, but we should not have to be a party to this any longer.

It sickens me to think that I will have to read about the "reasons" for this horror, as though the torments of the shooter could account for the terrible cost for all of these innocent children, their families, their communities - and our country.

I don't want to see the photos of those Connecticut parents burying their kids. And it makes me die inside to think we could have prevented this tragedy but we didn't get serious enough. About guns, about insanity. We need to make it stop.

This essay was first published in Newsday.

Springsteen's public talk about his depression

With its 140-character limit, Twitter is anything but subtle. A tweet from a recent 19-page New Yorker profile of Bruce Springsteen focused on just one thing: his admission that he's suffered depression.

It's startling that a person so fabulously successful could have been depressed. Even more surprising, depression hit after his breakthrough commercial album "Born to Run" in 1975.

The profile recounted a 1982 drive Springsteen made from the East Coast to California, and then back again. "He was feeling suicidal," his friend and biographer Dave Marsh is quoted as saying. The New Yorker's David Remnick, who wrote the profile, says Springsteen could not let go of "a sense that he had inherited his father's depressive self-isolation." He began seeing a psychotherapist.

Because of his status, Springsteen's revelation may reduce the persistent stigma surrounding depression. Kay Redfield Jamison, a professor of psychiatry who recounted her manic-depression in the 1997 book "An Unquiet Mind," talks about the "silent successful" - people who get well from psychiatric illness but are afraid to speak about it.

"This reluctance is very understandable, very human, but it is unfortunate because it perpetuates the misperception that mental illness cannot be treated," she has written. "What remains visible in the public eye are the newspaper accounts of violence, the homeless mentally ill, the untreated illness in friends, family and colleagues."

People can recover and lead normal lives, or even achieve stardom like Springsteen and, as I recounted in this space upon his death in April, TV journalist Mike Wallace. Springsteen's admission speaks to a new audience and generation.

But without role models for healthy recovery, individuals may reject treatment for fear they'll be mistaken for "crazies" who dye their hair orange and allegedly hunt movie patrons. They rob themselves of the chance for recovery.

Silence also lets decision-makers remain blindered to the prevalence of depression and other mental illnesses. Our society is in denial, to use the psychiatric term. One result is that we place too little importance on adequate funding for mental health offices at universities. Mass murderers keep emerging from campuses where they've had at least some contact with psychiatric counselors - the University of Colorado (suspect James Holmes), Pima (Az.) Community College (suspect Jared Loughner) and Virginia Tech (Seung-Hui Cho). Shouldn't we be asking why they walked out of the counseling offices to kill dozens of people? Perhaps we fail to take campus counseling seriously because we believe mental illness cannot be controlled. The contrary truth is another casualty of the silent successful.

We should applaud those who speak openly. Chicago Rep. Jesse Jackson Jr., who took a leave from Congress on June 10, recently disclosed that he is being evaluated at the Mayo Clinic in Rochester, Minn. for gastrointestinal issues and depression. Will he be accepted as a functioning member of Congress - as much as any Congressman warrants that description nowadays - if he returns to his job? Will a political opponent use his need for treatment against him? I'm afraid you can count on it.

It's less risky for Springsteen, now 62 and apparently long past his darkness, to recount it at this point. No one is going to skip a concert because The Boss sees a shrink. Still, his owning up will color how we view the art he has created. It alters his legacy. So coming out about depression took courage.

Only time will tell if his courage helps a Jesse Jackson Jr. return to a full life, or inspires a fan to get help. Each act against silence inspires hope.

This essay was first published in Newsday.

Deny mass killers the celebrity they crave

This is a column about the man accused of killing a dozen innocent people in a movie theater in Aurora, Colo. But you won't read his name here.

I won't degrade our conversation with it. He doesn't deserve the attention, which apparently he craved. And potential copycats don't need the encouragement that might come from giving any more notoriety to this guy.

It's time we deprived such people of the fame they too easily achieve with their horrific acts. Maybe if we cut off the oxygen of attention, the murderous flames would die down.

I'm not the only one who thinks so. In 2007, a Nebraska man opened fire in a shopping mall and killed eight people before turning the gun on himself. He left a suicide note saying, "I'm going out in style. I'm going to be famous." Do you remember his name? Me neither.

Forget for a moment how sad a commentary that is on the state of our country - we have so many mass murders that eight in Omaha doesn't stand permanently in memory. The point is that, after that shooting, radio host Paul Harvey refused to say the killer's name on the air. It was his personal protest against a twisted being who would inflict so much damage for a place in the history books.

Some are taking a similar tack today. A Dallas columnist, Jeffrey Weiss, wrote: "You may have noticed I've never mentioned the accused shooter's name ... it's pretty obvious he wants to be famous. I can't stop that, but I don't have to be a party to it."

Jordan Ghawi, the brother of slain sports journalist Jessica Ghawi, 24, asked for people to focus on how his sister lived. He tweeted, "remember the names of the victims and not the name of the coward who committed this act."

President Barack Obama, after visiting with victims and families at the University of Colorado Hospital on Sunday evening, gave a televised speech saying that it will be the good people and the heroic acts that will be remembered - not the alleged gunman. The president didn't mention the suspect by name, assuring listeners that though there was a lot of focus on him now, eventually that notoriety will fade.

"In the end, after he has felt the full force of our justice system, what will be remembered are the good people who were impacted by this tragedy," Obama said.

Exactly so.

It's possible that studying the shooter's life - his education, his family, his habits - could help us learn how to avoid another tragic massacre. But the thousands of hours of reporting and writing about the Columbine and Virginia Tech killings didn't prevent the Aurora tragedy. The attention may instead have encouraged escalating horrors.

But we would rather not accept that randomness and chaos can reach us at benign events like a movie premiere. We study the motives of a killer to calm our fears and find "reasons" for his actions - the way, when we hear of cancer, we hope to hear of smoking, or when we hear of an auto fatality, we're reassured if seat belts weren't used. We buckle up.

If I were in charge of the world, I'd withdraw at least one motivation for evil: the thrill of national attention. Take the cameras out of the courtroom. Let editors withhold photos from their publications. Let the justice system work its way to a result.

The ancient Athenians and the Quakers used to ostracize or shun people who refused to live by their rules. In baseball broadcasts, cameras often turn away from fans running out onto the field bent on mischief. Why reward that behavior with instant celebrity?

Celebrity, at least 15 minutes of it, is what Andy Warhol predicted was the fate of every person. Let's rob the Aurora killer of his remaining time on the clock.

This essay was first published in Newsday.