MICHEL MARTIN, HOST:
This is TELL ME MORE from NPR News. I'm Michel Martin. We are going to start the program today thinking again about the killings last weekend in Isla Vista Calif. Unlike other tragedies we've witnessed across the country this has us thinking a lot about mental health. According to authorities Elliott Rogers sought multiple mental health professionals throughout his life he was even visited by law enforcement. All this before he killed six people and wounded 13 others.
But he also left a robust explanation of his state of mind in the form of a lengthy YouTube rant where he described his rage at women for not be more attracted to him and at minorities whom he considered inferior but somehow more socially successful. So we thought we'd like to spend some time thinking about what this tragedy might teach us about mental health treatment and policy. And we've called two people who have had occasion to consider this issue before. Ron Honberg is director of policy and legal affairs at the National Alliance on Mental Illness or NAMI. He's with us in our studios in Washington, D.C. Once again, welcome back - thanks for joining us.
RON HONBERG: Thank you, Michel.
MARTIN: Also joining us once again is Dr. Carl Bell. He's a staff psychiatrist at Jackson Park Hospital family medicine clinic - that's in Chicago. He joins us from there. Dr. Bell has a deep background in treating the effects of violence and has also done extensive research on the psychological ramifications of extreme racism. So we're glad to have him back with us as well. Dr. Bell, welcome back.
CARL BELL: Thank you.
MARTIN: So, Dr. Bell, let me start with you. I, of course, recognize you've never treated this young man, you never saw him - but just from the public record that he left what comes to your mind? What occurs to?
BELL: Well, based on the records, he obviously was having psychiatric problems. One of the, I think, important things is that he was being adequately monitored by the people who loved him - his parents. And because of that they were able to recognize the potential danger that he was exhibiting and ultimately, you know, fulfilled.
MARTIN: But they said that they couldn't - when he was first - when they first contacted authorities I think it was a couple of months ago he had not at that point raised any specific threats but they were clearly alarmed by what they were hearing from him. Is there anything else that one can do in a situation like that?
BELL: Well, you know, the whole issue of dangerousness and mental illness is very complex - multi-determined. Unfortunately, what most people do in our society is that they shun and they stigmatize people who are mentally ill which leaves them unmonitored. And as a result of being unmonitored their kind of off on their own doing whatever it is that they are doing. You know, it's a double-edged sword because on the one hand you've got civil liberties and you want people to be able to be free and do what they need to do but on the other hand they got issues of dangerousness and sometimes the need to force treatment of people if they're dangerous to self or others and that line gets fuzzy.
MARTIN: What do you think they should've done differently? Is there anything that - and let me just be clear - we are not judging this family because we don't know an awful lot about what they may have done or how deeply involved that they were. And they clearly were involved to the point of making sure that he...
BELL: They were involved.
MARTIN: ...Was in Treatment. They clearly were..
MARTIN: ...So we're not judging them I just want to be very clear on that.
BELL: Sure. But do you think that they should have made - he was living independently - he was living apart from his parents he was living with roommates - do you think that they should have taken steps to - what? - keep searching his belongings? To make sure that they were - what do you think?
BELL: That's a little bit invasive and when you're like that with people who have psychiatric issues they resent it. They feel like they are not being treated with dignity or respect. So again I didn't really get much that they were doing wrong or out of sort they were taking care of their son and monitoring him and trying to do the best they could for him. But again as a grown man he's got the legal rights to refuse care and apparently that's what happened. And then when you add the confusion that the authorities have to judge somebody that's dangerous and when to act it gets really messy.
MARTIN: Ron Honberg, what are your thoughts about this? I mean obviously - I believe laws are different from place to place but is there a general rule about when a family member can step in and ask for a more direct intervention based on concerns that they see in a person's behavior or speech?
HONBERG: Well, Michel, show two points I'd like to make about that first of all Doctor Bell is absolutely correct - it is very, very difficult to get someone who's symptoms may be so severe that they don't recognize their in need for help. It's very difficult to get help for that person. The laws are not only - they not only differ from jurisdiction to jurisdiction they are very complicated they often time involve multiple procedures. And it's more than the laws - the fact is that in many parts of the country, most parts of the country - the health care system is not adequately equipped...
HONBERG: ... To respond to the needs of people so there may not be hospital beds available. We heard that the case of Creigh Deeds's son.
MARTIN: Former state senator in Virginia whose son grievously wounded him and then killed himself.
HONBERG: Correct. Yes. And the mental health system is very much a downstream system. So because of lack of resources it waits until people are in crisis before it responds...
MARTIN: So is the triggering event generally that he would have had to make a specific threat - I'm going to do X, Y, Z, he did at one point make a specific threat but that was - apparently his therapist and parents found out about it too late to stop him. By the time they found out about it he was already in the middle of his plans.
HONBERG: Well, that really feeds into the second point I wanted to make. Think about it, we ask law enforcement to be the judges. We ask -and this is true not just in Santa Barbara this is true across the country. And many law enforcement agencies have actually trained their police on how to the escalate psychiatric...
HONBERG: ...Crisis. But we're asking police officers to make the kind of judgments that are very, very complicated that we really need trained mental health professionals to make. And that, I think, is very much illustrated - the problems with that are very much illustrated in this case.
MARTIN: I'm going to ask you to hold that thought for a minute, Ron Honberg, and give us some clues about how you think policy can be more helpful in this area. But Dr. Bell another thing I want to ask you about because I know you the research in this area - he displayed some very hateful views toward women and other minorities in his public utterances.
Is there a point which you feel the kind of animus he displayed both towards women whom he says was not attracted to him in the way that he felt he deserved to be - and the other minorities the hatred he expressed towards other minorities was that when he thought they were more socially successful than him although he felt more superior - is there something that you think should have occasioned a more aggressive intervention? Because one of the thing that's interesting to us is how many people have written that those kind of utterances are actually fairly common among some young people who feel socially frustrated.
MARTIN: So where...
BELL: No. You know...
MARTIN: ...What crosses a line for you?
BELL: This, you know, whole issue around racism and whether or not it might be a psychiatric disorder is really extraordinarily complex. Probably 98 percent of it is learned behavior but, you know. We did a chapter a couple of years ago in the Oxford Textbook of Personality and maybe two percent has a psychiatric base where people are paranoid or they're manic and they go off on these tirades about various people that are different. But again, these are very murky waters so it's messy.
MARTIN: Is there anything you think could have been done or that you would like to see done or that you would like us to be thinking about as a consequence of what we have now learned, Dr. Bell?
BELL: Well, I think that if we could fix the mental health system that would be wonderful. But it is a downstream system it's the last thing to get funding. If we could do more prevention I think we would be better off. And then the whole issue of even if it had been a mental health person involved in evaluating him he still might have lied through his teeth and said no I'm just fine when really he wasn't. Just fine. And, you know, mental health people and the police were not lie detectors that makes a more complex.
MARTIN: Ron Honberg, is there anything you think should have been done or that you would like us to think about as a consequence of what we learned here?
HONBERG: Well, going forward and I think Doctor Bell hit it on the nose when he said that the stigma and the fact that mental health conditions mental illnesses are frequently the subject of ridicule and...
HONBERG: ...And shunning makes a very, very challenging and difficult to get people - young people in particular engaged. So they will get out - often times, young people go out of their way to mask their symptoms. So certainly putting resources into community education putting resources into school-based services and university based mental health services.
MARTIN: but this he was already being treated. This is what I'm try to understand here - so what I kind think what you're saying is there's nothing could have been done here?
HONBERG: You know these kind of situations defy easy solutions but certainly if we did what both Dr. Bell and I talked about I think you would see fewer of these tragedies. Because when you look at some of the other ones these are people who had completely fallen through the tracks. Here its true that he was receiving some mental health treatment. However, we don't know if he had been prescribed medication we don't know if he was taking his medication...
BELL: Right, right.
HONBERG: ...We don't know if he was participating in treatment in days and weeks leading up to the tragedy.
MARTIN: And one has to ask about gun control question in...
MARTIN: ...This because I know that's something on a lot of peoples' minds - its certainly on the mind of the father of one of the victims here. Do you have an opinion on this whole question of at what point a person should be denied access to a gun? There is no evidence - all these guns were purchased legally. He was not in at the database of any person who has been prohibited of acquiring a gun - do you have an opinion about that?
HONBERG: Yeah, that again is a slippery slope. I mean, it's very easy to conclude ,well, if we prohibited anybody who has a mental illness from having a gun we can avoid these kind of situations but the reality is, A, how do you identify people and, B, we have to be very careful to not create further barriers to people seeking care. So Connecticut, in the wake of the Sandy Hook tragedy, passed a law that requires all people that are hospitalized in a database. Well, that could be a disorder to people seeking voluntary situations for the become emergencies.
HONBERG: So we have to be careful...
MARTIN: Dr. Bell, final thought from you?
BELL: Plus, plus...
MARTIN: We have about 30 - 40 seconds.
BELL: You know 20 percent of the American public, at some point, has a psychiatric illness.
BELL: So that's a whole lot of people to be restricting.
MARTIN: We only have about 20 seconds. Dr. Bell, it sounds as though - if you're also saying there's not a whole lot that could have been done here?
BELL: I think their families had their eyes and their hearts on this kid and they were doing the best they could for him. But it just - even though they were monitoring him as close as they could which is what I think would have prevented the other ones that have happen because the other ones were not being monitored. That's we got to do. We got to take these people into hearts and our livers and keep tabs on so that they're okay.
MARTIN: Dr. Carl Bell is a staff psychiatrist at Jackson Parks Hospital Family Medicine Clinic in Chicago. We reached him there. Ron Honberg is director of the policy and legal affairs at the National Alliance on Mental Illness or NAMI. He met with me in Washington, D.C. Thank you both so much for joining us.
HONBERG: Thank you.
BELL: Thank you. Transcript provided by NPR, Copyright NPR.