Why we shouldn’t depend on mental health professionals to detect mass killers: Elliot Rodger’s slipping “under the radar” is hardly rare

26 May , 2014  

Frequently in the solution to these mass shootings is to simply spend more money on mental health.

MAJOR GARRETT: . . . Do you believe the legislation the Senate did not pass would have made any difference in this case [the Elliot Rodger’s shooting]?

SENATOR RICHARD BLUMENTHAL: The legislation that failed to pass–it got support from fifty-five senators–would have provided a mental health initiative with more resources, greater ability for the Santa Barbara police to intervene–to use the sheriff’s word–to have professionals trained in diagnosing and detecting this kind of derangement. Obviously, not every kind of gun violence is going to be prevented by laws out of Washington but at least we can make a start and I am going to urge that we bring back those bills, maybe reconfigure them to center on mental health which is a point where we can agree that we need more resources to make the country healthier and to make sure that these kinds of horrific, insane, mad occurrences are stopped and the Congress will be complicit if we fail to act.

But there is a strong reason to believe that more money isn’t going to work wonders. Elliot Rodger’s family had plenty of money, indeed, he was seeing a therapist prior to the attack, but his problems where still not sufficiently understood. Rodger’s therapist didn’t realize their was a significant problem until they received a copy of Rodger’s manifesto from Rodger himself minutes before the rampage. Nor did the sheriff’s deputies who met with Rodger on April 30th. From USA Today:

Family friend Simon Astaire told the Los Angeles Times that 22-year-old Elliot Rodger’s therapist called his mother, Chin, at 9:17 pm Friday night. The therapist told Chin Rodger to look for her son’s email, which included his lengthy manifesto of the terror that was about to unfold. It was 13 minutes before the killing started. . . .

— Several times during his manifesto Rodger talks about seeing “my psychiatrist Dr. Charles Sophy” when he was 21 and 22 years of age.  Presumably Dr. Sophy is the therapist referred to in the previous paragraph.

The Washington Post and Face the Nation have details on what happened when the Sheriff’s department interviewed Rodger:

Had the officers sensed something awry during their April 30 visit, they might have searched Rodger’s home. They would have found his three semiautomatic handguns, dozens of rounds of ammunition and a draft of his 137-page memoir-manifesto. They would have read about his plot for a “Day of Retribution” — when, as Rodger wrote, he planned to “kill everyone in Isla Vista, to utterly destroy that wretched town.”
But the deputies did not look. They concluded that Rodger seemed “quiet and timid . . . polite and courteous,” Santa Barbara County Sheriff Bill Brown said Sunday on CBS’s “Face the Nation.”
So they left and never returned.
“He was able to make a very convincing story that there was no problem, that he wasn’t going to hurt himself or anyone else, and he just didn’t meet the criteria for any further intervention at that point,” Brown said. “Obviously, we certainly wish that we could turn the clock back and change some things, but at the time the deputies interacted with him, he was able to convince them that he was okay.” . . .

More details on the Sheriff’s department interview is available here from an interview with the Sheriff Sunday on Face the Nation:

we were asked by the Mental Health Department to conduct a welfare check with Elliot Rodger to determine if he was a danger to himself or anyone else. This was prompted by a call by a third party. The Mental Health Department contacted one of his relatives who had expressed some concern about his wellbeing. Our deputies went to check on Mister Elliot, contacted him outside his residence, they found him to be, at that time, rather quiet and timid. He was polite and courteous. He was able to convince the deputies that this was all a misunderstanding that although he was having some social problems, he was probably not going to be staying in school and going to be returning home. And he was able to make a very convincing story that there was no problem that he wasn’t going to hurt himself or anyone else. And there– he just didn’t meet the criteria for any further intervention at that point. . . .

If Rodger’s own therapist didn’t see this coming until after he received Rodger’s manifesto, why should we expect the Sheriff’s department to catch it? Whatever concerns that the therapist and family members had were apparently not enough to push harder for further actions regarding Rodger after the deputies had interviewed him.

Below are some other well known cases, cases where the killer was seen by mental health experts but was still not identified as being a threat to others.  Between 950,000 to 2.2 million people suffer from schizophrenia (about 0.3 to 0.7 percent of the population) and millions more have other types of mental illness.  The percentage of those with schizophrenia who are likely to engage in these types of attacks is extremely small.  Identifying someone as having a mental illness is a long way from identifying them as posing a danger to others. There is also the risk of “false positives,” identifying people as a threat to others and thus depriving them of their freedom when they are not actually a threat. The continued political pressure to identify that tiny fraction of schizophrenics who represent a risk to others will primarily catch people with mental illness who are harmless to others.

Let’s just go through some numbers.

—  Suppose that there are 1.6 million people with schizophrenia.

A report last October by the Crime Prevention Research Center examined mass public shootings from January 2009 through the middle of July 2014, there were 25 mass public shootings where at least four people were killed with a gun (4.5 per year).  13 cases involved an individual with any history of mental illness.  Even if all those individual had schizophrenia (and that is clearly not the case), that comes to one mass public shooting per 123,077 schizophrenics.

To put it differently, if a psychiatrist was asked to screen 100,000 people with schizophrenia and identify the 1,000 most dangerous people from that group (the most dangerous 1 percent), less than 1 of that 1,000 would actually commit this crime and this assumes that you did accurately pick the 1,000 most dangerous individuals.  To put it differently, you would have hopefully caught at most one real dangerous person, but at the expense of 999+ “false positives.”  Again, note that this is 999 false positives out of 1,000 people is an overly optimistic number.  The true false positive rate will be much, much higher.

The question is: if we can’t even accurately identify those who are a threat when they see mental health professionals, what should be done if the screening for mental illness fails? Allowing potential victims to defend themselves is one option.

Some well known cases:

Ivan Lopez, Fort Hood in April 2014: The Army psychiatrist who last saw the Fort Hood killer found no “sign of likely violence, either to himself or to others.”

Adam Lanza, Sandy Hook Elementary School in December 2012: “Lanza ‘was under no extreme emotional disturbance for which there was a reasonable explanation or excuse.‘ . . . Lanza ‘was undoubtedly afflicted with mental health problems; yet despite a fascination with mass shootings and firearms, he displayed no aggressive or threatening tendencies,’ Sedensky wrote.”  State’s Attorney Stephen Sedensky III was the lead investigator in the Lanza investigation.

James Holmes, Aurora, Colorado movie theater showing premier of Batman movie on July 20, 2012: Holmes had been seen by three mental health professionals at the University of Colorado prior to the massacre. While Dr. Lynne Fenton did warn university officials about Holmes’ violent fantasies, but she “rejected the idea” that the threat was sufficiently serious for Holmes to taken into custody.

Nidal Malik Hasan, Fort Hood on November 5, 2009: Despite working with other psychiatrists, Hasan’s colleagues “failed to notice how deeply disturbed someone right in their midst was.” Fellow students and faculty described Hasan’s behavior as: “disconnected, aloof, paranoid, belligerent, and schizoid,” but action wasn’t taken against Hasan because “they didn’t have clear evidence that he was unstable, and they worried they might be “discriminating” against Hasan because of his seemingly extremist Islamic beliefs.

Robert A. Hawkins, Westroads Mall, Omaha, Nebraska on December 5, 2007: Long history of mental illness, “He also had two psychiatric hospitalizations, and has been diagnosed with attention deficit disorder, mood disorder, oppositional defiant disorder, and parent-child relationship problems.” In 2002, he was “placed in a mental health treatment center five years ago after making homicidal threats toward his stepmother.” Yet, despite this history, he was not deemed a threat at the time of the mall attack.

Seung-Hui Cho, Virginia Tech on April 16, 2007: Starting in July 1997 while Cho was still in middle school, he began receiving mental health treatment and those treatments continued through high school. In November 2005, Cho was deemed to present “an imminent danger to himself as a result of mental illness,” though he was not determined to be “an imminent danger to others as a result of mental illness.”  Apparently, since Cho agreed to voluntarily seek outpatient treatment, the judge did not feel the need to have Cho “involuntarily committed” to a mental health institution.  The Virginia Tech Review Panel report is available here.  This quote is particularly relevant (p. 47):

The evaluator completed the evaluation form cer-tifying his findings that Cho “is mentally ill; that he does not present an imminent danger to (himself/others), or is not substantially unable to care for himself, as a result of mental illness; and that he does not require involuntary hospitalization.”  The independent evaluator did not attend the commitment hearing; however, both counsel for Cho and the special justice signed off on the form certifying his findings.

UPDATE: Some notes from NBC News:

“You look backward and you see all these red flags,” agreed UCLA law Professor Adam Winkler. “But you look forward and you see there are potentially millions of people with some kind of red flags.” . . .

[James Alan Fox] cited a study by Mayors Against Illegal Guns of 56 mass shootings from 2009 through 2012, which found none of the assailants were prohibited by federal law from possessing firearms because they had been legally found mentally ill or involuntarily committed for treatment. In only four of the cases, he noted, was there any evidence that concerns about the mental health of the assailant had been brought to the attention of a medical practitioner or legal authority before a shooting spree. . . .

UPDATE: Another example from October 2014 where two psychiatrists were fooled by someone who was plotting to commit a mass public shooting.  From the Washington Times:

He called himself a “psychopath” in his secret diary and vowed revenge for slights dating back to elementary school before the Arapahoe High School shooter killed another student and himself last year, according to a sheriff’s report released Friday.

Law enforcement and school officials said that 18-year-old Karl Pierson, furious over being demoted Sept. 3 as a debate team captain, had become a discipline problem at school and threatened the debate coach, Tracy Murphy, before the deadly Dec. 13 rampage.

In his diary, Pierson also cited “elementary school teasing” and described himself as a “psychopath with a superiority complex” who wanted to commit “mass murder and be in a place of power where I and I alone are judge, jury and executioner.”

But two psychiatric evaluations conducted during the fall semester — a threat assessment by a school psychologist and a mental health evaluation done by therapists at a private behavioral clinic — determined he was a low-level threat, according to the 37-page report summary.

Arapahoe County District Attorney George Brauchler said at a Friday press conference that the gunman acted alone and that there were no plans to pursue charges against those who had evaluated him. . . .

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5 Responses

  1. […] all the discussions about mental illness, one has to understand how much care and planning these killers engage in. Here is something from […]

  2. […] on how onerous it’s to precisely display out those that are an actual hazard to others, check out this link. Difficult Engage Figure Going Health Idea Mass Mental Public screening shootings These Want […]

  3. […] exhibited mental illness before their attacks, though very few of even those with schizophrenia – many fewer than 1-in-100,000 – represent a danger to […]

  4. […] person poses a danger. Look at the inability of psychiatrists to identify mass shooters. It’s very common for mass killers to be seeing psychiatrists before their attacks, including Elliot Rodger (Santa […]

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