BoomerGirl Diary

Dear Susan:

Since you are a mental health professional, I want to know how those idiots in Virginia could have that psycho kid on a psych ward and just let him go. Were they blind? What good are psych hospitals if we can’t lock up the dangerous people?

Throw Away the Key

Dear Throw Away:

We’re all scared and frustrated about the tragedy at Virginia Tech. When we get scared, we tend to look for someone or something to blame, a weak link, in order to feel safe again. Even when it doesn’t work, and will have no logical impact on the future, we want to “do” something. Which is why millions of people boarding planes are taking off their shoes and putting itty-bitty toothpastes and shampoos in quart-size Ziplock bags — the illusion of security is preferable to facing the reality that we can neither predict nor control what determined, hate-filled people will do.

Moving along, the “idiots” you refer to are mental health professionals who have to follow the law. Even if they don’t like the law, or wish they had the power to decide based on their own "gut" response whether or not to hold someone indefinitely, that’s the way it is. In general, the law says that unless a person is an obvious immediate threat to self or others, you can’t just lock them up and “throw away the key.” Even when they are, it’s darn hard. Which means that 95 percent (a statistic I just made up) of people who are “screened” are not held, or held very briefly (like 1-2 nights), and referred for out-patient services. Once out, we cannot compel follow-up. Bluntly, in order to be released, someone just has to promise that they won’t do very bad things, and not be psychotic (need to know who they are, where they are, and not talk about voices.) Even "crazy" people can pretend to be normal long enough to be released.

I’m being a bit sarcastic here, but the general public has a distorted understanding of the parameters mental health professionals must work within. We are constrained by laws, by the requirements of confidentiality, by HIPPA (you know, the zillions of papers you sign at every doctor’s office?) As a therapist, I can’t just call up parents if I’m working with a college kid I’m worried about unless I have a specific signed release that gives me permission to do so. If a college kid says “You can’t talk to my parents,” then I cannot. If a spouse says, “No, you can’t contact my husband (or wife)" … I cannot. At the same time, I am required to take some action if I believe that the client is a danger to self or others. But it has to be more than a gut-feeling. I need evidence, such as a threat.

Threats are also subject to scrutiny under the law. Is the threat specific? Is it directed at a particular person? Is it deniable? (i.e. “I didn’t say that” or “I didn’t mean it… I was just mad and saying stuff. It’s not like I’d really blow someone away.”) People say “I wish I were dead” and “I can’t stand it anymore, I want to kill myself” all the time. It can be a challenge to separate words of serious intent from “just depressed.” One way to assess is to try to determine if there is a plan, a means (bought the gun, have the gun, have the pills) that the person will admit. If they deny a plan, or even say that they were thinking of violence but are feeling more calm and rational now, and agree verbally to seek follow-up treatment, they are likely to be released.

What happened at Virginia Tech was a tragedy. My nephew, Ross, goes there and was in a class in the next classroom building. I have been acutely aware for weeks now how my entire extended family would have been emotionally decimated if Ross had been killed … how every family event would never be the same, my sister and brother-in-law would have been shattered, how we would forever be a family defined by that loss. It would be hard to ever imagine us laughing together again.

One very disturbed, mentally ill young man is responsible for the carnage (not all the people who were doing their various jobs the best they knew how at a given moment in time). Or blame us as a culture, a society so bogged down trying to define “the right to bear arms” that it cannot distinguish guns appropriate for hunting and emergency self-defense from those that are machines designed and manufactured solely for the rapid execution of human beings.