Justice Matters with Bryan Porter: The mental health aspect of violence

Justice Matters with Bryan Porter: The mental health aspect of violence
(Courtesy photo)

Last month, I lamented the Virginia General Assembly’s inability to act on necessary gun-related legislation. Since that column went to press, our nation has suffered additional mass shootings. I hope that we are nearing a critical mass of support which will finally force legislators to debate legislative responses to this national calamity.

One component of the response is addressing the nation’s ability to assess and assist those diagnosed with mental illness. Before discussing this topic, two points must be made. First, studies prove the majority of those who encounter mental health issues do not commit crimes, let alone acts of violence. People who suffer from mental health disorders are far more likely to be a victim of crime than an offender. We must avoid unnecessarily stigmatizing peaceful citizens.

Second, lay people believe that a person is either “sane” or “crazy,” a binary choice. This is not how mental illness presents in reality. Mental health struggles exist on a spectrum and are not susceptible to algorithmic precision. Many mass shooters, such as Alexandria’s serial killer Charles Severance, have been diagnosed with personality disorders and not schizophrenia, meaning they do not suffer symptoms such as command hallucinations or thought insertion. People with personality disorders are often sufficiently rational to mask their symptoms and may never be identified as needing treatment. With those caveats in mind, I present several concrete proposals.

One: Government must increase funding for mental health services. We have far too few in-patient beds in Virginia and struggle to find treatment for those who could benefit from outpatient programs. If outpatient treatment and inpatient beds are not available, it is axiomatic that intervention cannot occur.

Two: We lessen the stigma attached to mental disorders. The unfortunate negativity attributed to people who are experiencing mental illness is a barrier to someone intervening with a family member or friend in the throes of a crisis.

Society does not normally take a negative view of those suffering from a physical ailment. A person who has mental illness is as much a victim of circumstance as a person with cancer.

Three: There should be a concerted public service campaign to explain personality disorders and their symptoms to the greater community. In the mental health profession, there is an understanding that personality disorders are linked to a higher risk of violence. If these disorders present symptoms outside of the traditional understanding of what mental illness “should look like,” society should be better trained to look for warning signs.

Four: We must create more options for mandating treatment for those suffering from severe mental illness. As it stands now, if a person experiencing a mental health crisis refuses treatment, the only way police can force him to see a doctor is if there is probable cause to believe he is an “imminent danger to himself or others.” Even if a person is suffering from an extremely serious mental health crisis, it is almost impossible to require him to receive mental health treatment unless he is actively threatening to harm someone.

I do not support expansive government power to sweep up the mentally ill. I do support creating a mechanism by which a judge could order a person to be taken into custody for a mental health evaluation or treatment if, based on the credible testimony of the person’s next-of-kin or his treating mental health professional, the judge finds custody is in the person’s best interest and the person is incapable of making an informed or rational decision about mental health treatment.

In many such cases, the person will be quickly released after a mental health professional determines outpatient treatment will suffice. In more serious cases, this mechanism would allow the system to intervene before a tragedy occurs. Of course, I propose that due process be baked in, for example, the right to an attorney and the right to appeal a judge’s decision.

Given the lack of treatment options, law enforcement officers are often forced to deal with those suffering a mental crisis. I have no desire to serve as the mental health provider of last resort – a job for which I am not trained. Prosecutors are a blunt tool, seeking to encourage compliance with societal norms through pressures such as probation.

A mentally ill person may be incapable of adapting his behavior to conform with what society expects. I strongly favor more funding for mental health treatment, hopefully to intervene before a person is arrested, but also to provide prosecutors with an avenue by which a non-violent criminal defendant may be diverted for treatment. My office’s innovative Mental Health Initiative is an example of a program for which additional funding could be put to good use.

The writer is Commonwealth’s Attorney for Alexandria