Would mandatory mental-health reporting have stopped Loughner?

After every tragic event, people try to figure out what could have stopped it.  In the case of the Tuscon shootings, the debate has finally turned from the ridiculous notion that people should stop using routine analogies lest we disturb the already-disturbed to what steps should be taken when we find someone dangerously disturbed in the first place.  After all, Pima Community College suspended Jared Lee Loughner and required a psychiatric clearance for him to return to the public school after staff and students became convinced that Loughner was dangerous.  Should they have been required to report Loughner to a mental-health facility?  Sally Satel and Jeffrey Geller say yes:

In fact, under Arizona law, any concerned party can petition the court for an Order for Treatment. If Loughner had been found “persistently and acutely disabled” by severe mental illness and “likely to benefit from treatment” — regardless of whether he had a weapon or was suicidal — an evaluation and subsequent care could have been court mandated.

Of course, hindsight is perfect. As incidents unfold in real time, most people are rightly skittish about infringing on a person’s freedom. But given Loughner’s troubling track record — the number of times the campus police were called to intervene; the pressing concerns of his teacher and of other students; and the very fact that the college would not re-admit him after his suspension without psychiatric clearance — it seems that a court petition could have been justified.

Good laws work only when applied, of course. And when Loughner did not return to school, Pima Community College was rid of a very troubled young man and his problems. It did what so many colleges, universities and businesses have done before: passed the problem along. …

Perhaps it is time to require action. When a school or business feels the need to protect itself from someone who is mentally ill, perhaps it should be required to try to protect others, too.

Thus, if a school or a business ejects or otherwise removes a student or employee out of concern about behavior and dangerousness, the principal, dean, or head of the Human Resources department would be required, under a mandatory reporting law, to inform the medical director of the appropriate public health jurisdiction. This public official would then have to initiate an evaluation that might lead to a face-to-face evaluation and, depending upon its outcome, possibly involuntary treatment.

Satel and Geller are on more solid ground when talking about public schools.  Those are public institutions, which exist for evaluation of both performance and behavior.  Working out a mandatory reporting system for public schools would be less complicated.  Even without such a mandate, though, one has to wonder why Pima Community College didn’t follow up on Loughner, other than the understandable relief at having put some distance between its faculty and student body and (at that time) a potentially dangerous young man.

The authors note that mandatory reporting already exists for issues like child abuse, which apply to both schools and medical clinics/hospitals.  The latter already have other mandatory reporting requirements for injuries from violent crimes, such as gunshots and knife wounds.  But again, medical clinics and hospitals exist to conduct health assessments already; adding a psychiatric mandate would add more complication but would be within the mission of the profession.  That, however, does not apply to businesses outside of the health profession.  In fact, it sets up the private sector to act as an expert in mental health when such an expertise lies far outside what they do.

Most businesses do not eject an employee for being crazy.  Thanks to wrongful-termination lawsuits over the last few decades, most business won’t fire anyone at all unless supervisors produce a clear track record of specific failures to perform, documented and corroborated by objective data.  Private-sector employers won’t fire someone over allegations of “dangerousness” alone; if they do, they’d better have lawyers on retainer to handle the lawsuit that inevitably would follow.  And once an employee gets terminated, the private-sector business has no obligation to anyone to act as an arbiter of mental health or to “report” their inexpert opinions to the government.

If we want to insist on mandatory reporting for entities when dangerous psychoses are suspected, let’s start first with those entities that are more equipped to diagnose those issues.  But let’s also realize the limitations of such mandates, and the danger of benign individuals getting caught in a trap where they are forced to prove their relative sanity, rather than having the government prove their insanity.

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