Serious Mental Illness and Gun Violence

by Tony Salvatore, MA

mhfirearmsAs an adult mental health crisis center serving southeastern Pennsylvania for almost forty years, Montgomery County Emergency Service is closely following the public discussion regarding violence and serious mental illness.  We deal daily with many of the concerns that have been raised.  Our input was sought by the Commonwealth of Virginia in the wake of the Virginia Tech situation.

As has been noted, such violent events cannot be foreseen and there is often very little opportunity to prevent their occurrence.  Sadly, such events can happen anywhere with no forewarning.  We agree that much more can be done to reduce the risk of such behavior in our communities.  Here we want to share some of the measures in place to do just that in Montgomery County.

First, our work is premised on the evidenced-based reality that the overwhelming majority of people struggling with serious mental illness do not engage in violent acts of any nature.  A very few do and we are prepared to deal with such cases.  However, shootings involving individuals with psychiatric histories in Phoenix, Aurora, and, closer to home, at Western Psychiatric Institute in Pittsburgh, are very rare, but well-publicized.

It is important to understand that as devastating as these events are, they involve only a very small fraction of those with serious mental illness.  Our experience, as supported by NAMI and other mental health advocacy groups, is that individuals with mental illness are far more likely to be victims of violence than perpetrators.  Many of those we serve come to us with severe emotional and physical trauma as a result of exposure to violence and abuse.

Second, because many of those with serious mental illness are very likely to have contact with emergency responders as a consequence of their illness, we have engaged local police and other law enforcement agencies as our partners in creating an early warning system for identifying and getting help as appropriate for those experiencing mental health crises.  We provide ongoing training to all criminal justice personnel in recognizing the signs of mental illness and the basics of crisis intervention.

We provide much more than knowledge and skills.  We back-up what we teach with 24/7 availability to officers in the field to answer questions, and give referrals and advice on resolving a situation in a manner that assures the safety of all parties and leads to the provision of emergency services by our facility or by community resources when the need is less urgent.  Police, in turn, keep us apprised of contacts with individuals at-risk that may warrant follow-up by our Outreach Program.

Third, we facilitate the ability of concerned individuals, including friends and family members, hospital emergency departments, and behavioral health providers, to arrange involuntary emergency psychiatric evaluations for individuals felt to be a danger to themselves or others because of mental illness.  Through the Montgomery County Department of Behavioral Health and Developmental Disabilities, we administer the emergency psychiatric provisions of the state mental health statutes.

We agree that our state and national mental health policies and spending should fit emerging needs and that existing behavioral health resources must be enhanced.  However, we also feel that every effort must be made to make full use of what is on hand to do everything possible to deter possible harm and meet needs as they arise.  To this end, our staff maintain currency on applicable mental health law and community resources so that we can aid those bringing potential emergency situations to our attention in understanding options, making a decision, and mobilizing the optimal intervention.

Fourth, as part of our responsibility to meet the emergency mental health needs of those who are unwilling or unable to do so we also fulfill the requirements of PA Act 77 that restricts purchase or ownership of firearms in Pennsylvania to anyone who is involuntarily admitted to a psychiatric hospital.  Information on all such admissions in Montgomery County is submitted to the PA State Police for entry in a state-wide data base.

Fifth, people with behavioral health problems may get involved with the criminal justice system apart from any crisis situation.  On their behalf, our assistance is sought by District Attorneys, Public Defenders, private defense attorneys, District Justices, Common Pleas Judges, Probation Officers, family members, and the police in clarifying the mental health status and needs of particular individuals.  This happens because our staff is seen as understanding mental illness, being able to assess an individual’s crisis level, and having a strong understanding of mental health laws and regulations. This capability represents a further layer of risk reduction.

Lastly, we fulfill our duties with an acute awareness that our actions have significant consequences for community safety, the welfare of at-risk individuals, and for their personal rights and liberties also.  Accordingly, we feel very strongly that the current prevailing interest in public safety at all costs be tempered by a concern for the rights and privacy of vulnerable individuals who present no threat to the community’s welfare.