The ‘Terror’ of Mental Illness

When the television alerts began to signal that one shooter – and then possibly more – had attacked the Navy Yard in Washington DC last week, it was pretty natural that anyone’s first thought went to "terrorism."

Hadn’t we been conditioned for these very moments, waiting for the other shoe to drop after the 9/11 attacks as though that horrifying September day never ended? The last 12 years have been a series of overblown arrests and false alarms (not to mention one murderous bombing in Boston last spring) that seem to make us more paranoid, less trusting and let’s face it, less free every day.

Aaron Alexis
Aaron Alexis

It became quite clear over the next 48 hours that it was a single shooter – Navy veteran and military contractor Aaron Alexis – and that he had been, according to emerging reports, suffering from classic symptoms of schizophrenia: delusions, hallucinations, paranoia. He had called police himself a month ago in Newport, R.I. because he thought men were following him with a "microwave machine." The police did nothing, but did send a note to the local naval station where it seems to have been lost in the ether. Alexis subsequently visited a VA hospital twice for insomnia, according to reports, where his more troubling symptoms weren’t presenting, apparently, so he left with sleeping pills and was still able to hold a security clearance that allowed him into that office building on Sept. 16. The rest as they say, is history.

Not to be overly dramatic, but while our heads – and massive federal budgets – have been trained on the War on Terror, we continue to lose sight of what’s become an increasingly lopsided battle here at home, with mental illness. The Navy Yard is the latest in at least three major mass shootings in the last six years – Virginia Tech, the Aurora theater Shootings and the horror at Newtown, Connecticut – which involved suspects who had been or should have been treated for some form of severe mental illness.

That is not to say the mentally ill are all one-step away from committing a massacre (though 5 to 10 percent of homicides are committed by untreated mentally ill people, according to statistics). But the vast majority do not harm others. They can destroy families, burden communities and schools, and above all, they harm themselves. More than 90 percent of suicides each year (nearly 40,000) are precipitated by mental health disorders and/or substance abuse (which often occurs because of mental illness, including manic depression, anxiety, bipolar disorder, schizophrenia and post-traumatic stress).

According to the National Institute of Mental Health, about six percent, or one in 17 adults, are suffering from a serious mental illness today in the US, including 2.4 million over the age of 18 who have schizophrenia, 40 million with anxiety disorders, 7.7 million in that age range with post-traumatic stress, and 1.6 percent of American adults who have borderline personality disorders.

According to federal data in 2006, 64 percent of local jail inmates, 56 percent of state prisoners and 45 percent of federal prisoners had symptoms of serious mental illness. A disproportionate number of Americans living on the streets today are suffering from it, mostly schizophrenia and bipolar disorder.

The costs of mental illness are enormous, in every way. In May, the Centers for Disease Control cited a cost of $247 billion for children’s mental health care in the US. The World Health Organization estimated in 2010 that the total cost for mental health in the world – two-thirds of which is in indirect costs (loss of employment for both sufferer and caregiver, social safety net programs, etc.) – was $2.5 trillion, with an estimated increase to $6 trillion by 2030.

“No group of chronic diseases costs the world more than brain disorders,” said Barbara Sahakian, a professor at Cambridge University and president of the British Association of Psychopharmacology, in June. She spoke directly about the diagnoses of 45 million such illnesses in Britain in 2010 alone. “If we don’t do something soon … we will be overwhelmed by brain disorders."

This is a real crisis on the domestic front, yet when the economic bubble burst in 2008, it was domestic funding like mental health that took the greatest hit (and quietly), while the drums for continued spending for war and the military have been loud and largely successful. While the warhawk politicians, think tanks and the defense industry were warning about the "loss of military readiness," "sending signals of weakness to adversaries" and "massive job losses," states all over the US began shifting money away from mental health care, including community clinics that serve as the primary point of access for low-income sufferers, with no one but small, typically low-funded advocacy groups to lobby for them at state houses and on Capitol Hill.

According to a Mother Jones report in April, states cut a total of $4.35 billion from their mental health budgets from 2009 to 2012. "As budget cuts have mounted, both inpatient and community services for both children and adults living with serious mental illness, have been downsized or eliminated," said the National Alliance on Mental Illness (NAMI) in a 2011 report. "In some states entire hospitals have been closed; in others, community mental health programs have been eliminated."

The defense industry spent $131.1 million on lobbying Capitol Hill in 2012, a big election year. Comparably, the big mental health advocates (American Psychological Association, American Psychiatric Association, and National Mental Health Association) which come under "health professionals" in the Center for Responsive Politics database, spent just over $2 million on lobbying during the same cycle. Throw in Autism Speaks ($460,000), the Alzheimer’s Association ($230,000) and the National Alliance on Mental Illness ($29,278) and such advocacy still falls staggeringly short of the big bucks backing the military industrial complex.

Perversely, but not surprisingly, this crisis has hit the military, too, and at all points. Because a) the rush to send millions of men and women to war required an extraordinary recruitment effort that often lowered standards and ignored mental health red flags and b) a military-wide stigma and culture left the military ill-prepared for the myriad mental health problems – including post-traumatic stress – during and after the war, the Pentagon and VA system are now struggling to plug constantly popping holes in the dyke.

In researching and writing about this topic, it’s clear that the military’s inability (or disinterest) in addressing mental health issues from the beginning (right at the recruit’s first health screening), has made what would be a complex problem even more daunting. Suicide rates have skyrocketed, as have crimes at military installations with a high demand for mental health services. Soldiers and veterans are overmedicated and at risk of psychotic episodes, overdoses and suicide. Veterans are homeless. We hear repeated stories of veterans who had taken their own lives after falling through the cracks or literally turned away because the money wasn’t there to help them at local VA clinics.

In a way their plight mirrors the wider problem among the civilian population. But given that as a nation we have sacrificed so much for our gargantuan military budgets over the last decade (spending grew 81 percent in that time, topping $698 billion in 2010), seeing that sacrifice contribute to yet another generation of homeless, dependent, sick vets makes it all that more difficult to stomach.

Charles Krauthammer, rightwing columnist and television pundit who is a licensed psychiatrist, wrote a most-revealing piece for The Washington Post on Friday. In talking about the tragedy of Aaron Alexis and the victims of his apparent psychotic breakdown last week, Krauthammer said the system had failed Alexis by not taking his previous cries for help more seriously, which might have led to an involuntary commitment in order to get him on a treatment regimen absolutely essential for people suffering from psychosis likely brought on by schizophrenia.

"That’s what a compassionate society does. "It would no more abandon this man to fend for himself than it would a man suffering a stroke," Krauthammer wrote, challenging Americans to "recalibrate" our commitment to the mentally ill.

We are not the first to point out that Krauthammer’s hero Ronald Reagan signed the bipartisan bill that was the first to discontinue involuntary commitment on a major scale as governor in California in 1967, resulting in the closing of hospitals, and later, a major homeless problem that continues to this day. As president, he ended direct federal funding of mental health by creating problematic block grants to the states. To be fair, there had already been a widespread movement, mostly liberal, to de-institutionalize mental health by shifting people to outpatient treatment and community-based independent living. But it was no panacea, and one of the biggest problems has been the lack of resources to keep such programs going and — no surprise — it’s mostly cost-cutting Republicans who’ve shifted mental health downward on the budget priority scale, particularly during the last fiscal crisis (an interesting timeline here).

Krauthammer is a warhawk, but he is also a psychiatrist. Maybe he is finally seeing that the treatment of "brain disorders" by the military and civilian world is coming home to roost. Maybe Alexis, a Navy man who fell through the cracks, on the heels of so many recent senseless tragedies, will have a lasting effect on policy, somehow. We know now, that "the terror" is really in our backyard and it has a name. It has nothing to do with the Muslim Brotherhood or radical mosques. It’s called ignoring mental illness and we can’t afford it anymore.

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Author: Kelley B. Vlahos

Kelley Beaucar Vlahos, a Washington, D.C.-based freelance writer, is a longtime political reporter for and a contributing editor at The American Conservative. She is also a Washington correspondent for Homeland Security Today magazine. Her Twitter account is @KelleyBVlahos.