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Challenges Abound in Trying to Prevent Violence Via Mental Health Screening

September 25, 2013 at 12:00 AM EST
Revelations about the mental health of Navy Yard gunman Aaron Alexis raises questions about whether better screening processes could have prevented the shooting. Gwen Ifill talks to Barry Rosenfeld of Fordham University about the challenges of identifying on an individual level when someone with mental illness may pose a threat.
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GWEN IFILL: The latest information on the gunman in the Navy Yard shootings comes amid more disclosures this week about his own troubles with mental illness and problems never fully reported all the way up the chain. It’s also prompting questions about whether better screening and treatment could help prevent some of the mass killings.

For more on that, we turn to Barry Rosenfeld of Fordham University. He is a clinical forensic psychologist whose recent work has focused on assessing the risk of violence in patients.

Welcome, Dr. Rosenfeld.

Could you explain to us what we don’t know? How can we determine when someone is sick enough to keep an eye on? Who may crack?

 BARRY ROSENFELD, Fordham University: Well, that’s about four things all at once.

What we don’t know is a pretty long list. We have come a long ways in terms of what we understand about mental illness and violence. We do much better when we look at things at the aggregate. We have general ideas that when people have — or general — generally accepted research that when people have some of the beliefs that, in fact, Mr. Alexis revealed, things like delusions that you’re being controlled by other people, we’re pretty good at recognizing those as risk factors for future violence.

We’re very good at the macro-level, saying here’s 100 people, these the handful that I think are at the greatest risk. We have a much harder time when it comes to an individual prediction, to say, how about this one person sitting in front of us? And that’s a really in-depth and detailed analysis that takes quite a bit of effort that we can’t do on the fly in an emergency room when somebody comes in and asks for a medication for insomnia.

GWEN IFILL: So, what is — why is it so hard? What is to be argued against trying to put a red flag on anyone who comes to you or comes to several different mental health organizations, as he did, and says, I’m hearing voices?

BARRY ROSENFELD:  Well, you know, what’s hard about it? There’s many things that are hard about it.

First of all, we don’t have any kind of centralized focus, a centralized system where we can say, this person’s coming to hospital A, oh, he was in hospital C last week. We don’t have that I’m aware of in many systems that kind of ability to recognize a pattern like that.

So, if somebody comes into the same hospital repeatedly and sees maybe even the same doctors, we’re going recognize that pattern. But when someone goes place to place and maybe even across state lines, we’re not going to know that they have gone to other places.

When someone comes in and shows one of these red flag symptoms that we’re aware of, assuming the person that’s seen them recognizes those as red flags — and I think that’s another — another hurdle that has to be overcome — then I think we do have mechanisms for, let’s say, hospitalizing people for observation and treatment. We have come a long ways in terms of recognizing and treating the patients we identify, but we’re still talking about a very small minority of people with mental illness. And picking that one is a real challenge.

GWEN IFILL: What have we learned, if anything, from past mass killings?

We heard the president this weekend talk about how has been to five different locations now where there were mass killings to grieve with the victims. Have we learned anything from what these alleged in many cases and convicted in other cases or murdered in other cases of shooters, what we learned about them that we can apply for future possibilities?

BARRY ROSENFELD:  Well, you know, I hate to sound pessimistic, but I think one of the things we have learned is that there’s a great deal of variability in what people look like who engage in this kind of behavior.

Some have serious mental illness that’s obvious to anyone who asks them. Others seem to be — quote, unquote — “normal,” until we dig and dig and dig, and then we find things that are relatively subtle. So the idea that there’s some profile out there and we can just make a checklist and say here are the eight things to look for or here are the three things to look for, I think what these — what these repeated episodes show us is that it’s really a very broad range of things that lead people to the same outcome.

(CROSSTALK)

GWEN IFILL: And that the cracks — and that the cracks — and that the cracks that they slip through can’t necessarily be sealed?

BARRY ROSENFELD:  Well, how could they be sealed? They could be sealed by having some kind of centralized health care registry. They could be sealed if when someone went to purchase a gun, they looked online and saw, oh, this person presented at an emergency room with paranoid symptoms. Maybe there’s some provision in place for not giving them a gun.

They could be sealed, but that requires a lot of steps that I think many people are uncomfortable with and a great deal of infringement on the rights of people who don’t need those cracks sealed for them. So to find that need until a haystack, we have to step on a lot of people’s rights, and I think that’s where we run into a lot of problems.

GWEN IFILL: Barry Rosenfeld of Fordham University, thank you so much.

BARRY ROSENFELD:  Thank you.