U.S. News

02.09.14

What Military Base Shootings Reveal About the Mental Health Debate

Critics argue that better mental health screening could prevent the next Aurora or Newtown. Does the military, which closely monitors the mental health of its soldiers, offer a model?

A few weeks ago I received a phone call from a woman with a story to tell. Renee Richardson’s 18-year-old son, Ezra Gerald Smith, was shot to death on April 24, 2009 while walking to school, allegedly by a soldier stationed at Texas’s Fort Bliss. Richardson and her family had been living for two and-a-half years on the El Paso Army base, where her husband (since retired) was a staff sergeant, when their oldest child, a senior in high school, was killed. The alleged shooter, Spc. Gerald Polanco, was diagnosed with combat-stress disorder caused by his 15-month tour of duty in Iraq, sent to a Bureau of Prisons psychiatric hospital, and judged unfit to stand trial. (Polanco’s attorney did not respond to calls or emails for this story).

Since October 2010, Richardson has been trying unsuccessfully to sue the U.S. government, arguing that the military was negligent in diagnosing and treating Polanco’s PTSD and other potential psychiatric disorders. On October 7, 2013, her efforts were exhausted. The Supreme Court threw out the case, after having ready been denied at the district and circuit court level.

Richardson found her way to me by way of an article I’d written last year about two families who filed a similar lawsuit against the U.S. government claiming negligence in the murders of their children by a loosely organized anti-government militia of soldiers at Georgia’s Fort Stewart Base. She initially reached out to Brian Brook, the lawyer representing the victims’ families in the Georgia militia case. Unable to help her legally, as her case had already been dismissed at every level, Brook referred her to me.

“I just feel like the military has swept this under the rug,” Richardson tells me in her Kentucky twang, which makes every statement sound rich and cheerful despite her frustration. “Hardly anyone knows about this. He was a senior in high school. Things should have been handled differently, this could have been prevented.”

As I explained in my piece about the Georgia militia murders, Richardson’s stonewalling is not an uncommon outcome for attempts to hold the military responsible for negligence. I wrote at the time:

"The Federal Torts Claim Act allows an individual to sue the U.S. government for wrongdoing committed by someone acting on the government’s, or in this case the military’s, behalf. Timothy Bakken, a law professor at West Point, explains that the Army generally cannot be held responsible for crimes that are committed by soldiers outside of their jobs, such as killing civilians. There is one exception to that rule, however, which was established by the 1988 Supreme Court case Sheridan v. United States. That precedent indicates that if the plaintiffs can prove the Army knew the members of the FEAR militia were violent and may have had a motive to kill civilians like Michael and Tiffany, then the Army had an obligation to stop them."

Documents obtained by the El Paso Times through a Freedom of Information Act request reveal that Polanco’s mental and emotional struggles had affected his behavior prior to the shooting. He had reportedly missed a number of early-morning formations, faltered on work assignments, and disappeared without warning for days. He threatened a lieutenant who told him he had to participate in physical training.  He was also frequently becoming indignant, refusing to take orders from higher-ranked soldiers if they had not served in combat. The morning that Polanco allegedly shot and killed Smith—and wounded another unidentified Fort Bliss soldier—his wife and mother had gone to the soldier’s superiors with concerns about his erratic behavior, pleading with them to do something.

Still, prior to the shooting, records show that Polanco managed to convince his officers that he was capable and in good mental health, taking care to make himself look presentable and even admitting that he’d been suffering from combat-stress problems but claiming he was seeking treatment. His platoon sergeant hadn’t required that Polanco prove he’d been to counseling because he “didn’t want to make him stop seeking help, thinking that the chain of command would be judging him.” When he disappeared prior to the shooting, an uncle of Polanco’s called a former platoon sergeant to inform him that his nephew was in El Paso and “had some serious mental-health problems, but was able to put on a good show to those in authority.” His platoon leaders had reportedly been in the process of getting a “command referral,” allowing them to communicate directly with the base’s mental health professionals about Polanco.

If the military can’t prevent violence, how can the civilian mental health system—for which its twice as hard to force treatment upon the unwilling—be expected to?

Renee Richardson may never get the justification she needs for her son’s untimely death. But her tragedy offers an opportunity to consider how, if at all, such violence can be stopped.

The truth is, people suffering from mental illness account for only about 4 percent of violent crimes committed in the United States. Still, as we continue to discover what treatment mass killers like Adam Lanza and Jared Loughner received for mental illness before their respective shooting sprees, gun rights proponents argue that the real problem plaguing our society is not unrestricted access to guns but insufficient access to mental health treatment.

If the case of Gerald Polanco—or Navy Yard gunman Aaron Alexis or Fort Hood shooter Nidal Hasan—proves anything it’s that there are no simple solutions. The military is one of the few institutions in this country whose members’ employment is dependent on their mental health screenings. Suing the military for negligence has proved a waste of time and money, suggesting that even as it’s tasked with monitoring the mental health of its members it can almost never be blamed for the actions of its mentally ill soldiers.

So if the military can’t be held responsible for violence enacted by the mentally ill among their ranks, how can they prevent it?  And if the military can’t prevent it, how can the civilian mental health system—for which its twice as hard to force treatment upon the unwilling—be expected to?

*****

Elspeth Cameron Ritchie is a retired career Army psychiatrist who served for five years as the Office of the Army Surgeon General’s top advocate for mental health, and is now the chief clinical officer for the District of Columbia’s Department of Mental Health. She is quick to differentiate between mild and severe mental illness; the definitional difference between who’s allowed to remain in the military and who’s not. Despite being subject to regular mental health screenings—before admission, immediately after returning from deployment, and periodically throughout service—most mental illnesses are identified by fellow soldiers, not military doctors.

“People who want to get into the military aren’t going to self-report something that is going to disqualify them from joining,” Ritchie tells The Daily Beast. “That’s why basic training is important: eating, sleeping with other people. That’s when major mental illnesses are more likely to show.”

Of course, mental illnesses can develop after joining the military. Not only PTSD, but severe mental illnesses such as schizophrenia often emerge in one’s late teens or early twenties. And fellow soldiers cannot always be relied on to report strange behavior, especially when someone is called up for training or deployment after being in the reserves.

“There is always a pendulum between public health and public safety and patients’ rights. It’s a debate over privacy and how much the government can monitor you,” explains Ritchie. “If you’ve joined the military, you’ve agreed to be monitored. Similarly if you’re a police officer, you have a greater responsibility, you have to be fit for duty. Whether or not you can do that kind of evaluation on the civilian population is an enormous question.”

But that pendulum has slowly swung in the direction of increased supervision of the mentally ill, nearly six decades after the start of the deinstitutionalization movement. Starting in 1955, severely mentally ill people, who would previously have been resigned to life in a public psychiatric hospital, were discharged and the institutions that housed them subsequently closed. According to critics of deinstitutionalization, this caused the country’s current shortage of psychiatric beds.

In November, Virginia State Senator Creigh Deeds was stabbed 10 times by his 24-year-old son, Austin “Gus” Deeds, who then shot himself to death. The altercation happened one day after the younger Deeds was taken by police to a local hospital for a mental health evaluation and released shortly thereafter because there were no psychiatric beds available for him. Mental health advocates pointed to the Deeds’ tragedy as proof of a growing crisis, arguing that a continued shortage of hospital beds for psychiatric patients would be responsible for future acts of violence.

“You see over and over again that somebody tried to get them into treatment and they refused to go or they went briefly,” says Ritchie. “You don’t hear stories about people who are in treatment and taking medication. You hear stories about the people who the system failed.”

Though the majority of violent criminals in this country are not mentally ill, Ritchie notes that certain mental illnesses are more often associated with violence and prevention often means well-timed intervention. Among the mentally ill, young men in the early phases of psychosis, out of touch with reality, suffering from paranoid delusions, and not receiving treatment are often at the highest risk of hurting someone—or, more likely, themselves.

“Studies show one in 5 people in their early phases of psychosis will have a suicide attempt, which is a really high number,” says Jason Schiffman, a University of Maryland-Baltimore County professor of psychology and staff member at Maryland’s Center for Excellence on Early Intervention for Serious Mental Illness. Last year, Maryland’s General Assembly responded to the 2012 shooting at Sandy Hook Elementary School in Newtown, Connecticut by dedicating $1.2 million to create the center, which focuses on identifying early signs of psychosis and treatments to prevent future violence.

Schiffman and his colleagues work mostly with young people between the ages of 14 and 22, who are either referred by parents or guardians or come of their own volition, complaining about things like bullies or trouble making friends.

“They may not have the full symptoms of psychosis, such as delusions, or beliefs held onto tenaciously despite evidence to the contrary. They may not be hearing voices or believe the FBI has planted a microchip in their tooth,” Schiffman explains. “But a lot of times people who eventually develop psychosis have anxiety symptoms early on. They suffer from distress that they can’t exactly explain.”

It’s up to Schiffman and his colleagues to identify which of these young people’s angsts are early signs of psychosis and get them started on treatment. Schiffman’s research shows that the Behavior Assessment System for Children, Second Edition (or the BASC-2), a checklist that helps identify a range of mental illnesses, is often effective at spotting these signs. Still, while Schiffman thinks universal mental health screenings would be beneficial, the BASC-2 is only currently administered to young people already receiving mental health services. Which brings us to the issue of self-reporting and forced treatment.

Last month, an Associated Press report revealed that Washington Navy Yard shooter Aaron Alexis had convinced Veterans Affairs doctors that he was not suffering from any mental health issues, despite exhibiting strange, paranoid behavior. Before his shooting spree, which killed 12 last September, Alexis left a note claiming that over the previous three months—during which he’d visited VA doctors and repeatedly denied feeling stressed, angry, or anxious—he’d been the target of low frequency radio waves. The family of one of Alexis’ victims, a 51-year-old cyber security expert named Mary Francis DeLorenzo Knight, is suing the government for $37.5 million, claiming that the Navy and Department of Veterans Affairs missed signs that the shooter was suffering from mental illness.

Gerald Polanco told his platoon sergeants that he was seeking treatment for his PTSD, but no one ever bothered confirmed it. “In the Army it’s easier to force treatment. You essentially can say ‘you either get treatment or you don’t stay on active duty, and even if they get treatment sometimes they aren’t fit for duty,” says Ritchie. “In the civilian world it’s much harder.”

Laws on committing people to involuntary inpatient treatment vary from state to state, but in most cases a court is required to deem the person to be some combination of mentally ill, unable to function independently, and a danger to themselves or others. Even when the police bring someone in for a psychiatric evaluation, the hospital usually can’t hold them for more than 48 hours.

“You don’t want to say that just because someone has a mental illness they have to go and stay in a hospital without any rights,” says Ritchie. “On the other hand, we want to prevent horrific crimes.”

Schiffman points to countries like Norway and Australia which have dedicated money and resources to increasing access to mental health care while simultaneously working to reduce the stigmas associated with mental illness.  “In Norway, mental health concerns are not considered something you have to hide or something that makes you a bad person,” said Schiffman. “In Australia, they approach young people from a community-oriented perspective. Mental health centers are kind of like YMCAs, where young people are playing pool, talking, not stigmatized into hiding who they are.”

With much discussion of how increased mental health treatment can prevent future gun deaths, the United States are far from countries like Norway and Australia in de-stigmatizing mental illness. In fact, Ritchie worries that rules like those proposed by the federal government last month aiming to prevent people who’ve received involuntary psychiatric treatment from buying guns, will only encourage those suffering from mental illness to stay silent.

“We want to have people willing to seek treatment,” said Ritchie. “If someone is worried that their rights are going to be taken away, it will decrease their likelihood of seeking treatment.”

Ritchie, who has 24 years of military experience and even more as a psychiatrist, doesn’t think keeping guns out of the hands of the mentally ill will take much of a chunk out of our country’s murder rate anyway. Indeed, more people die of suicide by guns every year than murder, she points out. “Military bases in places where it’s relatively easy to obtain weapons, like Texas or North Carolina, have higher suicide rates than bases like Fort Drum in New York.”

Ritchie isn’t hopeful about the future of gun laws, but ideally she’d like to see an enforced cooling period: requiring a person to wait a few days or weeks between buying a gun and purchasing ammunition. Or mandatory training for gun shop employees to recognize signs of violence or suicide.

“Most people who are going to shoot up a dozen people aren’t going to talk about that [in a mental health screening,” she says. “But it’s much easier to kill a lot of people at one time with a weapon than it is with a car or a knife or your bare hands.”

Renee Richardson knows she'll likely never be able to assign blame for her son's death—she's done fighting for that. All she wants is for people to know what happened, so that while the country struggles to agree on how solve our shooting problem, perhaps another tragic death like her son's could be prevented.