The Shooting and its Effects on Mental Health Treatment

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Not sure what you're implying. Also, oops, I meant "take up" smoking.

[QUOTE=Iwillheal;12832135

We may reconsider gun laws because everything else being equalQUOTE]

absolutely. In fact, I encourage to put together a movement on a state by state basis in which you work to getting that through a great majority of state legislatures.......you know, like the way the CONSTITUTION has to be amended.

Until then, it's not an issue.

leftists make up their own bizarre wishs/interpretations of the second amendment all the time. The fact is clear- us owning guns is protected by the bill of rights.

Even in a fantasy world where the second amendment doesnt exist, anti-gun legislation would still have massive uphill battles.

Originally Posted by digitlnoize

Bump.

I have to wonder about this Batman guy. Reports are that his mom instantly recognized him as the perpetrator. If true, it would seem she had recognized some degree of maladaptive behavior in him...which, from what we know now, was untreated.

I think this just underscores the fact that we need better public awareness and willingness to seek and refer for mental health evaluation and treatment when a problem is suspected or recognized.

?????

to evaluate what exactly?

yes he has maladaptive behavior. What the hell is psychiatry supposed to do about it?

Umm...for the presence of a treatable condition maybe? Apparently, this guy was banned from a shooting range after he called and left a "nonsense" message which disturbed the owner of the range so much he told his employees not to let the guy some there...supposedly.

If true, how about instead, the range owner calls someone and gets the guy evaluated. If that phone message was strange enough for a layperson to recognize it as "off" and possibly dangerous, I think a reasonably competent psychiatrist could tell whether something was going on that might warrant treatment or not.

Not saying we should do risk assessments on these people, but a simple mental health screening by even a social worker when there is a concern might do a world of good in identifying people at risk earlier in the course of their disease.

Originally Posted by digitlnoize

Umm...for the presence of a treatable condition maybe? Apparently, this guy was banned from a shooting range after he called and left a "nonsense" message which disturbed the owner of the range so much he told his employees not to let the guy some there...supposedly.

If true, how about instead, the range owner calls someone and gets the guy evaluated. If that phone message was strange enough for a layperson to recognize it as "off" and possibly dangerous, I think a reasonably competent psychiatrist could tell whether something was going on that might warrant treatment or not.

Not saying we should do risk assessments on these people, but a simple mental health screening by even a social worker when there is a concern might do a world of good in identifying people at risk earlier in the course of their disease.

I think as someone said earlier, in the absence of obvious psychosis, impairment in reality testing, etc not much can be done. He's not wanting treatment after all. And I doubt he is going to admit "yeah, Im planning to shoot up a theatre tommorrow"....

Originally Posted by vistaril

I think as someone said earlier, in the absence of obvious psychosis, impairment in reality testing, etc not much can be done. He's not wanting treatment after all. And I doubt he is going to admit "yeah, Im planning to shoot up a theatre tommorrow"....

Ironic, just the day after the shooting some guy get pulled over doing over 100 and essentially does just that.

"State Police in Maine say they arrested a man driving erratically Sunday morning with a cache of weapons in his car, including an AK-47 assault weapon, four handguns and several boxes of ammunition, CBS Boston reported.

Courtois also allegedly told authorities when he was arrested that he was en route to Derry, NH to shoot a former employer

http://www.cbsnews.com/8301-504083_1...man-with-guns/

Originally Posted by surftheiop

Ironic, just the day after the shooting some guy get pulled over doing over 100 and essentially does just that.

"State Police in Maine say they arrested a man driving erratically Sunday morning with a cache of weapons in his car, including an AK-47 assault weapon, four handguns and several boxes of ammunition, CBS Boston reported.

Courtois also allegedly told authorities when he was arrested that he was en route to Derry, NH to shoot a former employer

http://www.cbsnews.com/8301-504083_1...man-with-guns/

of course....occasionally this happens. Im still not sure what it has to do with psychiatry. Psychiatry doesn't need to immediately get involved to take actions such as you describe above.

It's not like a he jumped from being a completely social "normal" person into someone who wants to go on a rampage overnight. It's probably true that once everything was set in his mind, intervention wouldn't have done much. But he was doing badly in school, uncharacteristically, so it was most likely a gradual process, and intervention at some stage could have changed things. I'm not sure what's so contentious about that.

Originally Posted by vistaril

in the absence of obvious psychosis, impairment in reality testing, etc not much can be done.

Yeah. But, from the reports from the shooting range owner, he may have HAD obvious psychosis.

All I'm saying is that it would be nice to do a basic screening exam on people when people in the public have these kind of suspicions and some evidence.

It could start with a call: "This weird guy called and said some weird stuff."

Then, move to an investigation: "Hello School A? I'm wondering how Person X has been doing lately?"

At this point, for this guy at least, we may have had reports of erratic behavior, a recent drastic decline in school performance despite earlier stellar efforts...which should be enough to get him in front of a mental health professional of some type for a Q&A session to see if there might be some illness that could be treated.

I don't have all the answers here, and I'm not saying that psychiatrists should be the Ultimate Solution, but we should have better community screening for mental disorders.

Originally Posted by digitlnoize

Yeah. But, from the reports from the shooting range owner, he may have HAD obvious psychosis.

All I'm saying is that it would be nice to do a basic screening exam on people when people in the public have these kind of suspicions and some evidence.

It could start with a call: "This weird guy called and said some weird stuff."

Then, move to an investigation: "Hello School A? I'm wondering how Person X has been doing lately?"

At this point, for this guy at least, we may have had reports of erratic behavior, a recent drastic decline in school performance despite earlier stellar efforts...which should be enough to get him in front of a mental health professional of some type for a Q&A session to see if there might be some illness that could be treated.

I don't have all the answers here, and I'm not saying that psychiatrists should be the Ultimate Solution, but we should have better community screening for mental disorders.

The trouble is that is exactly how the stasi worked, by relying on people who had contact with the general public informing on each other. Open to all sorts of abuse however well intentioned...all it takes is someone to take a dislike to you for any reason and bingo you get a file opened....

http://en.wikipedia.org/wiki/Stasi

Originally Posted by Ibid

The trouble is that is exactly how the stasi worked, by relying on people who had contact with the general public informing on each other. Open to all sorts of abuse however well intentioned...all it takes is someone to take a dislike to you for any reason and bingo you get a file opened....

http://en.wikipedia.org/wiki/Stasi

Hmm...yeah, not like that. There would obviously need to be safeguards to prevent abuse. No 3 day commitments based on what Mr. X down the street says, for example.

Believe it or not, I'm actually a libertarian at heart, so I'd like to find a way to screen people that didn't involve forcing them. It doesn't have to be such a bad thing...

What do we do if someone in the community suspects someone else in the community of having TB, HIV, or something?

I don't know how you'd screen people like that without having citizens informing on each other and then forcing evaluations. I think it'd be a civil liberties nightmare, clog up an already overly clogged mental health system and in the end not do much good.

The thing that makes me sad is that this amount of people get shot and killed in this country on a daily basis and this doesn't get nearly as much attention. And quite honestly, I'd rather fix that ongoing problem than screen every odd duck out there in a vain attempt to prevent these much rarer occurrences.

I don't have all the answers here, and I'm not saying that psychiatrists should be the Ultimate Solution, but we should have better community screening for mental disorders.

I'm fine with that so long as one could suggest a realistic system that was practical and did not mess up civil liberties.

But no one's suggesting one.

Back in the day, just a few decades ago, just being weird got you into an asylum with little to no hope of getting out.

The only one I can think of that IMHO could work is to improve the mental system to diagnose people in the prodrome phase of psychosis but we don't yet have that ability.

Originally Posted by sunlioness

I don't know how you'd screen people like that without having citizens informing on each other and then forcing evaluations. I think it'd be a civil liberties nightmare, clog up an already overly clogged mental health system and in the end not do much good.

The thing that makes me sad is that this amount of people get shot and killed in this country on a daily basis and this doesn't get nearly as much attention. And quite honestly, I'd rather fix that ongoing problem than screen every odd duck out there in a vain attempt to prevent these much rarer occurrences.

on the first point, yep agreed....can't be done.

on the second point.....you can't "fix" evil. what you do is continue to do what we are doing- when evil goes out and does evil things, you try to catch them.

Originally Posted by vistaril

..you can't "fix" evil. what you do is continue to do what we are doing- when evil goes out and does evil things, you try to catch them.

I think we can do better at one thing as far as catching evil before it does evil things--and that has to do with being alert about domestic violence. Basically you've got 3 Auroras happening in this country every day, rarely with mass media coverage. If victims can know their fears will be taken seriously, before it escalates to murder (and often, murder-suicide), we *might* make a dent in that number.

Originally Posted by OldPsychDoc

I think we can do better at one thing as far as catching evil before it does evil things--and that has to do with being alert about domestic violence. Basically you've got 3 Auroras happening in this country every day, rarely with mass media coverage. If victims can know their fears will be taken seriously, before it escalates to murder (and often, murder-suicide), we *might* make a dent in that number.

the problem I see with domestic violence is that there is no way for the criminal justice system, social servive system or whatever to protect one of the *real* fear female victims have, which is that they are afraid of being left if they "tell" and/or leave their abuser......

Neither me nor law enforcement nor an women's support agency can make an abusive husband or boyfriend stay with his wife he has been abusing.....

a little off topic, but PHQ2 screening for depression is common in primary care settings, and the AHA has listed depression/anxiety as risk factors for heart disease, so will screening in general at a PCP level for other mental illness become the norm at some point? Are there say, rapid screens with high sensitivity for Schizo or PTSD or whatever for use in a non psychiatric setting?

It's possible and is done frequently in some settings. It's common screening (depression and PTSD) at VA...

so will screening in general at a PCP level for other mental illness become the norm at some point?

I fear doing so will severely cut civil liberties or label people with an incorrect diagnosis. Most PCPs I know that screen for mental illness use a screen that's not reliable or valid. Some of the PCPs I find doing this are diagnosing way too many people with bipolar disorder.

Originally Posted by whopper

I fear doing so will severely cut civil liberties or label people with an incorrect diagnosis. Most PCPs I know that screen for mental illness use a screen that's not reliable or valid. Some of the PCPs I find doing this are diagnosing way too many people with bipolar disorder.

I could see/agree with the use of screeners if, with a "hit," the individual is then potentially referred for further evaluation. However, if the screener is actually serving diagnostic purposes, then the administrator isn't using it properly, given that most screening instruments are designed to be highly sensitive at the expense of specificity (resulting in the over-diagnosis that you mention).

I asked this in the thread that got deleted, but...

What happens if someone in the community suspects someone else of having TB or something?

Like, if I am living in an apartment building and I see the new immigrant guy downstairs coughing up blood and generally looking like death, is that reportable somehow?

Some infectious diseases must be reported....

But to apply this to psychiatry, the problem here is there isn't very good data showing that mental illness in general causes violence. Sure, we all know that some schizophrenics are violent due to the schizophrenia, but as a whole, the population isn't violent depending on what study you read.

My own personal opinion is that psychosis does raise violence if you look at specific facets of it. Positive symptoms, the most being paranoid delusions raise it, negative symptoms actually decrease it. I came to this opinion after reading several evidenced based articles on mental illness and violence with several suggesting there was no correlation, others saying there is and each one using a different mathematical method. IMHO the studies did not look at the specific facets of psychosis well enough. Of course someone who is schizophrenic catatonic type is most likely not going to be violent, but when the studies looked at it, they lumped all schizophrenic patients together without comparing the subdivisions. Catatonic patients were thrown in with the paranoid ones and IMHO they cancelled each other out.

As for bipolar patients, I'd say irritability and impulsivity are things I'd be on the lookout for. Reminder this opinion is based on clinical experience, not evidenced based data.

And getting to the point, if you're going to start red-flagging people before they've done anything yet, you got to be damn sure you are correct because then you're going to be robbing people of their civil liberties who weren't going to be violent. I haven't yet seen a test to predict future violence based on empirical evidence that gets to the degree of accuracy needed. If you're going to take away someone's civil liberties, it has to be based on data that is very clear, very easy to understand, and is reliable and valid.

IMHO, the next step is to start looking as specific aspects of psychosis or mania and not to lump the disorder as a whole in predicting future violence.

The most accurate factor in predicting future violence is prior significant violence, but in the Holmes case, we did not see it.

Originally Posted by whopper

The most accurate factor in predicting future violence is prior significant violence, but in the Holmes case, we did not see it.

That, or because he was an intelligent individual, he was just better at hiding it/explaining it away.

I do think it would be interesting to gather some data on violent offenders with mental illness, and seeing if there are significant differences between those with and without histories of violence (e.g., perhaps the previously-nonviolent offenders have histories of other transgressive behaviors, such as voyeurism, are more likely to be "internalizers" and have extreme peaks of anxiety/depression, and/or have difficulties with interpersonal assertiveness couple perhaps with very "unforgiving" and rule-based thought patterns ala OCPD-type stuff...all of which are absolute and complete guesses).

I also agree with you, whopper, that when it comes to schizophrenia (and psychosis in general), more attention needs to be devoted to delineating specific symptoms. Even better than going by subtype (or at least in addition to subtype) would be, as you've said, something along the lines of differentiating those with predominantly positive and negative features. I know schizophrenia researchers, particularly those dealing in interpersonal/social functioning and theory of mind, have been doing so (with some data indicating that the paranoid type in particular represents a unique condition, especially when looking at variables such as monitoring eye movements and picking up on nonverbal cues...at least as best I can remember), but it's not as widespread as it needs to be.

I did see one study that actually did separate psychotic patients into positive sx and negative sx and the positive sx group was more at risk for future violence and the negative sx group was at lower risk. This made sense to me, and it is what I am seeing clinically. The problem is that this is merely one study among several.

Nuts, I don't have a link to it. It was printed in the green journal years ago.

As for existing methods to predict future violence, they're not that accurate. This is not a professional conclusion, but the only thing so far in the Holmes case that I've read that could've tipped off anyone is the notebook he sent the psychiatrist that wasn't read until after the event happened---though that particular new piece of information would've been significant, if only if it could've been found before it the shooting occurred. The existing methods we have are more on the order of being able to identify something with extremely hazy vision vs. being blind.

That, or because he was an intelligent individual, he was just better at hiding it/explaining it away.

True.

Originally Posted by whopper

Some infectious diseases must be reported....

But to apply this to psychiatry, the problem here is there isn't very good data showing that mental illness in general causes violence.

I actually don't think if matters whether they're violent or not. It just seems that we could identify and treat more people (and be more aware of current patient went off treatment) if the general public would help out and say, "hey, there's this strange guy down here..."

Whether they're violent or not...if they're psychotic, they should be treated.

Originally Posted by vistaril

the problem I see with domestic violence is that there is no way for the criminal justice system, social servive system or whatever to protect one of the *real* fear female victims have, which is that they are afraid of being left if they "tell" and/or leave their abuser......

Neither me nor law enforcement nor an women's support agency can make an abusive husband or boyfriend stay with his wife he has been abusing.....

One of the reasons this is a fear for women is because the abuser often has forced the victim not to work and has progressively socially isolated them to the point they are completly reliant on the abuser for their (and their childrens) survival, its almost like a form of slavery.

In the case of a marriage where the abuser has any sort of assets, law enforcement (really the court system) can help this situation by awarding financial settlements in the divorce proceedings. For non-married individuals, social programs for victims of abuse would additionally help to alleviate the very real fear that they will have no where to live if they call the police on the abuser.

Additionally psychological damage/ PTSD inflicted by abuse contribute to the fact that victims often don't advocate for themselves. As a psychiatrist, you have numerous ways you can educate and help your patients overcome the obstacles between them and safety.

Its a hard situation, but sitting back and washing our hands of the matter and vaguely blaming the victim for not leaving is not the best care we can offer.

Originally Posted by digitlnoize

I actually don't think if matters whether they're violent or not. It just seems that we could identify and treat more people (and be more aware of current patient went off treatment) if the general public would help out and say, "hey, there's this strange guy down here..."

Whether they're violent or not...if they're psychotic, they should be treated.

There are a lot of people in the mental health field that have trouble differentiating between the mentally ill and the just-plain weird. The thought of taking any steps to having John Q. Public more entitled to report individuals for odd beliefs or mannerisms scares the bejeezus out of me. The 0.01% of the valid catches would not justify the 99.9% of the nonsense.

Originally Posted by surftheiop

Its a hard situation, but sitting back and washing our hands of the matter and vaguely blaming the victim for not leaving is not the best care we can offer.

I couldn't summon up the energy to refute yet another one of his posts. Thanks for taking the time to do so eloquently and thoughtfully.

Originally Posted by digitlnoize

I actually don't think if matters whether they're violent or not. It just seems that we could identify and treat more people (and be more aware of current patient went off treatment) if the general public would help out and say, "hey, there's this strange guy down here..."

Whether they're violent or not...if they're psychotic, they should be treated.

Or how about just mildly paranoid and isolative...

d

CNN, looking to do some "quality" news, decides to break a story on Holmes' psychiatrist along with her picture FRONT and CENTER...gee, looks like America has a new "bad guy" in this case.

http://www.cnn.com/2012/07/27/justic...html?hpt=hp_t1

The comments are telling of some "average american" sentimental of psychiatrist responsibility...

-"The psychiatrist should go to jail as an accessory to murder."
-"Dr. Lynne Fenton looks a few cans short of six pack herslf."
-"death penalty for both of them"
-"Apparently she wasn't a very good psychiatrist."
-"One has to wonder what she was saying to this young man."
-"This woman could avoid all this mess but like many other psychiatrist, she just want to analyze the money paid by the medical insurance. Possibly, she sleep well after this tragedy, it is sad."
-"Who the hell would listen to any psychiatrist?? After they finish all their sessions for the day they go talk to their psychiatrists to help sort out their own issues. Nut jobs.......all of 'em"
-"Just looking at his physiognomy, the Dr who fail to diagnose this lunatic should never practice again. Yes, I said it. We have too many so call professionals that sit through these consultations and waste money and as a result innoence lives. What a shame. Only grief and pain remain... "


EDIT: CNN greatly lengthened the original article, somewhat diluting the content to not be all about the psychiatrist -- subsequently shifting the comments to a more focus on Holmes and politics now.

EDIT EDIT: Some 6 hours later, CNN has taken the psychiatrist's picture down completely and replaced it with a slideshow of other people. Interesting.

Originally Posted by Blais

CNN, looking to do some "quality" news, decides to break a story on Holmes' psychiatrist along with her picture...

http://www.cnn.com/2012/07/27/justic...html?hpt=hp_t1

The comments are telling of some "average american" sentimental of psychiatrist responsibility...

"The doctor should be in jail too"
"death penalty for both of them"
"Apparently she wasn't a very good psychiatrist."
"This woman could avoid all this mess but like many other psychiatrist, she just want to analyze the money paid by the medical insurance. Possibly, she sleep well after this tragedy, it is sad."

Oh my:

"I want to know what MEDICATIONS this guy was on. Almost all of these mass killers (including the Columbine killers) were on anti-depressants at the time of the shooting.

Nevermind the gun lobby - the PHARMACEUTICAL lobby is the one we should be concerned about."

etc.

Originally Posted by digitlnoize

I actually don't think if matters whether they're violent or not. It just seems that we could identify and treat more people (and be more aware of current patient went off treatment) if the general public would help out and say, "hey, there's this strange guy down here..."

Whether they're violent or not...if they're psychotic, they should be treated.

Interesting. The tradeoff is an interesting debate, including what ultimately can be considered justification for removal of basic civil liberties. Varies by state. Should suspicion be enough? If psychosis is a criteria for treatment over objection, how much psychosis? Just having AH? Paranoia? How about if it's drug induced psychosis? How about if it MIGHT be drug induced? I'd actually be curious to read responses on these questions.

Examining the trend in the UK with DSPD might give a point of reference. The history is that in the UK psychiatrists (in a completely public system) didn't want to treat anything falling under axis II. There were then a couple of high profile murders by individuals with mental illness of some form. No one knew quite what to do with a psychopath (everyone on the same page as this being distinct from psychotic, right), so the government (non mental health professionals) decided to create their own diagnostic category of DSPD (Dangerous and Severe Personality Disorder) which was for anyone with a mental health issue and dangerousness. They then mandated that DSPD inpt units be created, where those with DSPD could be kept indefinitely on concern of a risk of violence for "treatment" (though no one had a particular treatment for their violent tendencies).

Do we want to go down that road? In that case psychiatrists didn't want the responsibility for these individuals, and were mandated to treat this group by the government.

"hey, there's this strange guy down here..."

And just how will you get someone who's "strange' to agree to an evaluation where he'll be sent to a hospital, have to wait possibly for hours, and then get billed for it?

Hmm, Hey Joe, you're odd. I have a goon-sqaud here to make you go to the hospital against your will. You'll be there for 12 hours. When you walk out you'll get a bill for a few hundred bucks. I'm doing this because I don't like that Justin Bieber picture on your desk. It just weirds me out. No grown man should like Justin Beiber.

CNN, looking to do some "quality" news, decides to break a story on Holmes' psychiatrist along with her picture FRONT and CENTER...gee, looks like America has a new "bad guy" in this case.

And this is a new development. This now begs the question what did she know and did she have reasonable evidence to believe he was a future danger? What was his diagnosis?

Originally Posted by whopper

And just how will you get someone who's "strange' to agree to an evaluation where he'll be sent to a hospital, have to wait possibly for hours, and then get billed for it?

Hmm, Hey Joe, you're odd. I have a goon-sqaud here to make you go to the hospital against your will. You'll be there for 12 hours. When you walk out you'll get a bill for a few hundred bucks. I'm doing this because I don't like that Justin Bieber picture on your desk. It just weirds me out. No grown man should like Justin Beiber.

Says the man who used to have David Hasselhof in a Speedo as his avatar...

I just can't help myself....Maybe I need to get an evaluation against my will and pay a few hundred bucks for it?

Ummm...dragging this back on topic...

What a nightmare for the doc!

It's bad enough when you get the call that one of your patients has succeeded in killing themselves (which is practically a given for each of us at some point in our career, if it hasn't happened to you already)...but this has got to be horrific. And then to have to be subjected to that kind of public commentary...

One of my colleagues had to let a guy go (perfectly justifiable based on the info at hand, the charting was impeccable, etc...) and a couple weeks later he committed a murder/suicide on his estranged wife. Never easy--especially when you look at some of these domestic dirtballs who abuse, control, and you just feel in your gut that something bad is going to happen--but hey, the judge won't commit on "gut" feelings, and there's nothing now that supports keeping him in...

Getting serious, I know of one case where a patient killed an elderly woman, and her outpatient doctor IMHO was incompetent. Although the case was high profile and plastered all over the local news, the doctor was never really investigated. The local news got experts who mentioned that the way mental health is, it's just so inaccurate that this doctor may have done the best he could.

I know this doctor and he's terrible. I didn't know for a fact if he screwed up on this particular one but he screwed up with almost all his inpatients I've seen.

Holmes's lawyers have call upon doctor-patient privilege to keep the notes from being used in court by the prosecution.

Originally Posted by nitemagi

Interesting. The tradeoff is an interesting debate, including what ultimately can be considered justification for removal of basic civil liberties. Varies by state. Should suspicion be enough? If psychosis is a criteria for treatment over objection, how much psychosis? Just having AH? Paranoia? How about if it's drug induced psychosis? How about if it MIGHT be drug induced? I'd actually be curious to read responses on these questions.
.

So I think that since we can't predict who is going to commit violence let alone who is going to recover from schizophrenia (many psychiatrists unfortunately thinking everyone follows the downward path they see in residency)....along with the fact that people with schizophrenia and psychotic disorders are more likely to have violence committed against them than them committing violence...along with hearing voices themselves - in some people - not presenting other impairments...along with just our poor predictive abilities about anything as a field, I say no, we shouldn't be removing civil liberties along those veins.

Originally Posted by Blais

CNN, looking to do some "quality" news, decides to break a story on Holmes' psychiatrist along with her picture FRONT and CENTER...gee, looks like America has a new "bad guy" in this case.[/I]

They also apparently went to her on-campus office (stopped by security) and home. Seriously? Invading her personal life all so that what, she could tell them that she can't comment on whether or not he was even her patient, let alone anything of import?

So I think that since we can't predict who is going to commit violence let alone who is going to recover from schizophrenia

Well we can predict future violence, though in general the accuracy is not spot-on.

With today's level of what we know, our accuracy is better than a layman, but not much better. IF certain things happen, then the accuracy goes up--but those things need to happen and they don't always do.

In the Holmes case, the notebook would've been very good reason to act, and I believe enough to have gotten him held for at least 72 hours, but the problem was the doctor didn't get a hold of it until after the event happened.

Originally Posted by whopper

Well we can predict future violence, though in general the accuracy is not spot-on.

With today's level of what we know, our accuracy is better than a layman, but not much better. IF certain things happen, then the accuracy goes up--but those things need to happen and they don't always do.

In the Holmes case, the notebook would've been very good reason to act, and I believe enough to have gotten him held for at least 72 hours, but the problem was the doctor didn't get a hold of it until after the event happened.

Agreed.

Originally Posted by whopper

Well we can predict future violence, though in general the accuracy is not spot-on.

With today's level of what we know, our accuracy is better than a layman, but not much better. IF certain things happen, then the accuracy goes up--but those things need to happen and they don't always do.

In the Holmes case, the notebook would've been very good reason to act, and I believe enough to have gotten him held for at least 72 hours, but the problem was the doctor didn't get a hold of it until after the event happened.

Agreed.

Originally Posted by whopper

And just how will you get someone who's "strange' to agree to an evaluation where he'll be sent to a hospital, have to wait possibly for hours, and then get billed for it?

Hmm, Hey Joe, you're odd. I have a goon-sqaud here to make you go to the hospital against your will. You'll be there for 12 hours. When you walk out you'll get a bill for a few hundred bucks. I'm doing this because I don't like that Justin Bieber picture on your desk. It just weirds me out. No grown man should like Justin Beiber.

I could envision a system where at least people could make reports, which could then be enough to not detain anyone, but to at least make sure they hadn't recently purchased large quantities of weapons and ammo. If something else dings during the investigation, THEN the person's civil liberties could be infringed upon and held for an eval.

An alternative (for those, like me, who detest big brother snooping my credit cards records) would simply be a system where people can report "odd behaviors" and if the behaviors were deemed severe enough (i.e. more serious than liking Bieber), then we could simply ASK that person if they would mind speaking to someone, for free. The incentive could be that if they agreed to an eval, then any future treatment could be paid for by the government, but if they declined the eval and THEN needed future treatment, they'd have to pony up for it themselves...

Or something. I would like to come up with a way where we could have better mental health screening BEFORE out patients get so sick they must held against their will. Basic education in schools about mental illness would be a good start. For example, explaining that schizophrenia is not the same as having "multiple personalities" and bipolar does not simply mean "mood swings."

Originally Posted by digitlnoize

For example, explaining that schizophrenia is not the same as having "multiple personalities" and bipolar does not simply mean "mood swings."

God, I wish.

Originally Posted by Blais

CNN, looking to do some "quality" news, decides to break a story on Holmes' psychiatrist along with her picture FRONT and CENTER...gee, looks like America has a new "bad guy" in this case.

http://www.cnn.com/2012/07/27/justic...html?hpt=hp_t1

The comments are telling of some "average american" sentimental of psychiatrist responsibility...

-"The psychiatrist should go to jail as an accessory to murder."
-"Dr. Lynne Fenton looks a few cans short of six pack herslf."
-"death penalty for both of them"
-"Apparently she wasn't a very good psychiatrist."
-"One has to wonder what she was saying to this young man."
-"This woman could avoid all this mess but like many other psychiatrist, she just want to analyze the money paid by the medical insurance. Possibly, she sleep well after this tragedy, it is sad."
-"Who the hell would listen to any psychiatrist?? After they finish all their sessions for the day they go talk to their psychiatrists to help sort out their own issues. Nut jobs.......all of 'em"
-"Just looking at his physiognomy, the Dr who fail to diagnose this lunatic should never practice again. Yes, I said it. We have too many so call professionals that sit through these consultations and waste money and as a result innoence lives. What a shame. Only grief and pain remain... "


EDIT: CNN greatly lengthened the original article, somewhat diluting the content to not be all about the psychiatrist -- subsequently shifting the comments to a more focus on Holmes and politics now.

Interesting... as of right now, there is no longer an image present of the psychiatrist. Wonder if she contacted CNN or what. Kind of funny going from having her be the only image (a HUGE image btw) smack-dab at the beginning of the article to now only a slideshow of [seemingly] everyone else BUT her.

Glad they took her down.

I could envision a system where at least people could make reports, which could then be enough to not detain anyone, but to at least make sure they hadn't recently purchased large quantities of weapons and ammo. If something else dings during the investigation, THEN the person's civil liberties could be infringed upon and held for an eval.

In short, a type of "waiting period" system for ammo? For guns, if certain things are on your record, you can't get a gun, well you can't legally.

The legal system and medical system's records are usually separate and with good reason. I see where you're coming from with this. The problem is how do you effectively bridge them to create such a new system? It'll take legislative action. Correct me if I'm wrong because my post is based on what I think you mean and I may have misinterpreted you BTW: that Bieber comment, I was being semi-sarcastic. No offense meant, just wanted to highlight that I don't think it's realistic to force people to have evaluations simply because they're weird.

Originally Posted by whopper

In short, a type of "waiting period" system for ammo? For guns, if certain things are on your record, you can't get a gun, well you can't legally.

The legal system and medical system's records are usually separate and with good reason. I see where you're coming from with this. The problem is how do you effectively bridge them to create such a new system? It'll take legislative action. Correct me if I'm wrong because my post is based on what I think you mean and I may have misinterpreted you BTW: that Bieber comment, I was being semi-sarcastic. No offense meant, just wanted to highlight that I don't think it's realistic to force people to have evaluations simply because they're weird.

Yeah, kind of. Not really a waiting period, but more of a real-time monitoring system, where someone's recent purchases could be checked if they met serious enough criteria. Not a system where everyone is monitored all the time, but one where if the shooting range owner says, "I got a call from a guy and he said, "..." and it was very strange and really scared me, then the system could be accessed to see if there was any evidence for risk.

I think the current "waiting period" for guns is laughable. There are plenty of ways to get a gun, and the system doesn't take into account the chance that it might be your first offense, like this guy.

Again, I really care much less about the firearms stuff. I just think we could spin this into a legislative reason to teach better mental health awareness in schools, on TV, and in the community.

Not sure how it works in other countries, but here in South Australia the first line in mental health treatment tends to be the GPs (General Practioners/Primary Care Physicians). If the person's illness is a tad too far out of their scope of training, or their are co-morbid complications, uncertain diagnosis, etc, they can order what's known as a 291 assessment from a Psychiatrist, who will see the patient, run through whatever tests need to be done, form a diagnosis, and then come up with a treatment plan that the GP then implements with the help of the Psychiatrist.

Next level after that is ACIS (Acute Crisis Intervention Service). Usually initiated if someone is showing signs of psychosis, self harm, suicidal or homicidal ideation, etc. It generally involves a home visit from a Psych RN & Social Worker to assess a patient's risk/sickness level, and the if necessary the patient is referred onto one of several ACIS outpatient centres for further assessment & short term, crisis help, if needed.

Final level is involuntary medication, involuntary hospitalisation & also the possibility of the being placed under a finance order (not sure of the exact correct term) by the Public Trustee. Any of these, beyond the standard 24-72 hour hold, have to go before a tribunal, which back in the 90s at least consisted of a panel of 3 Doctors who considered all the evidence, hospital reports, psych evaluations, etc, before making a decision. A lot of people I don't think realised that there was a lot more to it than just forcing a patient to comply with a medication regime, they were also provided with other healthcare checks, drug and alcohol monitoring, and so on. Patients going before the Tribunal were allowed to have an advocate, including a lawyer, speak on their behalf. I only know of one person who actually fought a Tribunal decision, and won. He suffered a psychotic break 2 weeks later, after injecting crystal meth, and committed suicide by train. They interviewed me for the coroner's report, it was a rather surreal experience.