The shooting deaths of two men by Thomas Caffall near Texas A&M University—followed by the killing of Caffall by police—marks another in the chain of homicides that will ultimately lead us to reinvigorate and revamp America’s mental health care system.
Only a massive public education campaign about how to identify and get help for those under siege by psychiatric illness, together with state laws that allow psychiatrists wider authority to enforce psychiatric treatment, will, ultimately, do any good. Changing gun laws will do nothing (unless they were loosened to allow more Americans to defend themselves). Those psychiatrically disordered individuals who murder with no apparent motive—with their minds hobbled by reality-twisting illnesses like severe depression, paranoid disorder and extreme personality disorders—would inflict no fewer casualties with their cars, or with blow torches or with makeshift bombs.
Caffall’s violence follows shocking mass murders at a movie theater in Aurora, Colorado and a Sikh temple in Oak Creek, Wisconsin.
In each case, we will learn that the killers were displaying symptoms of psychiatric illnesses which were mishandled or ignored.
In Aurora, at the University of Colorado, we already know that James Holmes’ psychiatrist, rather than hospitalizing him against his will, apparently referred her concerns to a campus committee that never fully addressed them, since Holmes withdrew as a student.
In Wisconsin, we already know that Wade Michael Page, after being assigned to an elite psychological warfare unit in the armed services, was abruptly given a less than honorable discharge in 1998—raising questions about whether he had displayed troubling thoughts or behavior even back then.
And in Texas, we hear that Thomas Caffall abruptly quit his job, and became a recluse who played video games all day. His altered mental status was anything but a secret. According to published reports, Caffall’s stepfather had become convinced that he might hurt or kill one of his own family members.
Now, this should go without saying, but it needs to be said, because many millions of people don’t know it or behave as though they don’t know it: When a person seems to be laboring under the effects of psychiatric symptoms and arouses the particular concern that then individual could become violent, then one should call 911, or the community mental health center “crisis team” in the area, or the local emergency room and endeavor to have that person evaluated.
Confidentiality is not relevant. Being right or wrong is not relevant. Being worried is the only thing that is relevant. And mental health professionals should get wise to the fact that you don’t pussyfoot around with illnesses that can get people killed—including the people suffering with them.
Far too often, clinicians think it is their job to instantly predict whether someone will be violent, when the truth is that they should instantly say they don’t know and that caution is the best course—even if that means an involuntary stay in a locked psychiatric unit (which, in and of itself, never killed, anyone, by the way).
Sooner or later, in the face of what I predict will be continued fallout from unprecedented social/cultural/psychological stressors, coupled with a shabby, shoddy, sorry excuse for a mental health care system, someone in Washington will get the point: It is time to rebuild America’s commitment to mental well-being. It has broken down under the weight of ineffective leadership from the American Psychiatric Association and the overzealous withholding of needed coverage by third party insurers. Doing so will, ultimately, save money. But much more importantly, it will save lives.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.