Mass killer and former Marine Ian David Long recently killed twelve people at the Borderline Bar in Thousand Oaks, California. As often occurs, a firearm was used by a person with history of obvious mental instability who was known to police authorities and mental health consultants. Ian Long was thought not to be an immediate threat to self or others and was apparently not seen in followed-up.

The most important aspect of preventing gun violence is making as sure as reasonably possible that psychotic, significantly mentally ill, intoxicated, and mentally unstable persons not have immediate access to guns and get prompt psychiatric attention and treatment. 

One confounding problem is the incomplete understanding of temporary mental instability of otherwise “normal persons”, mental illness in general, severe mental illness, and effective treatment. This essay proposes a  radical new way of approaching the violent person in the community.

 “Normal” Persons and Violence

Only ten percent of violent persons are psychotic. No easy approach to “normal” (or undiagnosed) persons who commit or threaten violence has been found. Except, they surely need assessment for dangerousness and the need for treatment. The effort to think about “the Normal” is important, because the majority of murders and suicides occur in persons who did not have current or prior severe mental illness. In a high percentage, the murderer was intoxicated with alcohol or another substance, and perhaps in addition to having a mental illness.

However, they, like “Normal” persons who are intoxicated and enraged, should not possess guns. A glibly recommended “anger management” program is beyond insufficient for persons threatening or strongly hinting about violence. More aggressive diagnostic and treatment programs and legal mandates for treatment need to be creatively developed and implemented aggressively in our communities.

“Patient’s Rights” and Guns

Gun violence and mass murders in America must stop. A mentally ill person who attempts or overtly threatens violence should have his civil rights suspended. Immediate psychiatric and psychological evaluation and a treatment plan must occur. The threshold for detection of violence needs to be much lower than it is currently. After a violent threat or potential threat is detected, the individual’s Second Amendment rights must be suspended for an indefinite time. All Americans must be mindful that their civil rights are contingent on their taking responsibility for the control of their behavior. Violent threats or actions mean loss of the privilege of their civil rights until they satisfy a civil process to regain their civil rights.

Handling the "Civil Rights” of Violent Persons

Prompt and thorough evaluation should be done on anyone threatening or showing warning signs of potential violence. Once a diagnosis is established, the following should be mandated by law.

The suspension of  basic “Patients’ Civil Rights” should be legally mandated until the patient is fully and positively involved in his treatment; and on the road to outpatient recovery or stability in a psychiatric hospital. At the point when treatment compliance is established, a select committee of a lawyer, a psychiatrist or psychologist, psychiatric social worker, and a mature layperson should monitor and act as resources for the patient and his family. In the in-patient setting, the patient advocate, a psychiatrist and another patient capable of serving could act as monitors. This mental health group should oversee and assure the community that the following requirements have been fulfilled:

1. Cooperation with in-patient treatment parameters or regular attendance at all out-patient treatment sessions must occur for twelve consecutive months.
2. Responsibility of the patient to take all psychiatric medications prescribed by the psychiatrist or trained prescriber for a minimum of twelve months has occurred.
3. Attendance at all recommended individual, group, or family therapy sessions has occurred for twelve months.
4. No episodes of violent or menacing behavior has occurred according to the therapist, family, spouse, or police authorities.
5. Loss of designated “patients’ civil rights” will be revoked for violations of this process and the person will start the process over again with a new community committee. After the twelve months of responsible compliance the community committee will reassess the further treatment plan compliance on a yearly basis for three years before any gun can be purchased or possessed by the individual.
6. National, state and local community records of this violence prevention program shall be readily available to gun show and firearm vendors for universally required background checks for all gun purchases in America.

A vital part of the therapy of a potentially violent person is the learning of the futility of violence to resolve or gain anything. Confrontation with one’s personal responsibility to obey the law and not harm other people or animals starts in childhood and wisdom about it is hopefully cumulative during family, school and church or community experiences. The above process would hopefully encourage active awareness of individual responsibility, and legal and social obligations

“Patient’s Rights” and Working with Hospitalized Severely Mentally Ill People.

Often a hospitalized patient will suddenly become violent or suddenly refuse to take prescribed medications. Often the staff working most comfortably and compassionately with the patient are the ones attacked. The psychiatrist and nursing staff are in a bind because legally medications can only be given in an emergency time frame.

Court procedures can be carried out to force the treatment issue.  However, the conscientious patient advocate attorney objects. The assumption here seems to be that full assertion of civil ‘patient’s rights’ is an unalterable and even healthy factor in helping the patient. Actually, the acutely or severely chronically psychotic person is often confused or unable to gain from such assertions about their civil rights. He can even incorporate his poorly asserted ‘patient rights’ into his paranoid delusional system. Further, he frequently uses his power destructively and inappropriately. He asserts that he does not have to take medications, go to group therapy, bath himself, or urinate or defecate in the appropriate locations. Other patients get angry and provoke or attempt to scapegoat the patient. The process discussed earlier would help the hospital staff to establish appropriate behavioral protocols on the unit and benefit the patients in their potential understanding about effective living in a community peacefully.