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August 20, 2018

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Experts question the effect of more mental hospitals

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Susan Stocker / Pool via The New York Times

Nikolas Cruz, the suspected gunman in one of the deadliest school shootings in modern American history, appears in court in Fort Lauderdale, Fla., via video conference on Thursday, Feb. 15, 2018. Cruz, 19, faces 17 counts of premeditated murder — one for each of the people he killed with a semiautomatic AR-15 rifle at Marjory Stoneman Douglas High School in Parkland, Fla., on Wednesday.

President Donald Trump called again on Thursday for the opening of more mental hospitals to help prevent mass murders such as the one at Marjory Stoneman Douglas High School in Parkland, Florida.

Yet ramping up institutional care, experts say, likely would not have prevented most of the spree killings regularly making headlines in this country.

“We’re going to be talking about mental institutions. And when you have some person like this, you can bring them into a mental institution, and they can see what they can do. But we’ve got to get them out of our communities,” the president said during a meeting at the White House with state and local officials.

In the 1960s, states across the country began to close or shrink mental hospitals after a series of court decisions that limited the powers of state and local officials to commit people. The decline continued for decades, in part because of cuts in both state and federal budgets for mental health care.

Those institutions housed people with severe mental disorders, such as schizophrenia, who were deemed unable to care for themselves. And while spree killers may be angry and emotionally disordered, few have had the sorts of illnesses that would have landed them in hospital custody.

The latest school shooter, Nikolas Cruz, 19, was clearly troubled and making threats, and he was stockpiling weapons. But he had no mental diagnosis. He has been described as angry, possibly depressed, perhaps isolated — not so different from millions of other teenagers.

A full psychiatric evaluation, if he’d had one, might have resulted in a temporary commitment at best, but not full-time institutionalization, experts said.

The idea that more such institutions would prevent this kind of violence “is ridiculous, because you can’t put half the people in the country with a mental disturbance in mental hospitals,” said Dr. Michael Stone, a forensic psychiatrist at Columbia University who has studied mass killers.

He added: “Most of these shooters are angry, anti-social individuals you cannot spot in advance, and even if you could, you don’t have the right to institutionalize them.”

The Sandy Hook murderer, who killed 26 elementary school children and teachers with an automatic weapon, did receive top-flight psychiatric attention at the Yale School of Medicine; he was not institutionalized.

The notorious Columbine High School mass murderers, Dylan Klebold and Eric Harris, likely had depression (Klebold) and psychopathy, an inability to feel empathy (Harris), researchers have found. But neither diagnosis would have made them candidates for lengthy hospitalizations.

The same is true of Elliot Rodger, the young man who killed six people and wounded 14 others in Santa Barbara, California, and Dylann Roof, the racist church murderer in Charleston, South Carolina.

Seung-Hui Cho, the Virginia Tech University shooter who gunned down 32 fellow students, had received a psychiatric evaluation — and was released. Stephen Paddock, the man who killed 58 people with assault rifles in Las Vegas in October, had no known mental health history.

And none of these men and boys had a history that remotely predicted their savage acts.

The decline in mental hospitals over the past half-century is of central importance to mental health care in the United States. That decrease — to about 40,000 psychiatric beds in the country from some 500,000 in 1955 — has coincided with an increase in homelessness and, in recent decades, explosive growth in the number of people with mental disorders who end up in prison.

Reversing that trend could have made a difference in two recent spree shootings, said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, which lobbies for more investment in psychiatric beds for people with severe mental illness.

Jared Loughner, who killed six people and wounded former Rep. Gabby Giffords, D-Ariz., in a 2011 attack, was clearly psychotic and harbored dark fantasies. The same was true of James Holmes, the graduate student who gunned down 12 people in a movie theater in Aurora, Colorado.

“I think these are instances where having a bed available could have helped, but there was nowhere to put them,” Torrey said.

The one thing all of these murderers had in common was access to military-style weapons. Around the time psychiatric hospitals began to close, weapons designed for maximum kill ratios entered the market.

The earliest school shootings, before the late 1960s, “were mostly young kids that got into angry arguments with teachers or with another pupil, sometimes in rivalry for a girlfriend, or because they got expelled — and they killed one or two persons, never large numbers of people,” Stone said.

“For that, you need the semi-automatic guns that came in the late 1960s.”