we ask - what if-
interesting read
Jared Loughner's increasingly menacing behavior, what may look like a psychotic spiral in hindsight, likely would not have been enough to have him forced into psychiatric care, much less arrested.
His painful mental deterioration is detailed in public records and interviews with friends and neighbors.
But mental-health and legal experts say it's likely that no one could have seen a tragedy coming before Saturday.
That day, prosecutors say, Loughner gunned down six people outside a Safeway supermarket north of Tucson and wounded 13 others including Rep. Gabrielle Giffords.
Experts say the case offers a chilling reminder to reach out to people who may be struggling and provides further evidence that - because of gaps in the mental-health system, stigma and a lack of understanding about signs and symptoms - far too many people get treatment only after they've been arrested. Or end their lives first.
Even with Arizona's broader laws on involuntary psychiatric commitment, it's still a high bar.
"You have to have evidence that he is imminently likely to harm himself or others," said psychiatrist Chris Carson, who runs the Urgent Psychiatric Care Center in Phoenix, a crisis-evaluation facility.
"This was an unpredictable event, based on what we know," Carson said. "This is a kid who, from what I can tell, had never harmed anybody. People were put off by him. But there's no evidence that he was a danger to himself or others."
Friends say Loughner had become paranoid, obsessed with notions of what he called "conscience dreaming" and government brainwashing.
Classmates and teachers at Pima Community College were afraid of his angry outbursts. The school suspended him in September, saying he could return only if he got a mental-health evaluation.
Loughner was isolating himself. He couldn't keep a job. His Internet postings grew more ominous, such as this one on his MySpace page Dec. 13: "I don't feel good; I'm ready to kill a police officer! I can say it."
Commitment standards
It's easier to have someone committed in Arizona than in most others states. In addition to the "imminent danger" criteria, which is the standard, Arizona law also allows someone to be held against his will for a psychiatric evaluation if he is "gravely" or "persistently and acutely" disabled.
That means anyone can petition the court to seek help for someone he fears is unable to care for himself, such as a relative or a neighbor, for example, who has become so paranoid he refuses to leave his house.By most accounts, even though Loughner was growing more suspicious and anti-social, he was still functioning.
Getting professional help
During the past year, Arizona lawmakers have slashed services for seriously mentally ill adults who don't qualify for Medicaid and eliminated most general mental-health and substance-abuse coverage for adults and children.
Altogether, tens of thousands of Arizonans have lost services including therapy, housing and medication. Arizona's public mental-health system still serves roughly 25,000 people.
But Loughner doesn't appear to have slipped through the cracks of the public mental-health system.
State health officials say there's no record of him contacting crisis centers or clinics or receiving treatment. It's possible he or his parents called a crisis line without giving their name, but there would be no way to track that.
It's also not known if he sought or received private therapy. His parents could have begged him to seek help. Maybe they couldn't afford it. Or they may have chosen, like many families, to hope and pray that it would get better.
"There's a real gap between what's needed and what's available and what people can afford," said Anne Ronan, an attorney who represents the plaintiffs in Arizona's landmark lawsuit to provide care to the seriously mentally ill.
Families with private insurance can face roadblocks getting help for their loved ones, from cost to stigma to denial.
"Psychotic denial is a whole different level than neurotic denial," said Dr. Eric Benjamin, former chief of psychiatry at Phoenix Children's Hospital.
"There's a total loss of touch with reality about your own behavior. They refuse treatment or don't see they need it. Their prognosis goes down the tubes."
Too often, in such cases, the criminal-justice system becomes the doorway into the mental-health system.
"A lot of people had to come to us first," said Fredrica Strumpf, a public defender in Maricopa County's specialized mental-health court.
"I have had clients where the family comes to me and says, 'We tried, we tried, we tried. There was nothing we could do.'"
Mental-health support groups and advocacy organizations can steer families in the right direction, but diagnosis and treatment must come from a mental-health professional.
The signs of mental illness
Mental-health experts say Loughner's disjointed thinking, conspiracy theories and paranoid interactions have the hallmarks of schizophrenia.
Symptoms of mental illness, such as schizophrenia and bipolar disorder, typically emerge in late adolescence, just as teens and young adults are trying to fit in and become independent from their parents.
Benjamin said the trick is determining whether schizophrenia will lead to violence. About 1 percent of the population is schizophrenic, he said, but they are far more likely to be harmed themselves than to harm others.
"For most schizophrenics, that's a big leap," he said. "Most paranoid people tend to be shy and avoidant. They are more scared of us than we are of them. They try to avoid us."
Loughner, 22, lived with his parents in the same house he grew up in, tucked into a middle-class neighborhood north of Tucson. Friends and neighbors remember him as a typical kid in grade school, a saxophone player with a laid-back personality.
Randy and Amy Loughner probably knew their son was struggling. He dropped out of Mountain View High School as a senior in 2005, picked up drug paraphernalia and graffiti citations and was rejected from Army enlistment in 2008 because of drug use.
Then, after five years as a student at Pima Community College, his outbursts and angry interactions with teachers got him suspended.
Records released by the college this week show a troubled young man but not someone who had become violent or outwardly psychotic.
"(Loughner's) behavior is a real red flag to somebody who could recognize it for what it is," said Clarke Romans, executive director of NAMI Southern Arizona, an advocacy group for the mentally ill and their families.
Without that understanding, Romans said, the instinct is to be fearful and further isolate someone who's in need of help.
"The stigma takes over when there's a lack of knowledge," Romans said. "'This guy's a wacko. Get rid of him.' As opposed to, 'This guy needs help. How can we help him?'"
Despite Loughner's bizarre behavior, it may not have risen to the legal level of a threat that would have allowed the college to permanently remove him from campus.
And, so far, the college stands as the only record of any person or institution suggesting that Loughner get a mental-health evaluation.
Campus police received five complaints about Loughner from February through September on two campuses for disturbances in a library and in classrooms.
"Someone can be very off-putting," administrator Charlotte Fugett said. "Someone can even be frightening to some. That does not mean their actions have risen to having a direct threat against somebody."
The college suspended Loughner Sept. 29, the same day campus police discovered a YouTube video he created on the college's Northwest campus where he declared he was at war with the college.
"This is my genocide school," he said. "Where I'm going to be homeless because of this school. I haven't forgotten the teacher that gave me a B for freedom of speech."
Two campus police officers delivered the suspension letter that night to Loughner and his parents at their home. Officers spoke to Loughner for an hour in the garage while he "held a constant trance of staring" and said nothing. Finally, he spoke up. "I realize now that this is all a scam."
Loughner's parents accompanied him to a meeting with administrators Oct. 4, and he agreed to withdraw from the college.
In an Oct. 7 follow-up letter, the college said Loughner could return if he got "a mental health clearance indicating, in the opinion of a mental health professional, his presence at the College does not present a danger to himself or others."
Now, Loughner's mugshot has become the face of mental illness.
Mental-health advocates worry the case will further demonize those who are sick, rather than encourage people to reach out to each other and parents to get help for their children.
"People don't know where to go," said Vicki Johnson, director of MIKID, a non-profit group dedicated to helping parents and families find behavioral-health resources. "They're afraid to take any kind of steps. They hope it will get better.
"That first step can be very courageous. And it's scary."
At the urgent psychiatric center, Carson sees people every day who could go either way: They could deteriorate, or they could recover. But the illness will not improve on its own.
"There are lots of Jared Loughner types out there who don't end up in this situation," Carson said.
"For people who are in need and can't get in to be evaluated, it doesn't go away. It will worsen. And they will end up in the emergency room, or they will end up in jail."
