Consider more inpatient mental health treatment

Santa Fe, Texas – Last week, I sat in this small Texas town and listened to a mother tell me how a gunman killed her son as he hunkered in a classroom closet. Her boy was one of 10 people killed in the May 18, 2018, shooting at Santa Fe High School.

In the wake of the tragedy, she works in a counseling center that is helping the community heal. I’m glad psychiatric care is available for the victims, but there might not be any victims if the shooter had received such care.

After all, what mentally well person would shoot up a mall, a store or a school?

In recent years, our alternatives for dealing with the dangerously mentally ill have diminished. According to an Ohio State University study, there were 400,000 patients in American mental hospitals in 1950, a time when the population of the United States was half what it is today. Today, that number is about 30,000.

The deinstitutionalization of the mentally ill began in the 1970s with the best of intentions. The idea was to transition these troubled souls into community-based outpatient care. Instead, millions ended up homeless on American streets.

Communities such as East Moline, Galesburg, Kankakee, Jacksonville and Peoria once housed large state facilities dedicated not only to caring for the afflicted but protecting society from the potentially dangerous. And the story is the same in other states. Closing mental institutions, after all, was a national phenomenon.
If the rate of hospitalization had kept pace with population growth, about one million Americans would be receiving inpatient care for mental health issues, Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, said in a recent Wall Street Journal column.

Perhaps not surprisingly, the frequency of mass shootings has increased steadily since the 1980s, when the closing of state mental hospitals reached its peak.

Torrey noted that multiple studies have reported that, at any given time, between 40% and 50% of those who in an earlier era would have received hospital care are receiving no treatment for their mental illness. America emptied its public psychiatric hospitals without ensuring that the released patients would receive the necessary treatment to control their symptoms. We should not be surprised by these outbreaks of violence.
Torrey notes, multiple studies done between 2000 and 2015 suggest that about a third of mass killers have an untreated severe mental illness. If mental illness is defined more broadly, the percentage is higher. In 2018 the FBI released a report that found that 40% of the shooters had received a psychiatric diagnosis, and 70% had “mental health stressors” or “mental health concerning behaviors” before the attack.

But thinking in a broader sense, what rational person would commit a mass murder?

Mandatory injectable antipsychotic medication, which can be effective for as long as three months, may be something we should consider for individuals who refuse to take their medication. And, yes, we may need to consider expanding inpatient treatment options as well.

Is mental health treatment the only factor in reducing mass shootings? No. But it’s a good place to start.  

Scott Reeder is a veteran Statehouse journalist and a freelance reporter. Contact him at

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