When you are practicing psychiatry especially in emergency situations and hospitals, you need to be more practical. When I took the oral boards exams back in 1988 and subsequently when I was an examiner, one of the key dimensions that the examiners focused on was the assessment of dangerousness. Failing to explore that could be an exam failing mistake. Any psychiatric inpatient unit has aggression toward self or others as one of the main reasons for admission to acute care and forensic settings. With the recent fragmentation and rationing of psychiatric services, many people who would have been treated in hosptials are diverted to jails instead. That led one author to describe LA County jail as the country's largest psychiatric facility.
I have introduced the idea of looking for solutions into professional and political forums for over a decade now and it is always met with intense resistance. Some mental health advocates are threatened by the idea that it will further stigmatize the mentally ill as violent. Many people consider the problem to be hopeless. Others see it as the natural product of a heavily armed society and no matter what side you are on that argument - that is where the conversation ends.
In an attempt to reframe the issue so that this impasse could possibly be breached the Minnesota Psychiatric Society partnered with the the Barbara Schneider Foundation and SAVE Minnesota in the wake of a national shooting incident to suggest alternatives. Rather than speculate about psychiatric disorders or gun control we were focused on solutions that you can read through the link below.
The actual commentary was never published by the editor who apparently stated that there was a conflict of interest because we seemed to be fishing for research dollars. It appears that the press can only hear the cycle of tragedy, speculation about mental health problems, and the need to move on. The problem with that is that we continue to move on to another shooting.
George Dawson, MD
A Commentary Statement submitted to the StarTribune January 18, 2011 from the Minnesota Psychiatric Society, The Barbara Schneider Foundation, and SAVE - Suicide Awareness Voices of Education