Sandy hook shooting: Was Adam Lanza lashing out against treatment?

Sandy Hook shooter Adam Lanza may have been motivated by anger at his mother because of plans to have him committed for treatment, Fox News reported Thursday, citing comments from the son of an area church pastor and an unnamed neighborhood source. Fox also cited an unnamed senior law enforcement official saying anger at plans for “his future mental-health treatment” were being investigated as a possible motive.

While the Fox reports are still uncorroborated, other media reports paint a general picture that suggests Ms. Lanza was growing increasingly concerned about the mental health of her son.

These reports are bringing to light a debate over where to set the bar when it comes to forcing an individual into treatment – and whether those caring for people with mental-health issues have enough resources available to head off potential crises before they happen.

On one hand, warning signs are often apparent, so making it easier to commit someone for involuntary treatment could save lives.

The young adult men who end up being violent often “have others in their lives … who are trying desperately to get help before something bad happens. They can see it coming down the pike,” says Liza Gold, a clinical professor of psychiatry at Georgetown University School of Medicine. But caregivers “have run up against these commitment laws that are so restrictive – that come down so far on the side of civil liberties and privacy – that it is almost impossible to contain, hospitalize, treat someone with a chronic and escalating mental illness.”

On the other hand, forced treatment can also be emotionally wrenching for the patient and cause lingering anger, mental-health experts say.

“People who are forcibly treated so often feel traumatized by it,” says Robert Whitaker, author of “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.” “Women in particular will sometimes talk about it almost like a quasi-rape, because sometimes they are held down and injected,” he says.

For its part, Connecticut leans strongly toward supporting the civil liberties of individuals, making involuntary treatment difficult. It is one of six states that does not provide the option of "assisted outpatient treatment,” which allows qualifying individuals to receive court-ordered treatment in the community without being committed to a facility.

Moreover, an individual needs to be dangerous before intervention is possible. The state’s standard does not take into consideration an individual’s past psychiatric history, such as repeated hospitalizations or symptoms of psychiatric deterioration that could culminate in violence.

“Connecticut's civil commitment laws are among the most restrictive in the nation when it comes to getting help for a loved one in psychiatric crisis,” said Kristina Ragosta, senior legislative and policy counsel for the Treatment Advocacy Center in Arlington, Va., which pushes to make it easier to commit people for treatment before they become dangerous.

Connecticut does have a law allowing for someone to be sent to the hospital for 72 hours for evaluation if he or she poses a danger to himself or others, says Kate Mattias, executive director of the Connecticut branch of the National Alliance on Mental Illness.

Emergency mobile psychiatric services in hospitals – including one in Danbury, near Newtown – can come to a home or other location to bring someone into the hospital, she says. And after the 72 hours, if someone can demonstrate that he or she is a continued threat, a judge can order a 14-day stay, she says.

But Ms. Mattias's group and some other advocates oppose involuntary commitment because it “creates an adversary relationship that really poisons any relationship with providers, with caregivers,” she says. “This is one of the lingering fears that people who are living with mental illness have when you start to talk about involuntary commitment – you raise this specter of, ‘They’re going to put me away and throw away the key.’ ”

According to Fox, Joshua Flashman, a US Marine and an acquaintance of the Lanzas, said Ms. Lanza “was petitioning the court for conservatorship and wanted to have him committed…. Adam was apparently very upset about this. He thought she just wanted to send him away.”

Fox was not able to confirm that with a court official, who said such records are sealed.

Later Thursday, the New York Daily News reported that a family friend said Ms. Lanza had brought her son to a psychiatrist as he became increasingly antisocial. But the unnamed friend said Ms. Lanza was not planning to have him committed. “Nancy was so dedicated to Adam,” the friend said. “She would never send him away. She just couldn’t do that.”

Experts say it is plausible that Mr. Lanza’s actions could have been triggered by anger over the possibility of forced treatment. “Generally we know that a great many violent acts, particularly between intimates, are triggered by moments of perceived loss,” says Christopher Ferguson, a professor of psychology and criminal justice at Texas A&M International University in Laredo. There’s a heightened possibility of violence, for instance, after a stalker or abuser is charged or served with a restraining order, he notes.

But even if people are willing to be committed, it’s not easy to get such treatment, because the US moved away from the asylum system in the 1950s and ’60s, Ferguson says.

There were good reasons for this, but perhaps the pendulum has swung too far and made it overly difficult for people to get mental health treatment, voluntarily or otherwise, he and some others suggest.

“The funding is so limited that the average length of stay is three to seven days, but most psychiatric medications take two to six weeks to kick in,” says Professor Gold of Georgetown.

There should be an easier way for people to at least be “contained” temporarily to calm down if someone close to them can see that they are in crisis and could become dangerous, says Gold. “These crises pass. These people don’t wake up every day of their lives [homicidal],” she says.

The details certainly aren’t clear yet about what kind of treatment, if any, Ms. Lanza previously sought, or wanted in the future, for Mr. Lanza.

She had talked about moving to Washington State with her son because of a school there that she thought could help him, according to a Concord Monitor article that quoted Mark Tambascio, an owner of My Place, a Newtown restaurant frequented by Ms. Lanza.

Other media outlets have reported that Mr. Lanza spent time in a variety of school settings and had also been home-schooled by his mother.

Parents of troubled young people may need therapeutic support themselves, says Mattias of the National Alliance on Mental Illness. There’s a strong stigma in society where parents get the message that their child’s problems are somehow the parents’ fault, she says, and “parents over time can become isolated…. It’s very very hard to handle these things on your own.”

Mothers are the highest percentage of the people murdered by mentally ill young men, Gold adds. “The [young men] are usually living at home because they are dysfunctional…. The moms don’t bail. These are their children. They hang in with them, they try to get them help. And they’re the ones that get killed.”

But mental-health advocates caution against drawing overly broad conclusions. “You can’t predict what the reaction would be [to a family member seeking to impose treatment] or whether it would increase dangerousness,” says Michael Fitzpatrick, executive director of the National Alliance on Mental Illness.

Advocates also urge a renewed commitment to prevention, so that fewer caregivers end up having to make such difficult choices

There have been comprehensive reports on how to improve mental-health care, dating back to President Carter's administration, says Robert Bernstein, president and CEO of The Bazelon Center for Mental Health Law in Washington. Early intervention and prevention are key, he says, but “when funding gets cut those are the first programs to go.… What we have now is a system that only in rare instances does anything preventive.”