Sandoval’s Promise: Nevada gun laws and mental health services

There’s nothing simple about the issues involved in the delivery of mental health care, the availability of firearms, and the tragic connections between the two.  Nevada has already experienced this.  In early September 2011, thirty-three year old Eduardo Sencion of Carson City walked into the local IHOP restaurant and killed four (including himself) and wounded eight others, of the twelve people injured or killed were five members of the National Guard. [ABC]  The entire incident took 85 seconds during which Sencion fired his assault rifle at those in the restaurant, at a passing motorcyclist, and finally took his own life. [RGJ]  Sencion’s Norinco MAK90 had been altered to fire as an automatic weapon. And then there was this chilling detail:

“Doctors diagnosed Sencion with paranoid schizophrenia when he was 18, and he took medications to control the voices that told him to do bad things, (Sheriff) Furlong said. But toxicology tests revealed that none of those drugs was in his system on the day of the shooting, the sheriff said.” [RGJ]

On October 21, 2013 seventh grader Jose Reyes took the 9mm semi-automatic hand gun he found at home to school, he wounded two students, killed a teacher, and then committed suicide.  Reyes previously told his family felt bullied by other children, and at one point was prescribed a 10 mg dosage of Prozac.  One of the elements of particular interest: ” Police believe Reyes used a family computer to search the phrases “top 10 evil children,” “bullying,” “super columbine massacre role playing game,” and “school shootings.” [RGJ]

There’s always a danger in comparing elements of disparate tragedies, but there are legitimate points of comparison.  Both shooters were male. Both were young when diagnosed with mental health issues.  Both used firearms.  Both were citizens of a state in which mental health care funding is scarce at best, and all but non-existent at worst:

Dr. Tracey Green, the state health officer, said there is not enough space in the Rawson-Neal Psychiatric Hospital in Las Vegas and other hospitals, so mentally ill people wait and wait in emergency rooms for the next available beds. In January alone, an average of 139 people have been waiting each day on Legal 2000 three-day holds. She noted additional beds soon will open, but not enough to deal with the total problem. [LVRJ] (January 29, 2014)

Then on February 20, 2014 the walk in clinic at the Rawson-Neal Psychiatric Hospital in Las Vegas closed its doors. [Channel8]  By February 27, 2014 state officials were “scrambling” to find alternatives and options for mental health care treatment. [RGJ] On May 20, 2014 the Governor’s Behavioral Health and Wellness Council made 16 recommendations to help sort the problem. [RGJ] This in a state already notorious for shipping its ‘mental health problems’ out to other communities. [SacBee]

The report’s recommendations included suggestions ranging from providing services to the most chronically ill, to improved behavioral and mental health services in Nevada schools.

“The  Council  recommends  expansion  of  high  intensity case  management  and  housing services for  the  heaviest  users  of  the  most  expensive  behavioral  health  services  (i.e.,  emergency  room,  jail,  and  inpatient  admissions.)  We  especially  recommend  expansion  of  existing  programs such  as  Psychiatric  Assertive  Community  Treatment  (PACT)  teams  and  Mental  Health  Courts.”  [BHWC pdf]

and noted:

In  Nevada,  studies  have  suggested  that  19.3 percent of  elementary  school  children  have  behavioral  health  care  needs  and  over  30 percent of  adolescents  self reported  significant  levels  of  anxiety  or  depression.  According  to  the  Clark  County  Community  Mental  Health  Center,  in  2009,  almost  one quarter  of  Nevada’s  public  middle  school  students  seriously  thought  about  killing  themselves,  more  than  30 percent had  used  alcohol  or  illegal  drugs,  and  over  13 percent had attempted suicide.  … Child  mental  health related  visits to  hospital  emergency  rooms  have  increased  steadily  in  Nevada  over  the  last  five  years.    There  is  also  an  increasing  trend  of children  requiring  a  costly  in patient  admission  to  a  hospital  due  to  a  mental  health  crisis. [BHWC pdf]

None of the suggestions come cheaply.  The implementation of many of them will require assistance from the Federal government. The activation of some will require expenditures from state funds, and from the ACA expansion of Medicaid.  However, when compared to the human costs associated with the IHOP and Sparks Middle School shootings, it would be more expensive not to appropriate the requisite amount of funding.

After reading through the report, and its recommendations it’s impossible not to grapple with the feeling that the Council made its suggestions for the most affordable level of mental health care services for Nevadans, not necessarily what would constitute recommendations for providing the best level of mental health care for citizens of the state.  Perhaps this is yet another example of how the Austerians have won the day — when we speak not about how to be the BEST in the nation, but only to how we can address immediate needs and cobble together solutions to alleviate the current crisis.   The Austerity Enthusiasts may be pleased with the modest nature of the suggestions for improvement, but the report retains its minimalist tone, as if we have somehow lost the capacity to Think Big, in a Can Do nation.

And, so we muddle along.  And so do those who might follow Seung-Hui Cho (VA Tech), Adam Lanza (Sandy Hook), George Hennard (Lubbock TX), James Huberty (San Ysidro), Eric Harris and Dylan Kleibold (Columbine), Aaron Alexis (Washington Navy Yard),  James E. Holmes (Aurora), and Joseph Wesbecker (Louisville) Gerald Loughner (Phoenix) and Elliot Rodger (Isla Vista).  Not to glorify their names, but to illustrate: Young to middle aged, male, armed, and mentally ill.  But, what do we really know?

We know that there have been at least 62 mass shootings since 1982, and they have taken place in 30 states, and in most of these cases the gunman obtained firearms legally. [WaPo]

We know that those states which have stricter gun laws have fewer incidents of gun deaths. [Atlantic]

We know that while some of the most high profile perpetrators of gun violence are/were mentally ill — mental illness in itself isn’t a major factor, indeed there is no statistical correlation at the state level between mental illness and gun deaths. [Atlantic] However, it should be reasonably obvious that if gun purchasing restrictions are lax or nearly non-existent then more mentally ill individuals will have easier access to lethal weapons.

We know that there but for the diligence of concerned parents there might have been another Nevada tragedy in the offing after a Reno police officer sold a gun to a mentally ill young man.  [RGJ]

We also know that Governor Sandoval kept his promise to the NRA and vetoed SB 221 on June 13, 2013, which would have expanded background checks for firearms purchases because it might have “burdened” our citizens and impinged on their 2nd Amendment rights. [LVRJ]


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