3 Calls to Arms Concerning the Sandy Hook Shooting
Below are three calls to arms concerning the Sandy Hook Elementary School Shooting, or at least in reflection of it. I aim to make no conclusion here, that is not the intent. These articles are here so that each call can be known, compared, and reflected upon. Each individual is highly respected on their platform, and each would likely prefer not to be considered a conclusive intellect in their area of study, but their unique background and perspective contribute nonetheless.
1. Gun Laws Must Change
On Wednesday night, I hosted a town hall-style debate on guns in America,
talking to lawmakers, mass shooting survivors, lawyers, gun lobbyists --
anyone, basically, who has a strong opinion about what I consider to be the
single biggest issue facing America today.
Since I
joined CNN two years ago, there have been a series of gun-related tragedies,
including the attack on U.S. Rep. Gabrielle Giffords and the Aurora, Colorado,
movie theater massacre.
Each sparked
a short-term debate about guns. Yet each debate fizzled out with zero action
being taken to try and curb the use of deadly weapons on the streets of
America.
Now,
following the grotesque slaughter of 20 innocent young children at Sandy Hook Elementary School in Newtown, Connecticut, I
sense that the mood has changed.
We have
reached a crucial moment in this debate, and I intend to use my platform to
continue this conversation on Wednesday night and going forward. The media have
previously been quick to move on to other stories after these tragic acts of
gun violence. That must change.
I've made my
own views clear on my show -- the senseless killing has to stop. High-powered
assault rifles of the type used at Aurora and Newtown belong in the military
and police, not in civilian hands. High-capacity magazines, too, should be
banned. And background checks on anyone buying guns in America should be
comprehensive and stringently enforced.
As President Barack Obama said, doing nothing is no longer an
option.
But, at the
same time, law-abiding Americans who want to protect themselves under the
Second Amendment right to bear arms must be respected. As should the rights of
Americans to use guns for hunting and sport.
This is a
vital debate for the country. Some 12,000 people are murdered in the United
States with guns every year, compared with just 35 in Britain, where there are
strong gun laws.
Sandy Hook
should, and must, be a tipping point for real action to bring this number down
Piers Morgan - A graduate of Harlow
College and winner of The Celebrity Apprentice. In broadcasting and journalism
since 1985, Piers is now the editorial director of First News, a national newspaper for
children, and host of Piers Morgan Tonight on CNN, which he began
hosting on 17 January 2011.
2. How to rebuild the mental health system in America
It is time
to rebuild America's mental health care system, and to build it stronger than
ever. As I have said before on this site, the current system is shattered, on
its knees and a profound national embarrassment.
The
tragedies in Aurora, Colorado and in Newtown, Connecticut and the shooting of
Congressman Gabrielle Giffords and President Reagan and thousands of murders
around the country might well have been prevented if the mental health care
system were appropriately robust and paid special attention to those at risk
for violence.
Just as
promising, a reliable mental health care system could offer real hope to the
many millions of Americans currently untreated, under-treated or incompetently
treated, saving thousands more deaths from suicide and many billions of dollars
each year in lost productivity.
The
tragedies in Aurora, Colorado and in Newtown, Connecticut and the shooting of
Congressman Gabrielle Giffords and President Reagan and thousands of murders
around the country might well have been prevented if the mental health care
system were appropriately robust and paid special attention to those at risk
for violence.
-
In order to
accomplish this, psychiatrists must be placed back at the center of the mental
health care system. Psychiatrists are trained during four years of college
(preparing to meet stringent medical school admission requirements), four years
of medical school and four years of residency training in hospitals to properly
diagnose mental disorders, properly consider the impact of underlying medical
problems on those disorders and properly balance the potential impact of
treatments, including psychotherapy and psychopharmacology and new
technologies, including repetitive transcranial magnetic stimulation (rTMS).
Social workers, psychologists, nurses and non-psychiatry physicians can each
have an extremely important role to play in rendering care to psychiatric
patients, but they should not be the orchestrators of such care.
Largely to
save money, insurance companies are most responsible for decimating the mental
health care system in America by demanding such low payment scales that social
workers and nurses have been trying to do the heroic work of trying to act like
psychiatrists, while psychologists have been agitating for the right to prescribe
medications so they can make more money and while internal medicine physicians
and family physicians have too often tried to treat complex mental illnesses
with medications alone, ignoring the fact that psychological factors fuel those
illnesses and must be addressed.
The
pharmaceutical industry has vigorously pursued this downstream transfer of
knowledge—with online "educational" symposia, for example—to place as
much prescribing power in the hands of non-psychiatrists as possible.
A
psychiatrist, therefore, should be--by state legislation--available to any
psychiatric patient, no matter what that person's insurance coverage. That
psychiatrist should be--by legislation--compensated not only for quick
medication visits, but also as the coordinator of the patient's care, being
duty-bound to check in and advise on the work of anyone treating a psychiatric
condition. This coordinator role should include not only paid outreach to
counselors, social workers, nurses or internal medicine (or other) physicians
by phone or confidential email, but also actual, hour-long meetings with each
patient, not less than monthly (even if medication visits by the psychiatrist
are ongoing at the rather indefensible clip of 10 or 15 minutes a month). The
practice of medication management being limited to once every 90 days by
insurance companies should be prohibited by law.
In order to
prevent psychiatrists from emerging from training only prepared to write
prescriptions, psychiatry residency training programs should not be certified
if they do not provide sufficient training to residents in psychotherapy
techniques. It is a profound loss to the American people that a profession
based in empathy has been coerced to abandon its listening arts in favor of
turning out many graduating psychiatrists who have never been in psychotherapy
themselves and do not know how to perform it reliably, either.
Non-psychiatrist
clinicians (other than psychologists) should also be advised by state
departments of public health that it is undesirable for them to treat complex
cases of major mental illness without the direct supervision of a psychiatrist.
The practice
of insurance companies withholding payment for patients' inpatient
hospitalizations for mental disorders (including substance dependence) must be
substantially curtailed. I propose that an insurance company reviewer be
contacted prior to admitting a person to the hospital, but that no further
contact be permitted (or, at minimum, "required") with that insurance
company until the patient is ready for discharge. The only real reason such
contact is now made while a person is being treated is so that insurance
companies can pressure psychiatry units into prematurely discharging patients.
Once a decision to admit the patient has been made, the insurer should get out
of the way and prepare to pay the bill. Furthermore, I propose very substantial
penalties to any insurer for any case in which inpatient hospitalization
coverage was denied, and in which an appeal to two independent psychiatrist
reviewers shows that, on clinical grounds, it should not have been denied.
These independent psychiatrist reviewers would be retained by the hospital from
a panel of such psychiatrists certified by each state to review those cases in
which patients were admitted despite denial of insurance coverage.
Intermediate
care "crisis units" should be established in much greater numbers
within community mental health centers and in as many private hospitals as wish
to create them. These crisis units would replicate the "unlocked" or
"open" psychiatry units of the past (now almost extinct) and serve as
healing centers for those not ill enough for a locked inpatient unit, or those
who have partially recovered after an inpatient stay, but are not yet ready to
go home.
I would
leave it to individual states to determine how to relieve insurance companies
of the burden of long-term hospitalizations. (...some material omitted for length).
In order to
increase the quality of the work conducted on such psychiatry units, I propose
that each inpatient hospitalization result in a complete psychiatric history
being generated that includes documentation of outreach to outpatient
clinicians currently treating the individuals, outreach to prior outpatient
clinicians who have treated the individuals, interviews with at least two
first-degree relatives and a psychological history and plan that focuses on
defining both the emotional forces and the medical issues that may have
impacted the patient in the past and may be impacting the patient currently.
Sadly, most inpatient hospitalizations are no more today than a rush to switch
medications and get patients to "contract for safety" (to promise
they won't kill themselves or others—even if they don’t mean it) so they can be
thrown out by insurance company reviewers and the clinicians who too often
blindly do their bidding.
The current
knowledge base available to identify the relatively small percentage of
psychiatric patients at risk to commit violence toward others is woefully inadequate.
Hence, I believe a "future violence assessment tool" should be
developed by the National Institute of Mental Health to help screen for those
individuals who may be most at risk to hurt themselves or others (many of whom
will admit readily to their violent thoughts--if asked appropriate questions).
Restricted grants from the federal government to states should fund the
dissemination of such a tool, once it is available. This assessment should be
part of the complete psychiatric history noted above.
Prior to
discharge of any patient who is rated as a significant risk for lethal violence
toward others, a consultation by a forensic psychiatrist or psychologist should
be obtained.
"Court
clinics" which are currently maintained by states should be expanded, with
clinicians available to route defendants with serious psychiatric symptoms to
state psychiatric units for assessment. These clinicians should also weigh in
as expert witnesses to help put in place treatment plans that will be
incorporated into the terms of probation for psychiatrically ill individuals
convicted of violent crimes. These plans could include enforced psychotherapy,
medications, drug testing, or all of these.
Because many
psychiatric patients who have been violent in the past (or who are clearly at
risk for violence) refuse treatment as outpatients, states should be encouraged
to rapidly pass legislation that allows for "outpatient commitment"
of such individuals when stringent standards for dangerousness are met. This
would allow clinicians (or concerned family members working with a clinician)
to rapidly petition courts to enforce psychotherapy and medication treatment in
the community and immediately hospitalize those individuals who discontinue
such treatment.
All this
would be a beginning. We have allowed the disassembling of the mental health
care in America, giving into the lowest common denominator of treatments and
handing control of our gutted system to insurance companies and drug
manufacturers. Some may argue we did this in hopes of dialing back overzealous
treatment strategies during the period of "deinstitutionalization."
But I believe the real decline was fueled by the stigma still indefensibly
associated with mental illness. Because such a shoddy system of care would never
be allowed to exist in the world of cardiology or endocrinology or oncology.
This is by
no means a complete plan. Elements of it may be challenged, and should be
challenged. I hope others could contribute more creative and comprehensive
solutions to some of the shortcomings I have noted. Perhaps it would be wise
for the President to appoint a Deputy Surgeon General wholly dedicated to the
task.
Six days ago
20 children were killed by yet another mentally ill man who I believe we will
learn was inadequately treated. Enough is enough. Mental illness is rampant in
our society, and we have no real system with which to fight it.
Let us build
such a system, again.
Dr. Keith Ablow, a graduate cum laude of
Brown University and John Hopkins Medical School, is a forensic psychiatrist
and a Fox New Contributor with current practice in New York.
3. Time
(Original Post September 15, 2012)
So,
yesterday something horrible happened. Today we’re all searching for answers,
for causes, for something to make some sort of sense out of it. I don’t have
any of those answers.
Some
are going to dive headlong into various debates about public policy, rights,
and administration. This will, no doubt, spark conversations about gun control,
school policies about security, and maybe even human rights discussions
concerning mental health issues, records, disclosure and therapy. These discussions
are important and need to be tackled; but I don’t think that they can really
address the root of what is happening in our nation.
This
year we have had three major shootings in our nation. Over the past 15 years or
so, public shooting rampages have become somewhat of an epidemic.
Two
days ago I did something regrettable.
It was a behavior that many would not consider out of the ordinary, but for me
it is a sin. This behavior hurt me, hurt my family, hurt my relationship with God,
and will no doubt hurt my friends, even if they never realize it.
My
sin and this shooting epidemic are indirectly linked[1] because
they are products of the same culture. We have a problem in America; and it is
not our policies, our politics, our parties, our classes, or our laws. Our
problem is in our hearts.
I
have found, with my own sinful tendencies, that character cannot be molded by
rules and regulations. Character may be suppressed by laws for a time, but,
like alcohol during prohibition, it will always find a way to express itself.
We will never be able to make enough rules to change who we are; and no matter
what kind of policy changes we make, new security measures we enact, or
opportunities we take away, a mentally unstable individual will be able to find
a way to act out on his or her delusions. I have found that there is only one
answer to the problem of evil; and that is God.
Evil
is not something that is external to us. It is not embodied by Satan. It is not
rooted in the oft-maligned “them,” nor is it the exclusive policy of either
democrats or republicans. We cannot defeat evil through the ballot box or on
the congressional debate floor. Just like the Kingdom of God, the Kingdom of
Evil exists within our hearts; it is in us; and it is in our hearts that evil
must be conquered.
The
problem that our nation is experiencing is a problem of culture. Culture is
really nothing more than the collective weight of a million individual
decisions made by millions of individual people in individual situations. The
only way that culture changes is for those individual people to make
different choices.
School
shootings are a product of our culture, and as such, they are a product of
those millions of individual decisions. It is a monumental mistake to think
that we as individuals are not at fault for the shooting epidemic that has
gripped our nation because our individual choices are part of that collective
consent, a collective complicity. My own poor choices from just two days ago
are part of the tilled cultural ground from which our cultural problems grow.
I
am not defined by the mistakes of yesterday, but by the forgiveness of today.
We are not defined by the good we failed at, but by the good we attempted to
do. I am not defined by my poor choices, but by God’s grace. We are not defined
by how we have fallen, but by the one who was raised up, on a cross, for us.
Now, with the after-image of evil still burning in our vision, it is time to
let that forgiveness, that grace, that love flow through us and define our
world; it is time to let our individual choices be determined and defined by
the same love that gave itself up for us. That is the only way in which evil is
conquered; that is how we change the world.
Jonathan Pelton
(Jonathan is a
Graduate with Honors of Nazarene Theological Seminary and a contributor.
Jonathan can be followed at www.outofleftfield.blogspot.com)
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