Alternative Treatment

Each time there is a mass shooting or bombing in America, typically carried out by one or two individuals who are young, single and male, the gun control/mental illness debates start all over again. They last for a few days or weeks, then dissipate with little or nothing done about either issue, even though it seems completely reasonable to suggest that some more regulation of gun purchase and ownership, and some more budget allotted for the treatment of those with mental disorders, could only be a net positive in any society.

Notwithstanding such reasonableness, gaining political traction for policy changes regarding guns or mental illness is, at the very least, difficult. A current case in point is the effort coming from Gabrielle Giffords, a former member of Congress who, along with 18 others, was shot and critically injured by a mentally-ill young male in 2011 at an outdoor meeting in a suburb of Tuscon, Arizona. Ms. Giffords, still recovering from her head injury, and her husband, Mark Kelly, have founded the nonprofit Americans for Responsible Solutions which, while supporting the Second Amendment, aims at "keeping guns out of the hands of dangerous people like criminals, terrorists, and the mentally ill". In launching their organization one year ago today (just a few weeks after the Sandy Hook Elementary School shooting on December 14, 2012), Giffords noted that their goal was to reduce gun violence by matching the considerable resources of the gun lobby; reports indicate she is well along in obtaining donations - some $11 million by the end of last year - to press her positions in the upcoming 2014 Congressional elections. But no one thinks translating such efforts into new policy will be easy - in April 2013, a bi-partisan bill to simply expand background checks failed to pass the Senate. And to the extent that the American Congress is focused at all, it is on broader budget, unemployment and foreign policy issues.

But while change anytime soon in gun laws through the political process seems improbable, another branch of government has been aggressively addressing the sister issue - mental illness. Courts, in both America and Canada, responding to an ever-increasing number of mentally-disordered accused coming through the courthouse doors, have for over a decade been developing so-called Mental Health Courts. There are now some 300 such courts in the U.S., about a half-dozen in Canada. The movement - essentially, the decriminalization of the mentally ill - has two primary objectives: first, to deal efficiently and expeditiously with pre-trial issues of fitness to stand trial, and secondly, to at least slow down the "revolving door", whereby the mentally ill, often though not always charged with relatively minor offenses, return to court so frequently as to at times overwhelm operations. Treatment under this system is not incarceration, followed by release of persons who then re-offend, only to start the whole process again. Rather, through a team that includes specially-trained judges, prosecutors, clerks, social workers, psychiatrists, and probation officers, all assigned permanently to the court, the goal is to achieve stabilization of the offender, and to ensure that the accused leaves the court equipped with a set of clear conditions and expectations, with clothing and residence, with social assistance and therapy, and with frequent follow-up. The Massachusetts' Mental Health Court program, now being expanded beyond Boston, Springfield and Plymouth, is known as being particularly careful in both its initial assessment and subsequent monitoring, with probation officers checking every day with a relatively small number of clients who must prove they are free of recreational drugs including alcohol, who, if prescribed, must keep themselves appropriately medicated at all times, and who must report to their presiding judge once a week. 

There is little yet in the way of comprehensive evaluation of this new approach to treating mentally ill offenders. Preliminary studies suggest recidivism rates have dropped by half compared with traditional systems. By giving participants a second chance, with a "survival kit" that includes professional monitoring and back-up whenever required, it would seem to be an effective approach to reducing criminal offences, including gun violence. Ms. Giffords may wish to re-think her strategy by focusing more on this court system, rather than continuing to work within a sclerotic political framework in Washington.