Legislation not enough to catch next Florida school shooter

 In Politics

A patient and doctor are pictured. | Getty

Florida law does allow for forced outpatient treatment through the state’s landmark mental health law in 2016. But experts say it’s so woefully underfunded that it hasn’t been fully implemented in most communities. | Getty

TALLAHASSEE — To prevent more mass shootings, Gov. Rick Scott and Republican lawmakers want to pump as much as $138 million into the state’s mental health system, but experts say the proposals would do little to stop the next Nikolas Cruz.

The problem with identifying and treating a person like Cruz — the 19-year-old who confessed to killing 17 people at Marjory Stoneman Douglas High School on Feb. 14 — is that he displayed to mental health counselors behavior that they believed didn’t require intensive therapy. And he refused to recognize he had a problem and resisted treatment that could have required institutionalization.

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What’s more, they say, the legislation would create a parallel “shadow mental health system” in which schools, instead of the state’s already underfunded system, are duplicating services and trying to handle kids like Cruz with general mental health provisions that would be woefully inadequate.

And even in the current system, there’s no uniform assessment tool that can reliably predict who’s just an angry young man and who’s a budding mass shooter — a task that becomes even more complicated in a state awash in firearms and a patchwork of ad hoc mental health services that the state doesn’t fully fund or closely track in some cases.

“We know who the angry young men are, but we don’t know who out of the angry young men will become shooters,” Pensacola child psychiatrist Scott Benson said. “These angry young men frequently have psychopathic traits; often they don’t want treatment, which requires extraordinary skill on the therapist over a long time and is very costly.”

In sum, he said, “mental health does not have the answer to this problem.”

Indeed, the seriously mentally ill commit only 4 percent of all violent crimes, according to a widely quoted 2014 academic study.

And when it comes to people like Cruz, Benson said, the solution might be found in a controversial practice: institutionalization, which was largely halted and discouraged after a landmark 1999 Supreme Court case concerning the disabled. Benson said people like Cruz, assuming they can be identified, might need to be institutionalized for at least a year and for maybe even as long as three years — an extreme and expensive measure not even contemplated in either bill.

The House and Senate are proposing commissions to investigate Cruz’s numerous red flags — including violent threats and 39 house calls over a seven-year period — to determine what could have been done to prevent him from slaughtering former classmates and teachers. But neither of their proposals address the inpatient treatment centers that experts say might have been his only viable option for help.

Cruz, according to neighbors and acquaintances, was always troubled, showed violent tendencies and even tortured toads, stabbed rabbits with a stick, attempted to kill squirrels and tried to sic his dog on a neighbor’s piglets. Benson said that, though he hadn’t evaluated Cruz and couldn’t make a diagnosis, he suspected the young man had displayed sociopathic tendencies.

And many sociopaths don’t think there’s anything wrong with themselves and resist and refuse treatment.

Cruz did just that when he turned 18 and refused to allow the Broward County school district to continue giving him mental health services.

“You can’t make someone do something when the law says they have the right to make that determination,” Broward Schools Superintendent Robert Runcie told the Sun-Sentinel.

Florida law does allow for forced outpatient treatment through the state’s landmark mental health law in 2016. But experts say it’s so woefully underfunded that it hasn’t been fully implemented in most communities. And if Cruz were a psychopath, it could have required several hours of costly daily therapy. An hour of mandatory daily therapy would cost about $28,000 yearly, according to figures from the Central Florida Behavioral Health Network.

Had authorities caught him while he was still a minor, he could have potentially been placed in a state-contracted psychiatric hospital for kids through the Statewide Inpatient Psychiatric Program, an Intermediate Care Facility like a nursing home or a secure treatment facility through the juvenile justice system.

Institutionalization through SIPP would have cost $152,201 through the state’s Medicaid program, according to Agency for Health Care Administration data. Agency spokeswoman Mallory McManus told POLITICO there was no waiting list for SIPP services, but she didn’t know whether any contracted hospitals were at capacity because the agency doesn’t track that information.

In 2016, Cruz and his family were investigated by Department of Children and Families caseworkers after he had been cutting himself live on Snapchat, according to DCF records, to see whether he qualified to be temporarily committed. They determined he did not qualify under Florida’s Baker Act, which allows authorities to hold someone for three days for mental health evaluations.

In examining the records available, experts say Cruz likely would not have qualified for either an Intermediate Care Facility, because he was not disabled, or a juvenile justice treatment program, because he had never been arrested. And even if he had qualified for residential commitment through the juvenile justice system, he couldn’t have gotten into one. There’s currently a waitlist of 331 kids.

While the money lawmakers are proposing is welcome, the mental health community says it’s not targeted enough to violent kids like Cruz.

Dean Aufderheide, a forensic psychiatrist who runs Florida’s inpatient mental health program for prisoners, said there needs to be a new way to examine angry young men and determine who could be a killer.

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