As a licensed clinical counselor, I’m not surprised the Lewiston shooter fell through the cracks of mental health treatment. I see comments that his two-week hospitalization was obviously inadequate, but that is more care than many patients receive. Most insurers don’t cover the scope of services that could meaningfully help someone like Robert Card, who – based on reports from his family, friends and colleagues – had paranoid delusions and was becoming aggressive. Card’s mental health kept deteriorating, and we know the rest.

I also suspect some mental health worker in Katonah, New York, saw news of Lewiston’s mass shooting and thought with despair, “I told you so.” This has happened to me reading news stories on violent crime in Maine: The perpetrator was my patient, and I had raised concerns about them but was ignored. Most of my patients are kind, respectful community members. But whenever I did identify a safety threat, managers dismissed my clinical judgment, convinced I was “overreacting.” They simply don’t want responsibility for appropriate intervention, even when staff report exactly the signs of danger that Card showed: psychotic symptoms causing hostility toward others – and access to guns.

In my view, Card’s case shows two failures in U.S. mental health treatment: inadequate care and disregard for safety. The biggest problem here, no question, is gun laws. But to anyone concerned about mental illness as a contributing factor to gun violence: We need to provide far better individualized services, and we need to start taking front line staff’s warnings about unsafe patients seriously.

Rosalie Genova, LCPC, CCS
Portland

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