I met a possible school spree killer today

B

brandons87

250+ Posts
I'm on a psychiatry rotation right now. I'm working in a small 20 bed inpatient psych unit. I'm going to give only very general details of this case so as not to violate privacy rules.

Anyways this kid is a typical video game nerd who is in college. He came to us because he tried to commit suicide via pills. He flippantly denies all future suicide risk and says he did it simply to get back at his mom who he has some deep-seeded hate towards.

He's not really showing any signs of major depression, its more of an adjustment disorder type of picture. There's no evidence of psychotic features such as hallucinations or delusions.

Here's the kicker: the kid has access to all kinds of guns, his dad has a virtual treasure trove of (legal) guns. Furthermore, this kid has a massive sword collection. There's no evidence he's actually used these items to commit crimes, but he does have a history of fire-starting as a young kid (no animal cruelty that we know of).

Anyways, we held him on our unit for about 5 days and then had a family meeting. Since he didnt meet any criteria for major depression or any kind of psychosis, and also denied any suicidal or homicidal ideation, we released him.

Do I think he'll go shoot up his school if somebody gives him a hard time? No.

Would I be shocked if I read the paper in a couple of months and found out he went on a massive killing spree? No, honestly I wouldnt.

The reason I bring this up is because I think its typical of most of these school shooters. Its rare that you can look at these kids and say "yeah he's definitely going to shoot up the school." Its usually an extremely gray area like with this kid.

There's a good chance this kid could go on to have a totally normal life, but there's also a slight chance he could be the next Columbine shooter.

So my question is, what should the psychiatric community do in a situation like this? Insurance wont pay for ongoing hospitalization when you arent changing meds and he's not threatening anybody and pretty much stable. So thats one problem. But even if insurance would agree to pay for it, are you comfortable locking this kid up for life in a mental hospital because of the chance he could go postal?
 
This is a tough question to wrestle with. In most cases we only take away someone's liberty and freedom after they have been found beyond a reasonable doubt to have committed a crime. To take away liberty and freedom because from someone who might commit a crime in the future should require an even higher threshold, I think. One of the criminal lawyers on the board can tell us the actual standard for involuntary commitment (th OP probably knows it, too). I think it requires a clear showing that the person is a danger to himself or society.

It's easy after the fact to Monday morning quarterback and say that someone should have been committed, but I believe it should be very difficult to lock someone up because they might commit a crime.
 
yeah.... as a teacher, we all have those kids that we worry might freak out and come kill everyone. Ya just never know. We caught one last year who was plotting to shoot up my school. Managed to keep it out of the media, thank goodness. but scarey none the less.

I think we need to take the shooter's names out of the media so that they don't gain attention for this stuff.
 
i don't see why hospitalizing this kid is even coming into question. you say he has insurance, what is wrong with outpatient psychiatric care, or more likely 12 week therapy if you say it is an adjustment disorder case and not major depression? i'm guessing they will pay for that...
 
This is tough. When I was in high school (graduated '87) we had a home made BBS (yes we were nerds) where I personally posted some **** that would probably get me prosecuted today.

Bill the Vigilante was my fictional righter of wrongs and he wouldn't hesitate to carve a path of destruction through my 'enemies' both real and perceived. By and large the stories I wrote were intended for humor and stress relief and to entertain my friends.

I was no more going to go off and kill a bunch of people than I was going to bench press 500 lbs, but that was before Columbine.

I think the ones you have to watch out for are the ones who don't have a real firm grasp on reality and the ones who show sociopathic tendencies. Even then, the odds of someone actually following through on their plans are exceedingly rare and hard to identify.
 
Incarcerating someone for mental illness is really a slippery slope. See my thread on Horn Network about needing a lawyer. A friend was involuntarily committed to a mental hospital based on the recommendation of their boyfriends counselor. She had seen the counselor for 45 minutes 6 months before the incident to do a couples session. The counselor managed to convince the police that she had threatened herself and others with a gun and was barricaded in her house. None of this was true and the counselor would have had no way of knowing it even if it was true. No one bothered to ask critical questions of the counselor like "how would you know, are you sure etc." This women was able to get the SWAT team sent to my friends house and get her incarcerated for 5 days in a mental hospital before finally convincing them to let her go. She was evicted from her house, expelled from school, lost her funding at school, 7 university police walked around the department in uniform to "protect the deparment and make sure she didn't show back up". She also had to pull an abstract from a professional conference with is a huge deal. This has humiliated her and cost her her career.

A lot more care should be taken to protect people from involuntary incarceration. What happened to my friend was incredibly wrong and she is having trouble finding a lawyer to even take the case.
 
Unfortuneately, we probably all meet a potential spree shooter almost every day. People suffer depression, go through divorce, suffer financial setbacks, lose their jobs, or have mental problems-all of these people have been known to go postal. It can happen.
Society obviously cannot lock them all up until they are in a better mental frame of mind-it is a very difficult situation. Even the most deranged rarely act out violently. How can you know whick ones will actually do something horrible? There must be a hundred, a thousand, who utter similar threats, or rant, rave, are mad at their parents, school, or job, for every one who harms someone.
Can we lock them all up? We haven't been for many years now.
 
Obviously this child has some issues and I can't know all his background from an internet posting, but that is why I am fully for a national health service. If it was out of the hands of the insurance company, he would have continued care once he left hospital.
He would possibly have a social worker and psychologist or if necessary, psychiatrist assigned to him, to help him work through his issues, and hopefully become a healthy functioning adult in society.

Will he get the continued support he likely needs when insurance companies who's goal is not to loose money are involved? You tell me?
 
Ollie, regarding your national healthcare system preference- can you answer a question for me? The situation I'm about to describe was for standard "physical" care and not mental health care, so I'm wondering how similar the situation would be for the mental healthcare side.

A few Christmases ago I was in England visiting a friend of mine who has lived there his entire life. He had a foot problem that required surgery. The issue impeded his mobility quite a bit, so we're not talking about an "elective" surgery here.

He told me that through the national healthcare system the waiting time to get the surgery was over a year long. He then told me that if you wanted to get it done more quickly you could pay a Doctor to do it on the side, and that it could easily be through the same doctor who'd do it if you waiting the year+ to have it done. Fortunately he does pretty well, so he paid the extra cash to have it done outside of the national healthcare system.

I have no idea how common that is, but would/could the same thing happen for mental care in the national system?
 
It would depend on a number of factors. These being the area and the resources available to that area. Did they have too many cases to deal with, etc. This of course does happen and it is a case of government funding.

However, if the hospital thought there was a genuine risk, he would likely be referred and in the hospital a mental health professional would probably meet with him and go from there.

You can of course always go private. You can of course buy private health insurance so if you don't want to wait, you don't have to. Waiting again depends on the area, the need and condition of your issue, etc.

It's not perfect by any means, but I don't think you will find many people in the UK that would like to do away with the NHS, even the wealthy people who can afford private healthcare, see the good in caring for your population.
 
I was a chaplain at an MH/MR facility in Butner, NC years ago, and b/c of that training I'm often court appt. to represent folks who have a history of mental illness in order to see whether a long term committment is in his/her best interests.

It is an extremely hard job with prospective consequences that can be devastating.

5 years ago I was appt. to represent a fairly infamous character in town who was known to hang around the court house and JP districts and file lawsuits for really petty stuff. Well, his wife up and left him and he went off the deep in...convinced that there was a grand conspiracy between her, her mother, and their pastor to cut him out of the family. And even before then he didn't possess the tools necessary to cope with such a trauma.

So, we convinced the judge to send him to Rusk for 30 days. There wasn't too much convincing needed: this guy was very, very sick and getting worse by the minute b/c w/ his wife gone he was unable to get to the clinic/pharmacy to get his meds, and when he did he was unable to understand the schedule and order of the meds he was taking (which is essential for psychotropic meds to work as hoped). And by sick, I mean sick....his meds included things like haldol (bid), risperdal (tid), xanax (tid), and on and on.

Well, as anyone w/ experience in MH knows, it's a heads-on-beds issue, w/ way more heads than beds. So, once someone's court order is up, they're out unless they continue to pose a greater risk to themselves or others than person X does.

So our guy is about to be discharged, and he's begging them to keep him, saying things like "I can't do this! I'm not ready! I don't what to do! I may hurt myself!"

His mental health team determined that he posed less of a risk that the incoming resident, and discharged him.

36 hours later he killed his mother-in-law and shot both of his children, each of whom survived, and barricaded himself in his mother-in-law's house, screaming things like "I told y'all I can't do this! See what y'all did!?!"

He's now serving a life sentence in TDC-ID.

The system failed him.

And I, as his advocate and a part of that system, failed him.

I will take that one to my grave.

Brandon, you make double-damn sure that you don't have something like that happen. It will haunt you the rest of your life.

Trust me....
 
You must log in or register to reply here.

Weekly Prediction Contest

* Predict HORNS-AGGIES *
Sat, Nov 30 • 6:30 PM on ABC

Recent Threads

Prediction Results Threads

2024 Schedules

Back
Top