Tuesday, January 11, 2011

Terror in Arizona: Can It Happen Here? Is Nevada Next?

You know, Rachel Maddow has a point. This wasn't really "unimaginable". It's been happening all over the country...

So might the next horrifying American massacre happen here in Nevada? At UNR? Near an Elko mine? At a casino on Las Vegas Boulevard? At a brothel in Pahrump? Perhaps so.

Here's the law as it stands...

Nevada Gun Laws

Concealed Carry Weapons

On July 7, 1995, Senate Bill 299 was signed into law, and soon afterward, thousands of Nevada residents took advantage of the law that allowed them to carry a handgun concealed upon them. A steady stream of Nevadans have been obtaining carry of concealed weapon permits ever since. In 1999, Assembly Bill 166 made legal concealed carry possible in more public places.


Clark County requires registration of handguns only. All other counties have no registration of any guns.

Background Check

All Nevada counties implement the national background check through the Nevada Highway Patrol. By state law, any private party may access Nevada's background check system for the purpose of checking the background of a potential gun purchaser. Currently, the check costs $25.

Open Carry

In Nevada, you may carry a loaded or unloaded firearm on your person without a permit so long as the firearm is fully exposed (known as "open carry"). An example of open carry is when a handgun is carried in an "outside the pants" hip holster. Full or partial concealment (such as a purse, jacket, etc.) is considered concealed carry.

And here's what's been happening.

With more guns sold and registered per capita than anywhere in the U.S., Nevada is a gun state - always has been.

It also is the gun-death state. According to the Center for Disease Control, since 2000, Nevada has led the nation with an average of 26 gun-related deaths per 100,000 people.

War-torn Iraq averaged 32 gun deaths per 100,000 people last year, according to the same study.

At least once a year, an accidental gun death here makes national headlines.

And here's the frightening reality of how incredibly easy it is for some mentally disturbed person or deranged sociopath to obtain lethal firearms in Nevada.

According to the latest scorecard by the National Brady Campaign to Prevent Gun Violence, Nevada fails miserably when it comes to curbing illegal firearm trafficking, conducting background checks, promoting child safety, banning assault weapons, and keeping guns out of public places.

Nevada received only 11 points out of a possible 100. [...]

While there is no state law requiring a waiting period for first-time handgun buyers, [Gun store owner Bob] Irwin says Clark County has a 3-day restriction.

Yet anyone can buy a handgun or assault weapon on the spot at a Nevada gun show — no questions asked.

“I can’t believe that’s allowed. It’s putting people at risk,” said Maria Outcalt with Domestic Violence Prevention.

It’s that easy access that has Outcalt convinced that stronger gun control laws would help curb violence.

While our gun laws are not nearly as lax as Arizona's, they're certainly "forgiving" enough for someone who otherwise shouldn't be carrying guns to access them.

This is a problem. Seriously.

While some may not agree with the gun safety proposals discussed by Lawrence O'Donnell and Rep. Carolyn McCarthy (D-New York) last night, at least they were willing to have an honest discussion on the alarming trend of allowing more dangerous weapons to fall into the hands of those likely not able to handle them.

Yes, yes, I've heard that famous clause: "Guns don't kill. People do." But you know what? When mentally disturbed people can access extremely lethal "weapons of mass distruction" so easily at the neighborhood gun store or local gun show, that's a serious problem.

And you know what else is a problem? This.

Nevada's mental health director says this state ranks near the bottom of per person spending on services. And it's just about to get worse with deep budget cuts.

Jared Loughner's mindset and motives before the Tucson shooting are now under scrutiny. Those who know him these past years paint a picture of a mentally disturbed young man, describing his as ranting, destructive and threatening. Fellow students feared he might bring a gun to the school. [...]

[Las Vegas/Clark County] Metro police say there are around 6,000 cases of mental health detainments every year. Those detainments last up to 72 hours and then the state may get involved if there's and issue.

State mental health services face a 14 percent cut and program eliminations this year which is in addition to cuts they have suffered in previous years. UMC's Emergency Chief Dale Carrison spoke to the I-Team last fall about the backlog.

"We've medically cleared them. Now, there's a big line, and if southern Nevada adult mental health for some reason can't turn the patients over, than it builds up."

Nevada's budget cuts this year are likely to include mental health court. It's a program designed to get convicted mental ill people into treatment programs so jail is not their only option.

Back in December, then Governor-elect Brian Sandoval didn't wince as news was leaking of severe budget cuts in the pipeline. And if that wasn't bad enough, The Nevada View reported just last week my new State Senator, Michael Roberson (R-Henderson), hinted at the renewed "tea party" effort to push a "cuts only" budget agenda that would gut the very mental health resources that can possibly prevent another mentally unstable person from taking to violence here in Clark County, as Jared Lee Loughner did in Tucson last week.

The LA Times' Steve Lopez zeroed in on this crisis in the making in his column today.

Sure, Loughner's homicidal outburst might have been affected by anti-government rhetoric and political diatribes on the Internet or on the airwaves. But we're missing the point if that's all we focus on.

Arizona has implemented dramatic cuts in mental health services in the last few years, as have states across the nation. And if the national healthcare reform bill is repealed, as government-shrinking crusaders are promising, more mental health services will be lost.

Loughner was able to buy a gun — the gun authorities said he used to shoot Rep. Gabrielle Giffords and 19 others at a supermarket — despite numerous interactions with authorities suggesting he was unstable. If you're surprised, you shouldn't be. Many in this country have worked hard to make it easier to get guns than mental health services, even after the Virginia Tech massacre of 2006, in which 32 people were killed by a young man who was mentally ill.

Now let me pause here to clarify something, because the last thing I want to do is make the stigma surrounding mental illness worse than it is, or to suggest that you ought to pick up the phone and call authorities every time you see someone who acts a little peculiar.

The vast majority of people with mental illness aren't dangerous. But a small minority will become violent, especially those with severe symptoms that go untreated. Ironically, one reason so many don't seek help is because of the stigma, along with the fact that this country has never given mental health treatment the priority it deserves. If you doubt that, just take a look at recent reports on the military's disinclination to diagnose and treat traumatic brain injury in soldiers from Iraq and Afghanistan.

What the Arizona tragedy ought to spark is not a hysterical conversation about politics, but an honest conversation on the need for earlier diagnosis and better education about mental illness. Since the first signs of delusional behavior often emerge in the late teens and early 20s, teachers and staff at high schools and colleges should be trained to recognize the signs of mental disorders and intervene effectively.

I know from experience that it isn't always easy to convince someone to seek help or to predict the behavior of someone who has severe mental disorders. But although mental illness can't be cured, it can often be treated and managed in a way that relieves suffering for those afflicted, as well as for their families, and helps prevent tragedy.

While California's own mental health resources have been strained due to budget cuts there, they at least have something. Both Arizona and Nevada have next to nothing. Strangely enough, it's far easier here to buy a gun than to get help. This is nothing short of frightening.

As usual, Desert Beacon sheds more light on this pressing issue.

The consequences may be not always be nationally tragic, but for families and individuals trapped by the debilitation of mental diseases the results are always tragic. And not always addressed -- as demonstrated by this commentary from a nurse: "Having spent many years of my life working in a locked psychiatric unit as a nurse, I can attest that the majority of our schizophrenic clients, though sometimes frightening, especially to those not familiar with the illness, were not dangerous. However, clients diagnosed with paranoid schizophrenia will sometimes act on their paranoid delusions. I have personally seen how difficult our mental health system can be to navigate. Family members would call me and beg for help, but help is available only under a very special set of circumstances. Sometimes people will seek treatment voluntarily, however, in order to commit a person involuntarily they have to meet certain criteria, either DTS (danger to self), DTO (danger to others) or GD(gravely disabled). The greater problem is that now it is very difficult to obtain any type of outpatient treatment, as insurance generally will not pay for it, or pay only a very small amount. Most people simply cannot afford any more to pay for mental health treatment.

We know that Loughner appears to have some traits associated with mental illness, including confused and distorted thought patterns, implying his receptivity to conspiracy theories, both internally and externally derived. We may infer that he acted on these, which adds another layer to the overall diagnosis. Those who had contact with him at Pima Community College report that he was removed from a math class by a counselor and a police officer, was suspended, and later agreed to withdraw from school in October. [WaPo]

What help he might have sought, or what assistance might have been sought for him, have yet to be revealed publicly.  However, it's clear that obtaining mental health services is at least as difficult as the nurse-commenter referenced above. Google "state mental health budget cuts" and you'll get at least 22,200,000 results.  Mental health advocates in Texas are worried about the impact of decreased funding, [KHOU]  advocates in Mississippi are worried as well, they may be facing cuts of 15%.  [LaurelLdr] Mental health budgets have been slashed in Oklahoma. [KRMG]   At the top of the list of NAMI's Ten States Hurt by the Mental Health Budget cuts, is Arizona.  Nevada stands 7th on that listing. [...]

Before anyone in Nevada is tempted to pass judgment on Arizona's situation in terms of mental and behavioral health services, we should note that in 2006 Nevada received a "D" grade from the National Alliance for the Mentally Ill, and the same "D" grade three years later in 2009.  In health promotion and measurement terms (evidence based practices, emergency room waiting time, quantity of psychiatric beds) Nevada got an "F." Nevada got a 45% "D" for financing, Medicaid reimbursements to providers to evidence based providers, and more; another "D" for measures such as consumer and family access to essential information from the state, promotion of consumer run programs, and family/peer education and support. There was another "F" for state support of activities requiring collaboration among state mental health agencies and other state agencies and systems. Among the "urgent needs" suggested by the NAMI: (1) restore inpatient staffing levels; (2) increased support for case management, medications, and therapy; and (3) increased resources for supportive housing options. 

Interestingly enough, this week's news was supposed to be dominated by upcoming Congressional debate over repealing health care reform... The very same health care reform legislation that included efforts to improve mental health care.

The law signed by President Obama last week expands parity to a much wider pool, making it possible for millions more people to get the same coverage for substance abuse and illnesses like bipolar disorder, major depression and schizophrenia as they would for, say, diabetes or cancer. There are no exact figures, but the mentally ill are more likely to be uninsured than the general population, advocates and researchers say.

“A lot of this still has to play out in terms of how parity works,” said Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, or NAMI, an advocacy group. But the new law “can change the mental health system in America and really give families and individuals an opportunity to get a level of access to care we could only fantasize about before this became law,” he said.

Parity means that deductibles, co-payments and limits on the number of visits or days of coverage must be no more restrictive for coverage of mental illnesses and substance abuse than for coverage of medical and surgical treatments. If a plan provides for out-of-network medical benefits, it must provide out-of-network mental health benefits.

Under the new health law, employees of companies with 50 or fewer workers, whose employers were not required to comply with the existing parity law, would receive equal mental health benefits if their employers opt for the state-run exchange plans, available in 2014.

Health care reform also means expanded coverage for mental health care in Medicare and Medicaid programs. Considering what just happened last weekend, perhaps House Republican leaders need to do more than just postpone their planned vote on repealing health care reform. Since repeal is unlikely and the reform legislation now looks more necessary than ever before, perhaps repeal needs to be permanently shelved. Instead, wouldn't it be refreshing to see Congress actually address the pressing issues of today by examining why it's easier to obtain a gun than to access mental health care? And wouldn't it be encouraging to see Governor Sandoval and The Nevada Legislature also address these pressing issues by looking at our own budget and our own problems in taking care of our fellow Nevadans?

Haven't we had more than enough tragedy already?

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