Jerome Wakefield: Strict laws cannot reach all parts of a dangerous mind

Predictably, the Arizona tragedy has elicited calls for policy changes. But what, if anything, should be done differently?

The vast majority of severely mentally disordered individuals are not violent. Predicting which few without a prior history of violence will become violent is almost impossible. At the same time, proposals to protect society from the dangerously mentally ill pose basic civil liberties issues.

A Russian reporter, Andrei Sitov, raised this question when he asserted at a White House press conference that American freedom was complicit in the Arizona shootings: "It's the reverse side of freedom. Unless you want restrictions, unless you want a bigger role for the government … This is America, democracy, freedom of speech, freedom of assembly, the freedom to petition your government. And many people outside would also say the 'freedom' of a deranged mind to react in a violent way is also American."

President Barack Obama's press secretary said American values do not endorse violence. That is true, but irrelevant. The question is whether American values favouring individual rights somehow facilitated the Arizona tragedy. After all, rates of severe mental illness are about the same across the developed world, yet the US seems to have more such shootings than other countries.

One freedom-related suggestion is that the US needs stricter laws that keep guns out of the hands of the mentally ill. But the alleged shooter had never been formally diagnosed as mentally ill, so such targeted laws would not have prevented him from obtaining a gun.

The US also needs more accessible mental-health services. Although his college demanded professional evaluation before he would be allowed to return, Jared Loughner, the suspect in the Arizona shootings, it seems, failed to seek help from Tucson's available services.

Many colleges have increased monitoring of students' odd behaviour by threat-assessment teams. But such mass screening is notoriously ineffective in predicting violence. For example, psychiatric screening for suicide risk in one New York high school identified 44 per cent of the student body as being at risk. Similarly, screening for loose, eccentric thinking yields mostly individuals who never become psychiatrically disordered.

In the months before the shootings, Loughner's behaviour displayed marked signs of serious mental problems, including confusing speech, disruptiveness in class, bizarre imagery, deterioration in social, academic, and occupational functioning, and a dramatic personality change.With such blatant signals, why didn't others intervene? Arizona law allows any interested party to report an individual's bizarre or threatening behaviour to the authorities, who can involuntarily commit the individual.

Though his community college suspended the suspect for his threatening demeanour, it took no further action. One reason is that US educational privacy laws severely restrict the sharing of information, even with parents, let alone with other authorities. Additional privacy protections for medical records sometimes make it difficult to notify parents when a child is troubled.

Moreover, the US constitution prohibits preventative detention: even severely disturbed individuals cannot be detained involuntarily unless judged an imminent threat to themselves or others.

Such protections should not be surrendered easily. The irony of Mr Sitov's comment is that during the Soviet era, Russian political dissidents were psychiatrically diagnosed, institutionalised, and drugged into submission.

Soviet Premier Nikita Khrushchev, paving the way for the political abuse of psychiatric diagnosis, argued that: "Of those who might start calling for opposition to Communism… we can say that clearly their mental state is not normal."

• Jerome Wakefield is a professor at New York University's Silver School of Social Work and professor of psychiatry at NYU's School of Medicine.