Mass shootings highlight our failure in mental health

We missed another killer. Twice. It’s still unclear what motivated the shooter in Uvalde, Texas, but the gruesome shootings in Buffalo, N.Y., allegedly by Payton Gendron, spotlight our ongoing failures to identify potentially dangerous and violent individuals. The Buffalo killings also remind us of how extremism and racism stain our society.

While the facts behind the Uvalde shooting still come in, let’s deconstruct what we know of the Buffalo case — and others — that illustrate all-too-common missteps and shortfalls.

I have advised many senior leaders and attorneys over several decades on cases of accused terrorists and violent men and women. I have seen individuals that are dangerous, and those that have injured and killed many innocent victims. And I have seen others that have been in the wrong place and said the wrong things at the wrong time. For too many years, I have witnessed that we have neglected to enact policies and procedures to mitigate violent shootings and the dangers to our communities.

Lessons to be learned: The case of Payton Gendron contrasts sharply with the case of Khaled Miah that went to trial last year. Payton Gendron is white and allegedly targeted Blacks in a heinous act of violence. Khaled Miah is Muslim and killed no one, nor even harmed any person or animal ever in his life, to my knowledge. The reports on Gendron point to signs and symptoms of serious mental illness that do not seem to have been properly diagnosed nor treated. In comparison, I diagnosed Miah with a serious mental illness, as I’ve testified in court, but he did not get treatment until he landed in jail. Getting treatment has profoundly improved Miah’s mental state.

Both Gendron and Miah had encounters with the mental health system that failed to adequately evaluate them and provide appropriate therapy and treatment. Their cases are textbook examples that effective mental health services are woefully lacking. Moreover, there were failures to coordinate law enforcement with mental health.

The signs of mental illness and propensity to violence that Gendron showed had reportedly been apparent for years — history of violence and cruelty to animals, short-term hospitalization, bizarre behavior (wearing a Hazmat suit to school) and increasing social isolation, not dismissing the alarming online rants about violence and declaring that his high school graduation school project had been committing murder-suicide. Gendron had been posting information online since February about committing mass killings and had expressed astonishment that law enforcement showed little interest. No wonder that Black Americans are aggrieved. The FBI and other law enforcement agencies did not track nor monitor Gendron’s activities despite the obvious signs of dangerousness that he showed. His case makes it appear that law enforcement has been too politicized, targeting non-whites.

The case of Khaled Miah stands out as the counterpoint. Miah is one of many non-white young men and women accused of terrorism or material support since 9/11 in the war on terror. He is a 29-year-old Bangladeshi male, whose family came to the U.S. in 2003; he was convicted of knowingly and willfully transmitting in interstate commerce a communication containing a threat to injure the person of another. Miah is awaiting sentencing in Pittsburgh. He never hurt or killed anyone. But he did taunt and ridicule the FBI with online texts after they came to his apartment and questioned him about his postings on social media and other activities.

In his episodic wacky mental states, Miah recorded himself in reenactments of television series and movies, videos that were bizarre, childish, and preposterous. None of his online activity targeted potential victims or detailed plans of attack. The wording used by Miah is significantly different from and clearly contrasts with that of Gendron and others. My evaluation uncovered that Miah had been suffering from serious mood swings and thinking disorders that impaired his mental state, but he was not targeting individuals nor was he violent. He was obviously mentally ill, and the FBI knew it. Nonetheless, the FBI doggedly conducted a close surveillance of Miah for months, including tracking his trip from Pittsburgh to the national Capitol with a pretext that he may have been plotting an attack against government officials. Reviewing the evidence makes it obvious — to me at least — that their suspicions were preposterous.

The psychological autopsy of these cases uncovers important findings:

First, the mental health system — both public and private — is fragmented and flawed.  Gendron received an evaluation that failed to uncover his core dangerousness and likely pathology. For decades, mental health experts have recognized that cruelty to animals is a serious indicator of dangerousness and harm to others. I have not seen his records – but surmise that the hospitalization and examination were too abbreviated and cursory to discern the severity of illness that he may suffer. Miah received a too-brief evaluation several years before his arrest that failed to discern serious mental illness. Despite the constraints on frontline and emergency mental health services, practical improvements can be implemented with simple resourcing.

Second, mental health services, law enforcement, and other public agencies do not adequately collaborate in identifying and intervening with potentially serious cases. Too many shooters have slipped through the cracks. Measures have been implemented to improve coordination by judges and public officials, but the efforts are not widespread enough. More needs to be done. My review of activities by the FBI and other agencies has been that they have not prioritized tools available to them in cases of probable serious mental illness. The cases I have reviewed had neither mental health practitioners nor behavioral science teams analyze the information collected on the suspected individuals. There is no indication that the law enforcement agencies have applied artificial intelligence or other capabilities for assessing suspects or judging the dangerousness.

Thirdly, too much emphasis is placed on radicalism and what people say — ideology and racism — distracting agencies from priority issues of potential for violence. Radicalism and irresponsible speech — even if abhorrent, either politically, socially, or racially — have been embraced by the psychiatrically sane and insane alike. Focusing on radicalism has been both highly politicized and the fashion since 9/11, but it has obfuscated and derailed priority concerns on violence and dangerousness. Too often our law enforcement agencies have criminalized serious mental illness while lacking the understanding and skills to deal with predispositions to violence and harm. Had better analysis been undertaken by law enforcement, it would have shown that Gendron had worked on a plan and carried it out. Miah was just spouting off and acting bizarre. There’s crazy and there’s dangerously crazy; society should be most worried about the latter — individuals who act in ways to harm others and plan out attacks.

Effective mental health services in our communities are woefully lacking. Our society has failed to provide the breadth and depth of mental health services that are needed to protect our communities and families from potentially violent and dangerous individuals.

Mental health is fundamental to our safety, security, and productivity. In the interest of public health, we immunize our children against fatal illnesses, track down cases of tuberculosis, and have world-class safeguards for clean water and sanitation. Good mental health should be treated similarly as a public health concern.

Stephen N. Xenakis, a psychiatrist and retired Army Brigadier General, serves on the executive boards of The Center for Ethics & the Rule of Law at the University of Pennsylvania and is an adjunct professor at the Uniformed Services University of Health Sciences. Follow him on Twitter: @SteveXen