Prediction -- Mental illness may have prompted Empire State Building shooting

At least eight people were shot Friday morning near the Empire State building in New York City. At least two of them are now dead. The shooter, who was killed by police, has been described as a disgruntled employee fired from his job on Thursday.

Two days earlier, a Camden, N.J., mother decapitated her 2-year-old son, then stabbed herself to death when police arrived. On August 13, Thomas Caffall shot two men to death in College Station, Texas, near Texas A&M University, before being killed by police.

These killings follow shocking mass murders at a movie theatre in Aurora, Colo., and a Sikh temple in Oak Creek, Wisc.

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While the criminal justice system will be the venue to administer justice to those killers who actually survive the scenes of their horrific violence, it is now obvious that the mental health care system is failing to identify, treat and contain those at risk for such violence.

In Aurora, College Station, Oak Creek and Camden—and almost certainly on Friday in Manhattan—psychiatric disorders figure prominently in the loss of life.  And I would bet that in each and every one of the cases, a mental health care provider interacted with the killer, at some point not too long before lives were lost.

The public—including family members, employers and teachers—still do not know where to turn to report concerns about ominous behavior, or whether they are at liberty to report those concerns at all.  And mental health clinicians, as a group, have not developed a clear, internal understanding and consensus about their responsibilities to act decisively when they are made privy to violent thoughts, or even the stated intention to commit violent acts.

Far too often, men and women who express rage toward others are not asked by clinicians whether they would harm the people they resent.  And far too often, even if those individuals allow that they might act violently, they are encouraged to rescind such statements and “contract for safety.”

As I have said before, it is time for a national effort to educate the public how to refer concerns about others who may be mentally disordered to the mental health care system.  And that effort must be paired with an effort to educate clinicians how to take a detailed history to assess the risk of violence, complete with the availability of a network of forensic psychiatry consultants by phone or Skype.

We are not facing an epidemic of gun violence. We are not facing an epidemic of first-degree murder.  We are facing an epidemic of mental illness, improperly triaged and treated, leading to killings with no apparent motive.  They will stop when we decide to stop them—by providing robust mental health care services, targeted to those individuals whose mental illnesses include a component of violent or psychotic thinking.