Two disturbed people, two tragedies

Adam Lanza use a gun.

Erika Menendez used a subway train.

Both tragically snatched life from innocent people.

Adam Lanza was not known to the mental health or legal system prior to Sandy Hook massacre.

Erika Menendez was already known by both systems. She has a history of violence against strangers; she hit the headlines for allegedly pushing Sunando Sen in front of an oncoming New York subway.

How did Menendez slip through the system? There was nothing to indicate that Erika Menendez had been successfully treated, nothing that indicated she would NOT continue to assault people.

Will more people like Erika Menendez make their way into and out of the mental health and legal system until they commit a crime? The sad truth is that treatment alone is not enough, a history of violence is not enough, and monitoring people to keep them on their medication and in treatment is impossible if they don’t want to be medicated or treated.

Unless someone is legally mandated or being held as an “inpatient,” we simply can’t monitor and enforce medical care.  The economic reality of both managed care and out-of-pocket medical expenses often take voluntary treatment and/or hospitalization off the table. Unless you have been found to be insane and are serving your time in a hospital instead of jail, the stay in a hospital is going to be very short. And it will be lacking in any kind of successful treatment.

What about medication once someone has been through the system? Patients rarely want to stay on their meds for stabilization because of unpleasant side effects, paranoia or denial that they are sick. Frequently, if the medication is helping, patients often assume they are better and stop taking it.

We can’t predict who is going to become violent, but we do know without the RIGHT kind of help, medication, monitoring and intervention, violence is a likely behavior, using whatever means is at hand.