Scott Gibson: The myth of a mental health solution

Once again, our country has been traumatized by a mass shooting, this time  a synagogue in Pittsburgh. And once again, we have heard calls for America to fix its “broken mental health care system.”

But in spite of all the killings, the debate on mental health always stops at the We-Gotta-Fix-It stage. Nothing more ever gets done.


In the U.S. today, we already have excellent tools for helping the mentally ill. With the right medication and therapy, patients can experience tremendous, even life-changing, improvement.

In spite of this, there are good reasons why improving mental health care on a large scale is difficult. And there are real limits to how much we can achieve.

In the interest of kick-starting the debate about mental health and mass killings, I would like to discuss some roadblocks that limit treatment of the mentally ill as a means of ending the mass murders.

1) Identifying the mentally ill can be hard. In fact, it may be the weakest link in the system.

According to the National Academy of Science, about two-thirds of people with a diagnosable mental illness do not receive treatment. And stigma is one big reason.

Guest Writer

Dr. Scott Gibson s a board-certified internist who has established a local practice almost 30 years ago. He maintains an affiliation with the Willamette Valley Medical Center in addition to operating the Yamhill Valley Surgical Center, specializing in colonoscopies and endoscopies. He served several years on the McMinnville School Board before moving to Amity to open a bed and breakfast inn with his wife, Melody. He is also an accomplished landscape photographer.

It doesn’t help when people like Wayne LaPierre of the National Rifle Association call for a national registry of mentally ill persons. If getting a prescription for Prozac or confessing to PTSD can put you on a registry, still fewer people will seek treatment.  

Even homicidal people can be hard to detect in advance. Take the bump-stock shooter in Las Vegas, who killed scores of concert-goers in 2017. He had shown no sign of serious mental illness before he committed mass murder.

Determining who is and is not mentally ill will remain a daunting challenge regardless.

2) The mentally ill sometimes resist treatment. This is especially true in the case of certain severe illnesses, like schizophrenia, where people lose touch with reality and do not comprehend the disorder in their thinking.

Schizophrenics are also paranoid, making them suspicious of the very people seeking to aid them. A 2005 study found 74 percent of schizophrenics discontinued their medications, and a study of bipolar patients found 40 percent were non-compliant.

The mentally ill have the right to refuse therapy, and often do. At what point are we willing as a society to coerce treatment, especially for those who have broken no laws? 

3) Separating the dangerously mentally ill from the harmlessly mentally ill is nearly impossible.

Here is a vital point rarely mentioned — no psychiatrist, psychologist or social worker can reliably predict the future behavior of mentally ill persons. Short of a person stating an intention to do harm, we do not have tools to predict violent behavior in any individual.

Studies confirm this. Researcher Jeffrey Swanson of Duke University states, “Psychiatrists using clinical judgment are not much better than chance at predicting which individual patients will do something violent and which will not.”

Human behavior is simply too complex. And chance events can push previously docile individuals past a tipping point into violence.

Current law limits involuntary detention to those deemed to pose an “imminent risk” to themselves or others. That reflects the reality that we are very poor at predicting behavior beyond the immediate future.

In fact, the great majority of mentally ill persons are nonviolent. Picking out the few who will commit horrific crimes is just a futuristic dream.

4) Distinguishing anger from mental illness is a tricky affair.

Many people in America are angry with our politics now. But how do we define the transition from anger to mental illness?

Cesar Sayoc, the man who sent pipe bombs to prominent Democrats and Trump critics, drove a van plastered with anti-Democrat bumper stickers, including one depicting Hillary Clinton in rifle cross-hairs. And the man who killed the Jews in the Pittsburgh synagogue posted deplorable anti-Jewish messages on social media.

At what point does exercising free speech get you a mandated mental health exam? Do we have a bumper sticker limit? Ten or more and you see the forensic psychologist? Will depicting cross-hairs on people get you a Rorschach test? 

There are hosts of people in America who have opinions others find inconceivable, irrational, hateful and even dangerous. Those opinions are, however, protected by our right to freedom of speech, guaranteed in the First Amendment. And that is a very tall fence to get over.

5) Last, mass treatment of the mentally ill could be incredibly expensive. How much it would cost would depend on how aggressively we wanted to expand the system. If we are going to make a big difference on a national scale, we have to be prepared for some sticker shock.

Improving our mental health system is vitally important, as it is badly underfunded and understaffed. There is no doubt we can make our country a better place by aiding those suffering from a mental illness.

But expanded mental health care will not eliminate hatred and anger. It will not make people decide to be treated. It will not distinguish the dangerous from the harmless. And it will not be cheap.

We may have to rethink how civil liberties like freedom of speech and the right to refuse treatment intersect with the mentally ill. 

Too often, in the debate over mass shootings, “fixing” mental health care is used to end the discussion. But even if we untie the Gordian knot of our mental health system, mass killings will continue.

We need to consider all possible ways to stem the carnage. The mentally ill will always be with us, and a few will always prove dangerous.

We should not delude ourselves into thinking we can medicate our way to safety.




Scott I think you wrote a great piece on mental illness in our country. You had many great points and I couldn’t agree with them more. It’s a tough situation for individuals,family’s,law enforcement and the general public. I don’t have any magic to offer but I hope as a Nation of people we can eventually offer better help and guidance to this group of humans.

Scott Gibson

Jim, I agree that it would be good if we could find and intervene positively with the mentally disturbed. But I also feel we should spend more time working on solutions that have been shown to decrease shooting deaths that don't depend on somehow unlocking the human psyche. That goal is a long way off, and it is time we admitted that.


Thanks Dr Gibson for a very thought provoking essay.
In my view, many,if not most, of our problems as humans are amendable to prevention and treatment utilizing interventions that are underpinned with scientific studies. Polio? Thanks Mr Salk for utilizing the scientific method to find a cure. Desire to fly like the birds? Thanks Wright brothers for utilizing the science of physics to make it a reality.
However, their are some aspects of human nature and behavior that seem beyond the reach of science. These acts of violence that Dr Gibson speaks of are one example (and by the way, despite Dr Gibson's lopsided use of far right examples, extremists on BOTH sides of the political spectrum, as well as non or apolitical individuals, engage in these kind of violent acts).
At some point we have to acknowledge that the scientific method has limitations. So when it comes to preventing mass shooting and the mental illness that precipitates them, if not science, what? Well, this isn't going to go over very well in our society that currently worships at the alter of secularism, (and at this point many may stop reading and just write me off as a kook, and I'm okay with that) but here goes anyway...the cure is a return to God. Not in a black and white "my God is better than your God" way. But in returning to God as you know him (or her).
Alcoholics and drug addicts will tell you that scientific treatments from Psychiatrists are for the most part impotent in curing their affliction. Why? It's another example of an aspect of our human behavior that is beyond the reach of science. What works best to help the addict? AA. What is the central tenet of AA? turning ones life over to a higher power.
So again, in my view, we as a nation need to return to God. We have cast Him out and in so doing we sowed the eastwind. Is it any wonder we are now reaping the whirlwind?


Joel - I respect your "return to God" belief, but I think we also need a return to mental health funding and it may be necessary to return to involuntary hospitalization. In the early 1980s president Reagan ended involuntary hospitalization and evaluation and he failed to renew funding for mental health. He also released half of the mental patients into the general population to roam the streets of California. So, God...yes (if it works for you)....funding yes...and a closer look at returning to involuntary hospitalization may be needed to get the problem under control. Right now many of the mentally ill are incarcerated when they need to be mandated to mental hospitals instead where they can get treatment for a possible healthy return to society....jmo.


I completely agree, Mudstump. Along with a return to God I believe we should try everything we can think of... and what you have proposed makes good sense.


Hosea 8:7: "For they have sown the wind, and they shall reap the whirlwind." I don't know where the east wind figures in with this warning.
Mudstump is absolutely right about the emptying of mental institutions, dumping sick, psychotic people on the streets in the idealistic quest for the least-restrictive environment. That practice is also popular in schools and, while a swell idea on paper to sociologists, it simply doesn't work. God's involvement means nothing, either; it's used as a carrot-and-stick, or rod and staff, motivator. There may be many mansions in the Promised Land, but we need physical places here on earth that lock.


Joel - I grew up in Kansas City. Just north of KC is a town called St. Joseph where the state mental hospital is located. I have to chuckle when I think about my mother and how she used to say..."Do you want them to come get you and take you to St. Joe?"....when I was misbehaving of course. It was real then....the state could mandate that you be evaluated and if necessary they put you in the hospital until you were well enough to return to society. No one likes the idea that one could be committed to the hospital for treatment against their will, but right now these people are free to cause harm to others. We see the consequences when we hear that another mass shooting has occurred.


Sounds like you have a cool mom, Mudstump. I think it would be great if our state would commit people to a mental hospital. I feel bad for anyone that has to go through that, but I feel a lot worse when I see mentally ill people committing these mass shootings.
I don't think more gun control is the answer...we have the second amendment. I don't think banning violent video games is the answer...we have the first amendment.
I think you're on to something, Mudstump. Identify who the mentally ill people are, lock them up in a hospital and treat them until they are safe to be in society. It's not a perfect fix, nothing is, but it would make a difference.

Scott Gibson

I appreciate the discussion that I see here. I was hoping I might be able to stimulate an exchange of ideas. Joel, I would agree that if we could get people to live by the "love thy neighbor as thyself" admonition of Jesus, we would not need to have this discussion. But as Ghandi said when he was asked what he thought of Western Civilization, he answered, "It would be a very good idea." As Lulu and Mudstump point out, we may need to consider re-examining involuntary treatment of mental illness. And as Joel says, it might make a difference. I do have to diverge on the issue of gun control. Even within the Second Amendment, there is room for regulation. Hence the proscription of machine gun ownership. I think we should look for gun regulations that will pass Constitutional muster and may help decrease the risk of mass murder. I would start with bump stocks.


Back in my younger years we didn't have these "mass shootings" at schools. We dealt with issues like mature individuals, or we simply resolved it via a one on one fist fight. No knives, no guns, and no cheating. The loser lost and the winner earned respect. That was the way of it because of how we were raised. Back then parents actually disciplined their children, which included not only a verbal tirade and being grounded, but if you really dropped the ball you got either a belt or a wooden spoon across the behind. We feared that phrase mom uttered, "wait until your father gets home." We learned to respect our elders and those in a position of authority. More than that, we were disciplined.

Today my generation is just shaking our heads at the youth of today; parents too young and immature to even be parents, parents not allowed to discipline their kids. teachers not allowed to discipline their students...there is absolutely NO fear of let alone any respect for those in positions of authority or elders. Kids today have been taught that their individual right(s) to be ignorant, lazy, immature, act out, fail and expect positive treatment, so on and so forth trumps every other individual's rights and especially that of the collective.

As of late the needs of the many no longer outweigh the needs of the few, or the one. It is the exact opposite. That is the real issue here that leads to this so-called "mental illness" issue. The only illness I see is liberalism, the cause of all these self-entitled individuals running amuck unchecked doing what they will and blaming everyone else but themselves for their choices and actions and lack of personal responsibility for same.


Kids spend more time at school than they do home, likewise adults spend more time at work than they do at home.

Kids who have no fear of person in authority, lack discipline, allowed to act out with no repercussion get easily frustrated, angry, and confused with no source of help (at least none that they are willing to go to, if they did, that means they are weak and unstable). They don't talk to their parents who likely ignore them anyways, and those parents clearly don't pay attention to them enough to see a potential problem brewing. So where do you think these troubled kids are going to take their anger (from being ignored at home, at school, bullied by peers) out on? They certainly are not shooting up their home or neighborhood, no, they go to school and do that.

There is clearly a huge disconnect going on in the lives of every individual born after the 90s when liberalism really stuck its claws into society, the public education system and even the workplace.

If parents were just allowed to parent again, spank their kids and put the fear back into them when they hear, "just wait until your dad gets home," things would change. Kids would be more disciplined and have more respect not only for their parents, others in positions of authority, and elders but mainly themselves.

And don't retort with those pseudo-scientific studies of how the belt, wooden spoon or open hand on a kids behind causes them to be angry and violent later in life. There is a distinct difference between that corporal punishment and abuse by being thrown across the room, slammed against the wall and punched in the face.


When I went through basic training, we were broken down mentally (yelled at) and physically (training) then built back up into strong minded, strong willed and highly disciplined individuals.

Parents need to be allowed to yell at their children without it being called mental abuse. Parents need to be allowed to discipline their children without it being called child abuse.

Adults of today (and as of late) are just children, undisciplined, spoiled, ignorant of many things despite the participation trophies and sliding grading scales allowing them to achieve a diploma that is essentially meaningless.

The only thing they learned is the brainwashing (indoctrination) that diversity is good, tolerance is bliss, sexuality is fluid, how to use devices for sexual gratification, safe sodomy acts, their opinion matters more than anyone else', that you don't need to prove your opinion as it just is and you're entitled to it and everyone else is wrong, transgenderism is not a mental illness, and just about everything else under the sun that is completely factually inaccurate and should not be learned at kindergarten, let alone at any young age when such information should be held until college or senior year of high school when the kids are a little more mature and exhibit some semblance of rational thought processes.

What did society do about those who acted out too much? Big Pharma came in to the rescue and offered drug after drug for ADHD and every other acronym or misdiagnosis. This only compounded the problem resulting in more kids becoming depressed, anxious, and even suicidal.

Compound that with social media and tech, and we have mindless zombie on the loose demanding what they want without earning it, then throwing a violent fit when they don't get it.


Scott Gibson - "Even within the Second Amendment, there is room for regulation."

No, there is not.

"...the right of the people to keep and bear Arms, shall not be infringed."

shall not be infringed is absolute.

While SCOTUS may have read into it what they wanted to and not what it actually clearly states is not a legit/legal justification to "infringe" on "the right of the people to keep and bear Arms."

SCOTUS is not always correct, as proven by opinions where it has reversed itself and ruling as they should have to begin with.

There is simply no amount or measure of any control that will ever stop or reduce violence by people intent on being violent. Look at London where stabbing attacks/deaths surpassed violence in NYC recently. Take away one tool and another will take its place. The issue is not about the inanimate object but everything to do with human behavior.

While many call it a mental health problem, I call it an undisciplined human behavior problem as I described in the previous comments. People today simply don't fear failure as the liberal democratic policies will always be there to give them what they want, and for free. What they fear is success and becoming successful. They scorn those who are successful yet want what they have without earning it themselves. Which is why the liberal indoctrination of socialism has become so appealing to these free loading participation trophy sliding graded scale losers who are honestly just too ignorant to realize just how ignorant they truly are.

I mean really. What does it say about a society that fights tooth and nail to punish parents who don't allow their toddler who wants to be the opposite sex "transgender," but they fight with equal if not greater zest to stop 18-20 year olds from buying guns (WA state), yet expect that same age group to use military grade weapons to defend their rights to push their ignorant agendas!

Chris Chenoweth


This piece was thought provoking and hopefully is indicative of a societal shift back toward institutionalization. I am not sure the approach that was used in the past is the best, however, and I hope we will find a much better way than "Prozak and a cot". Providing a place that actually helps people and develops trust with the patients rather than hides them from public view will help to deal with many of your concerns.

Joel I wholeheartedly agree. However it is not just the removal of God (as bad as that was). Our country has systematically removed discipline and the training of morality from our public sphere. The absolutes that guided and defined us are fading into a humanistic panacea of drug fueled utopianism. The results were predictable.

I was saddened at the continued partisan comments made by multiple parties in this exchange. That is what kills discussion. Mudstump please read this:


Scott can I posit this to you: The Republicans know that the majority of Americans oppose most forms of gun control and almost no gun control law will pass Constitutional muster anyway. They also know that for a few weeks following a mass shootings that opinions in the middle shift and thus they throw out the mental health crisis. This is not to kill but rather to stall the conversation on gun control until the mood swings back.

There is a built in incentive to AVOID fixing problems because those problems provided excuses, fund raising opportunities, and ways to turn out the base. Further exasperating the problem is the media needing and fueling division to try to capture the attention of their depleting readership.

The question is, as great as this piece was, what can be done to move the ball forward? I fear that we keep electing the political class and their goal is the next election and not to find solutions to complex problems.

Scott Gibson

Chris, the ball will move forward, sadly, only when a critical mass of victims moves the bereaved and frightened to act at the ballot box.


Scott Gibson - "Chris, the ball will move forward, sadly, only when a critical mass of victims moves the bereaved and frightened to act at the ballot box."

Yeah, voting with a highly emotive knee-jerk reaction fueled by inaccurate political rhetoric (i.e. fear mongering) is absolutely sound logic (i.e. informed voter) being executed by the voter.

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