Wendel Abel

Let me offer my condolences to the friends and families of the students who were killed at Virginia Tech University in the United States. Our prayers too for all those traumatised by the shooting incident.

The incident raises a number of questions regarding detection, treatment and our attitudes toward persons suspected of having or living with mental disorders.

Was the killer mentally ill?

Based on reports given by his roommates, family and his previous contact with the mental health services in 2005, the alleged shooter in the incident was clearly suffering from paranoid schizophrenia.

What signs were there?

Social withdrawal, having no friends, disorganised speech, poor communication, stalking, expressing ideas that persons were trying to harm him, and having an imaginary girlfriend. In addition, he had contact with the mental health services in 2005 and he was referred for psychiatric treatment.

The videotape that was released after the incident showed clear signs of thought disorder and delusions of persecution (beliefs that everybody was against him and had humiliated him).

Was this condition treatable?

Schizophrenia, like many other mental disorders, may not be curable but can be treated and most persons can complete college, pursue a career and lead productive lives. Critical to this, however, must be that they accept their illness and comply with treatment. A supportive network of family and friends always has a positive outcome on the illness.

Is crime always associated with mental illness?

No, definitely not. Only less than one per cent of violent crime is associated with mental illness. Unfortunately, cases like these are overpublicised and the issue is blown out of proportion to give the impression that mentally ill persons are dangerous. We treat over 30 persons in our public health system on an outpatient basis and they are stable and productive in the community.

Why did he fall through the cracks?

1. Attitudes toward mental illness: There is so much stigma and attitude toward mental illness worldwide, including in Jamaica, that despite the early warning signs, people are reluctant to seek treatment. Relatives, family members and friends sometimes are in denial and sometimes are resistant to access treatment.

2. The challenges for persons in college: Many individuals get their first breakdown while in college. The reasons are many: college life can be stressful, it may represent the first time an individual is away from home and they are now being called upon to function in an autonomous and independent manner. This is, therefore, a vulnerable period in an individual's life and it is the period that conditions such as schizophrenia, depression and bipolar disorders are likely to become manifest.

3. The difficulty of referring persons for treatment: This young man was in college; colleges do not have the authority to force persons into treatment. When faced with situations like these, mental health professionals must balance the act of safeguarding individual rights and the need to protect individuals and society. Fortunately for us in Jamaica, mental health professionals have more powers within the law to intervene when someone is suspected of being mentally ill and, moreso, if they are suspected of potential harm to self or others.

4. Failure of the legal system: The laws in the United States of America make it difficult to admit someone involuntarily to a mental health facility for treatment. In fact, in order to do so, a petition has to be made to the courts for civil commitment to be granted. Our laws make it easier for involuntary admission for treatment in Jamaica.

How to avoid persons falling through the cracks.

1) Recognise and act on the early warning signs. This is especially so for students leaving home to study. Family members should monitor their adjustment.

2) Avoid stigma and denial. It may be painful to accept a diagnosis of mental illness.

3) Seek early treatment. This ca the course of the illness and affect outcome.

4) Cooperate with mental health professionals. They are trained and have the long-term interest of individuals at heart.