Airport shooter shows need for better VA mental health care

We still don’t know the whole story of why a National Guard veteran opened fire in the Fort Lauderdale airport, taking five lives at random. We may never know to our satisfaction. What is clear to me is that since his association with Islamic radicalism appears to be delusional rather than ideological, the news networks and front pages have moved on. Now he’s just “crazy.”

As a child and adolescent psychiatrist concerned about our young people, including those who serve in our armed services, this is troubling. We come up with easy answers to avoid thinking about tough problems.

Because Esteban Santiago appears to have a history of psychological distress and hospitalization, we write him off as disturbed. Because we associate mental illness with violence, we wonder why he wasn’t locked up in a psychiatric hospital where he couldn’t hurt people.

Although emotions run high when violence and mental illness are linked, I would ask that we leave this sort of black and white thinking behind and appreciate the shades of grey.

I have no idea of Santiago’s diagnosis, if any, or what psychological evaluations will reveal. But I do know that the mental health burden placed on our veterans is immense, and that the system is not up to the task. Stigma and lack of access to care for mental health disorders are serious public health issues for all Americans; this problem is compounded for young veterans.

More service members die by suicide than enemy fire. The suicide rate for veterans is roughly twice that of the civilian population, and it is increasing for the younger veterans of our recent wars in Iraq and Afghanistan. There is no rigorous mental health evaluation upon enlistment in the armed services. Some suggest the process that does exist encourages enlistees to hide mental health problems.

For everyone, mental health symptoms are likely caused by a mix of environmental factors and an individual’s unique risk. Santiago’s story is full of hints. His family suggests he was hospitalized after returning from deployment in Iraq. Recently, there were repeated reports of domestic violence. He was a new father.

A visit to an FBI office led to admission to a mental health facility after reporting hallucinations. He is at an age when psychotic disorders like schizophrenia begin to manifest; on the other hand, the disorganized thinking and erratic behavior reported could also be the result of substance abuse or a variety of other factors. We don’t know.

What we do know for sure is that this troubled young man did not receive help adequate to prevent him taking five people from their families, destroying his life in the process. Can we provide that level of care and dedication? We have to try. If we are serious about keeping the public safe, we need to be equally serious about the public health crisis of mental health care in our military and our country at large.

We need to have a frank conversation about where the right to bear arms stops. Although some will argue, I firmly believe that Santiago would not have done what he did, or would have been less deadly, had his gun remained with the FBI.

Mental health disorders are the most common diseases of Americans under the age of 24. Recruits should be formally screened — as should all of us, starting at school age. In either case, screening can lead to the identification of risk for certain disorders and an opportunity for prevention or early intervention.

This may result in support for people whose psychiatric illness would put them at risk for harmful behavior towards themselves and others; but on a grander scale, it will be a step towards reducing the number of Americans who suffer in silence with unidentified and untreated mental health disorders.

If we had better systems and care, it is possible that those five people in Florida would still be alive. But it is certain that more veterans would be living more fulfilling lives, and that fewer of them would take their own lives.