'We shouldn't bother expanding access to mental health services because 'those people' wouldn't use them anyway.'
Okay, one, that’s just wrong on so many levels that I can’t even begin to explain how enraged I am by that statement. Access to mental health services should be a human right, not an afterthought, and given that it’s a common good for society in general—since most mentally ill people benefit from stable access to treatment and can live very full, happy lives—it should just be a given that we need better mental health services.
Unfortunately, the only time we ever acknowledge the need for better mental health services is when someone’s shot up a school full of children and everyone rushes to attribute the horrific crime to mental illness. (Rather than to, say, the complex interweaving social and institutional structures that lead disaffected white males to think that taking weapons into a crowded public area and opening fire is a fantastic idea.)
So, let’s talk about the cases of rampage violence in which mental illness has been a factor; specifically, untreated mental illness. In most of those cases, the shooter had a history of interactions with the mental health system, and in some cases had been actively seeking treatment at some point. These individuals were failed by a system which failed to follow up, track, and support them. With no followthrough, they found it difficult to identify and adhere to a treatment programme, and ended up with severe untreated mental illness.
Here is a basic fact about mental illness that pretty much any crazy person can tell you: it can be difficult to treat at first. You need a thorough diagnostic evaluation and you may need to try several treatment methodologies to find one that works for you. A blend of meds and therapy is most common, but that requires finding the right meds, and the right therapist. You also need followthrough over time to make sure your treatment is still working for you, and to make adjustments as needed.
Treatment is a lifetime commitment.
For people who are experiencing severe mental illness, it can be very, very difficult to persist through the early stages of treatment, which is exactly why support is critical. Expanding access to mental health services doesn’t just make it easier for people to get care, it also makes it easier for people to continue receiving care. When someone doesn’t get the needed support to stay with it, that person is likely to stop going to therapy and stop taking meds.
That person may also turn to self-medication like alcohol and illegal drugs.
Guess what the biggest risk factor for violence to others among mentally ill people is?
So no, locking up all the crazy people, forcing treatment on them, or isolating all of us on an island far away won’t solve rampage violence. But expanding the scope and nature of mental health services would prevent cases where people like Jared Loughner fall through the cracks and react explosively.