Mental health of Washington Navy Yard shooter galvanizes Congress and raises red flag questions

The New York Times recently reported that Aaron Alexis, who became known Monday, September 16, 2013, as the Washington Navy Yard shooter, called Rhode Island police approximately a month before the rampage, telling them that he was being followed by people who sent vibrations through his hotel room walls, keeping him awake.

According to The Times’ report, the officers responded to Alexis’ call and arrived at his hotel early in the morning. Alexis explained to them that a man with whom he’d argued in a Virginia airport had sent people to follow him and bug him with the use of a “microwave machine.” He also reported hearing voices, which spoke through the walls, floors and ceiling, noted the police report.

Alexis had also sought treatment from the Veterans Affairs Department twice that month, specifically for psychiatric issues.

Then, on a Monday morning about one month later, Alexis shot and killed 12 people over the course of a 30-minute rampage in the Washington Navy Yard, before being killed in the middle of a gun battle with police.

Could a mental health coordinated care platform have made a difference?

Unraveling a history of mental health

According to The Times, the incident in Rhode Island was not the only indication that Alexis had been dealing with mental illness. As a Navy reservist, he had a history of infractions, various mental health problems and “run-ins” with the police regarding gun violence. According to The Times, the one constant was that Alexis’ behavior continually fell right under the radar. Had his infractions been more serious, Alexis might have gotten a less-than-honorable discharge from the military. Had his mental health issues seemed more prominent, perhaps he would have been involuntarily committed to a mental hospital.

USA Today spoke with a friend of Alexis’ from Fort Worth, Nutpisit Suthamtewakul, who said that Alexis showed signs of paranoia and regularly carried a pistol with him.

“He always thought someone was trying to hurt him,” Suthamtewakul said. “He was afraid of people.”

Congress debates and mental health advocacy groups respond

Unlike other recent tragedies mixing mental health and guns, US News and World Report noted that Congress is focusing on mental health legislation, not gun control, following the Navy Yard shooting. But according to mental healthcare advocacy groups, the best thing Congress could do for mental health would be to avoid touching the Patient Protection and Affordable Care Act. This piece of legislation has been a point of contention between Democrats and Republicans since it was introduced, but the Substance Abuse and Mental Health Services Administration noted that the ACA is primed to have a huge impact on mental healthcare in the U.S. Thanks to the ACA, reported SAMHSA, 2.6 million Americans with mental illness or substance abuse problems will be able to enroll for healthcare, once the new insurance marketplaces open on Oct. 1, 2013. Another 2.7 million Americans will be eligible for care through the expansion of Medicaid.

According to US News and World Report, the ACA legislation will cover a number of mental health procedures and medication, which many individuals with mental illness lack access to at the moment. Furthermore, more money will go into state governments in order to bolster mental health treatment, which has seen budget cuts of $4.35 billion between 2009 and 2012.

“The implementation of the ACA is critically important to helping people who are living with mental health conditions have more access,” said Katrina Gay, the director for communication for the National Alliance of Mental Health, a nonpartisan advocacy group. “Congress cannot try to delay something that is going to stop access to mental healthcare for people who need it. There are lot of people in that particular population that just do not have access to health are.”

Where were the red flags?

According to The Times, in 2004, following an incident with a gun in Seattle, Alexis’ father told police that his son dealt with post-traumatic stress symptoms as a result of volunteering in rescue efforts following the World Trade Center attacks in New York City. While there’s no record of Alexis volunteering, Alexis did tell a friend in Fort Worth, Melinda Downs, that he had post-traumatic stress disorder and it caused insomnia.

Despite these facts, Alexis still gained and kept security clearance from the Department of Defense giving him access to the navy yard where the shootings took place.

“The system didn’t pick up the red flags because the red flags in this case had not been fed into the system,” a Pentagon official said, cited by The Times. “Perhaps we need to look at the ‘filters,’ and whether some sorts of behaviors and incidents, even if they do not rise to the level of punishment, should nonetheless be part of the files for review.”

A platform of coordinated care which looped the justice system in with Alexis’ mental health EHR and caregivers might have made a difference. As the ACA proponents know, greater access to mental healthcare is an excellent start. But creating systems in which doctors, mental health and substance abuse specialists, the justice department and family are all in communication creates a more accountable model of care.