How Do We Stop the Next Aurora?

We need a mental health system that helps men like James Holmes—and Jared Loughner, and Seung-Hui Cho—before it’s too late.

In this handout provided by the Arapahoe County Sheriff's Office, accused movie theater shooter James Holmes poses for a booking photo on an unspecified date in Centennial, Colorado.
How do we prevent men like James Holmes from striking again?

Photo by Arapahoe County Sheriff’s Office via Getty Images.

James Holmes is mentally ill, lawyers for the accused Aurora, Colo., movie theater shooter say. They asked the judge on Thursday for more time to “assess the nature and depth” of his illness.

Here’s what will happen next: Holmes will be diagnosed with a form of delusional psychosis like schizophrenia, or perhaps with suicidal depression. He will be medicated until he comes out of the weird daze he’s been in during court appearances. Eventually, after the medication takes effect, he will be found competent to stand trial: The hurdle is low, so he just has to be able to understand the charges against him and be able to consult rationally with his lawyer. If the drugs have in fact made Holmes saner, he may plead guilty to avoid the death penalty. He’ll go away for life. And we’ll be no closer than we were before to fixing the holes in the mental health care system that he fell through—taking his victims with him.

Here’s what we know about Holmes, who is 24: He was a promising neuroscience Ph.D. student at the University of Colorado and one of six students with a prestigious training grant from the National Institutes of Health. He had no criminal record. But he failed his oral exams in the spring, and he was seeing a psychiatrist, Lynne Fenton, who in June was concerned enough about something she saw in him—we don’t yet know what—to call the campus police and to alert the university’s threat assessment team.

Before the team met, however, Holmes dropped out of school. And that looks like the end of the line for his psychiatric care. The university assessment team never met. Holmes surely stopped seeing Fenton once he lost his student status. It’s not clear whether she tried to refer him to another therapist outside the university. We do know that he mailed Fenton a package detailing his murderous plans, which arrived at the university the Monday after the shootings—too late. (The package did not sit in the mailroom for a week, as Fox originally reported, according to university officials.)

In sum, Holmes sent signals that he was on the edge—but once he left school, he was on his own. That is the fact at the center of this tragedy and others like it. James Holmes has far too much in common with Jared Loughner, who pleaded guilty this week to killing six people and wounding 13 more in the Arizona shooting that seriously injured Rep. Gabrielle Giffords. Loughner also dropped out before the shootings, after he was suspended from Pima Community College for erratic outbursts. “No one in that class would even sit next to him,” one of the students in his poetry course said. Pima required Loughner to get a mental health consultation before he could come back to school. He didn’t. And so, like Holmes, he was left to his own distress and delusions. It wasn’t until after the killings that Loughner was diagnosed as schizophrenic by a court-appointed psychologist. At that point he got medication, so he could be deemed competent to stand trial. And he started showing “some understanding of his actions,” according to the psychologist. He told her he wished he’d taken medication earlier. And he expressed remorse to her, saying, “I especially cried about the child,” in reference to the 9-year-old girl he killed.

This is so incredibly sad, from every vantage point—the killers’ as well as the victims’. As Dave Cullen writes in a superb analysis of the Aurora shootings, a mentally ill person who becomes violent often unravels slowly. As this frightening process unfolds, he is “typically perplexed and then distraught by the alarming thoughts ricocheting around his brain.” Seung-Hui Cho, who killed 32 people and wounded 25 at Virginia Tech in 2007, requested a psych evaluation as he felt himself falling into his mind’s abyss.

As far as we know, Holmes, too, voluntarily sought help from Fenton. What’s particularly terrible about the bare minimum of the facts we know—the judge in this case has imposed a blanket seal and gag order that he should soon lift—is how tantalizingly close he came to getting sustained care and to being flagged as dangerous. Closer than Loughner. Closer than Cho.

Of course, it’s only easy to say in retrospect that Fenton and the university assessment team she alerted should have acted with urgency. Surely, she and they would have done anything in their power to stop Holmes if they’d known he would soon kill 12 people and wound 58 more. The larger and crucial point about mentally ill people who become violent is this, as Benedict Carey wrote in the New York Times after Loughner’s shooting spree: “Even after the 2007 massacre by a student at Virginia Tech, institutions and employers are seldom set up to handle such potential threats, experts say — even when the warning signs are blatant and numerous.” There’s often no single person or office tracking students who behave strangely. Worse, if a student leaves school or an employee loses a job, he loses his access to university or employer-based health services—with no follow-up and no clear alternative.

I have to point out that it’s very rare for mentally ill people to become deranged killers. According to the Bazelon Center for Mental Health Law (disclosure: It’s named in memory of my grandfather), studies show that having a mental illness in itself doesn’t increase the likelihood of becoming seriously violent. Untreated mental illness, however, is a risk factor. And so it is terribly scary, as well as terribly sad, that “America’s mental health care system is horribly broken and horribly underfunded,” as Robert Bernstein, director of the Bazelon Center, underscored after the Arizona shootings.  

Serious mental illness can be incredibly hard to live with and to deal with. But these shootings keep telling us that we sweep it under the rug at our own peril. After a massacre like Aurora, it’s very hard to see the killer as worthy of any sort of sympathy. “They keep talking about fairness for him,” a man whose sister died in the Aurora shootings told the Associated Press at Holmes’ court appearance this week. “It’s like they’re babying this dude.” It’s an understandable reaction, but if Holmes’ lawyers are right and he is seriously ill, he won’t be coddled by the legal system. He’ll get the treatment he needed, but far too late.

After Loughner’s guilty plea, one of the survivors of his shooting spree had the compassion to point out the lack of mental health services for people like him. “We really have to be our brother’s keeper here and reach out and get them help,” victim Randy Gardner said. Real reform of mental health care, so that dropping out of school doesn’t mean being dropped by your therapist, would be arduous. It would offer no throb of vengeance. But it would make us safer.