New York subway shooting highlights mental health crisis in the US (Analysis)

Frank James pleaded not guilty or not guilty in court 2:46

(CNN) --

Investigators continue to sift through the extensive library of YouTube videos created by Frank James, the 62-year-old man accused of shooting 10 people on a New York City subway train, for clues about his motives. .

But those videos and her case have also refocused America's attention on the acute mental health crisis gripping this country, from the sheer number of untreated people in need of psychological help to the difficulty Congress will face if it really tries to fix what has long been a broken system.

Many details of James's story are still unknown, but the portrait that has emerged from some of his videos is of a man who seemed isolated, deeply frustrated by his treatment by society, and often full of rage, misogyny and animosity toward people of all races, including black people.

His thoughts in the videos were often disjointed and difficult to follow.

But he made his threats in full view of anyone who clicked, stating in a recent video that he had "been through a lot where I can tell he wanted to kill people" and he wanted to "see people die."

• This was the 30-hour search for Frank James, the suspect in the Brooklyn subway shooting

He explicitly referred to his own "mental health crisis in the '90s, '80s and '70s" and his interactions with healthcare workers while mocking New York City Mayor Eric Adams' plan to address safety. and subway homelessness by involving more mental health professionals, predicting that the mayor's effort was "doomed to fail."

In the middle of his trip from Wisconsin to the East Coast, he warned his viewers in a video uploaded on March 20 that he believed he was "returning to the danger zone", stating that he had a "severe case of post-traumatic stress".

Brooklyn shooting occurs amid spike in gun violence 3:02

Even to someone untrained, those would all have been red flags that suggested James might have benefited from at least a psychiatric evaluation.

The New York City mayor expressed his frustration during an appearance this week on CNN's "New Day," saying, "We're seeing signs all around us of those leaning toward violent action, and we're ignoring them."

But criminologists have also pointed out that James shared his violent thoughts within an ocean of social media, an enormous challenge for law enforcement, and he may be just one of millions of Americans who could have benefited from the help or a intervention that he did not obtain.

At a court hearing Thursday, Assistant US Attorney Sara Winik described the attack as "premeditated and carefully planned."

James has been accused of violating a law that prohibits violent and terrorist attacks on public transportation;

he pleaded not guilty and was denied bail.

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Even as New Yorkers question whether the attack could have been prevented, James's case reinvigorates debate about how many Americans are being left behind as the United States grapples with an acute shortage of mental health providers, a woefully inadequate number of inpatients, psychiatric beds, and very few community crisis centers where people can seek help outside of emergency rooms.

There are ongoing gaps in health insurance coverage for psychological problems and significant barriers even at the point of entry to finding a provider, made worse by low levels of reimbursement for mental health professionals willing to treat patients with government insurance.

Those issues barely scratch the surface of the problem, and all have been compounded by the strain that the Covid-19 pandemic has put on the health care system.

Even before the pandemic, studies showed that one in five Americans were living with mental illness and about 5.6% of adults had a serious mental illness, including diagnoses such as major depression, bipolar disorder, or schizophrenia.

The mental health crisis among young people in particular has accelerated.

For teens and adults alike, mental illness can often intertwine with substance use disorders as the nation grapples with a record number of drug overdose deaths.

One of the most surprising findings from last year's "National Report on Quality and Disparities in Health Care" is that more than half of the people who need mental health care in this country don't get it.

The report noted that "unmet need" is far greater among people of color: About 63% of African Americans experiencing such mental health problems received no treatment, along with 65% of Hispanics and nearly 80% of Asians and Pacific Islanders.

Suddenly, the public is paying more attention, not only because of the pandemic, the opioid crisis, and the rise in overdose deaths, but also because they are encountering an increasing number of people who are mentally ill as homelessness has become more visible in their neighborhoods.

President Joe Biden mentioned the nation's mental health struggles in his State of the Union address, calling for "full parity between physical and mental health care."

But the wheels of Congress are slowly grinding, and the reality is that there is very little room on that body's schedule this year to advance important legislation that is still in the works, even though recent hearings suggest there is indeed a bipartisan consensus that something must be done.

Oregon Sen. Ron Wyden, a Democrat who heads the Senate Finance Committee, has joined forces with the panel's ranking Republican member, Sen. Mike Crapo of Idaho, to organize what he called a "major bipartisan effort to bring behavioral health care at the forefront of America's health care system.

How is New York trying to reduce insecurity?

2:36

They have tasked 10 members, five from each party, with developing legislative solutions in five key areas including bolstering the behavioral health workforce and improving care for children and youth.

Wyden's goal is to draft legislation by the summer, and several other House and Senate committees are working on parallel tracks.

The motivation stems from the fact that members of Congress are listening to constituents about the need to address mental health.

This is due in part to concerns about rising crime and also how mental health, housing instability, and homelessness can be inextricably intertwined, sometimes with disastrous results.

The Brooklyn shooting followed several other high-profile incidents that have refocused attention on massive gaps in the mental health system.

After an incident in January in New York, where a homeless man pushed a woman in front of an oncoming subway train, Adams warned that fears are growing as people see that "homeless people with poor health mental health are not taken care of".

That same month in Los Angeles, a longtime nurse died after being hit in the face and falling to the ground while waiting for a bus in an attack by a man police described as homeless.

The act, police said, was "unprovoked and without reason."

Mitch Prinstein, scientific director of the American Psychological Association, said it was important for the public to remember that the vast majority of people who have psychological symptoms are not violent and that "while these exceptions make headlines, for every violent person experiencing psychological symptoms, there are hundreds of thousands of people who are suffering in silence.

While there has been more attention to mental health due to the pandemic and other reasons, he said he is concerned that what he has seen coming out of Washington so far "suggests gradual change."

"It's overloading the current systems that we have, to provide enough of a benefit to create the appearance that something meaningful was done," said Prinstein, who recently testified about what to do at a mental health hearing before the Senate Committee on USA in Health, Education, Work and Pensions.

Prinstein told commission members in written testimony that they should focus on expanding the ranks of the mental health workforce and making it more diverse.

In addition to investing in more programs that fund the education and training of mental health professionals, he said Congress should help reduce the student loan burden that doctoral psychologists bear after graduate school, including through legislation that would authorize a student loan repayment program for mental health professionals who agree to work in the many areas that lack accessible care.

To address the growing needs of children and youth, he also advocated for increased access to "mental health services in schools."

And he emphasized the need for better integration of primary care and behavioral health services, as well as the need for stronger enforcement of laws aimed at ending insurance discrimination against people with mental health and abuse disorders. of substances.

"What I really want people to recognize is that the system we have right now is so woefully inadequate, not only because we don't have the number of health care providers that we need to address mental health, but we're ignoring decades of science. that could help us prevent so many people from getting symptoms in the first place," he said.

As an example, he pointed out that the federal government spends $15 billion a year to train medical health providers and less than 1% goes to training mental health care providers.

Dr. Michelle P. Durham, vice chair for education at the Boston Medical Center's Department of Psychiatry, said she hopes lawmakers and Americans alike will recognize that it's "a system that has never really been invested in."

"We're at this point now where the pandemic has affected a lot of people and there's been an increase in demand for services with a lack of infrastructure at the community level across the country... There just aren't enough resources," Durham said. "We have to invest in the infrastructure, we have to invest in our workforce, and then we have to invest in community supports, period, so that people can get treatment when they need it."

He pointed to some of the ideas that Congress should explore, such as increased investment in outpatient clinics at the community level and mobile crisis teams that can send doctors to assess and treat those experiencing a crisis, as well as successful programs like the Health Initiative. of Child Behavior in Massachusetts that has made more therapists, case managers, and peer support systems available to families within their communities.

Durham said she was encouraged that the pandemic has brought some of those urgent needs to light.

"I think a lot of us in the field are hopeful, actually, that people are starting to listen; people are starting to understand more about the difficulties of the mental health care system in America." , she said.

The question now is whether members of Congress will show the political will to move forward.

shootings in the United States