TALLAHASSEE — To prevent more mass shootings, Gov. Rick Scott and Republican lawmakers want to pump as much as $138 million into the state’s mental health system, but experts say the proposals would do little to stop the next Nikolas Cruz.
The problem with identifying and treating a person like Cruz — the 19-year-old who confessed to killing 17 people at Marjory Stoneman Douglas High School on Feb. 14 — is that he displayed to mental health counselors behavior that they believed didn’t require intensive therapy. And he refused to recognize he had a problem and resisted treatment that could have required institutionalization.
What’s more, they say, the legislation would create a parallel “shadow mental health system” in which schools, instead of the state’s already underfunded system, are duplicating services and trying to handle kids like Cruz with general mental health provisions that would be woefully inadequate.
And even in the current system, there’s no uniform assessment tool that can reliably predict who’s just an angry young man and who’s a budding mass shooter — a task that becomes even more complicated in a state awash in firearms and a patchwork of ad hoc mental health services that the state doesn’t fully fund or closely track in some cases.
“We know who the angry young men are, but we don’t know who out of the angry young men will become shooters,” Pensacola child psychiatrist Scott Benson said. “These angry young men frequently have psychopathic traits; often they don’t want treatment, which requires extraordinary skill on the therapist over a long time and is very costly.”
In sum, he said, “mental health does not have the answer to this problem.”
Indeed, the seriously mentally ill commit only 4 percent of all violent crimes, according to a widely quoted 2014 academic study.
And when it comes to people like Cruz, Benson said, the solution might be found in a controversial practice: institutionalization, which was largely halted and discouraged after a landmark 1999 Supreme Court case concerning the disabled. Benson said people like Cruz, assuming they can be identified, might need to be institutionalized for at least a year and for maybe even as long as three years — an extreme and expensive measure not even contemplated in either bill.
The House and Senate are proposing commissions to investigate Cruz’s numerous red flags — including violent threats and 39 house calls over a seven-year period — to determine what could have been done to prevent him from slaughtering former classmates and teachers. But neither of their proposals address the inpatient treatment centers that experts say might have been his only viable option for help.
Cruz, according to neighbors and acquaintances, was always troubled, showed violent tendencies and even tortured toads, stabbed rabbits with a stick, attempted to kill squirrels and tried to sic his dog on a neighbor’s piglets. Benson said that, though he hadn’t evaluated Cruz and couldn’t make a diagnosis, he suspected the young man had displayed sociopathic tendencies.
And many sociopaths don’t think there’s anything wrong with themselves and resist and refuse treatment.
Cruz did just that when he turned 18 and refused to allow the Broward County school district to continue giving him mental health services.
“You can’t make someone do something when the law says they have the right to make that determination,” Broward Schools Superintendent Robert Runcie told the Sun-Sentinel.
Florida law does allow for forced outpatient treatment through the state’s landmark mental health law in 2016. But experts say it’s so woefully underfunded that it hasn’t been fully implemented in most communities. And if Cruz were a psychopath, it could have required several hours of costly daily therapy. An hour of mandatory daily therapy would cost about $28,000 yearly, according to figures from the Central Florida Behavioral Health Network.
Had authorities caught him while he was still a minor, he could have potentially been placed in a state-contracted psychiatric hospital for kids through the Statewide Inpatient Psychiatric Program, an Intermediate Care Facility like a nursing home or a secure treatment facility through the juvenile justice system.
Institutionalization through SIPP would have cost $152,201 through the state’s Medicaid program, according to Agency for Health Care Administration data. Agency spokeswoman Mallory McManus told POLITICO there was no waiting list for SIPP services, but she didn’t know whether any contracted hospitals were at capacity because the agency doesn’t track that information.
In 2016, Cruz and his family were investigated by Department of Children and Families caseworkers after he had been cutting himself live on Snapchat, according to DCF records, to see whether he qualified to be temporarily committed. They determined he did not qualify under Florida’s Baker Act, which allows authorities to hold someone for three days for mental health evaluations.
In examining the records available, experts say Cruz likely would not have qualified for either an Intermediate Care Facility, because he was not disabled, or a juvenile justice treatment program, because he had never been arrested. And even if he had qualified for residential commitment through the juvenile justice system, he couldn’t have gotten into one. There’s currently a waitlist of 331 kids.
While the money lawmakers are proposing is welcome, the mental health community says it’s not targeted enough to violent kids like Cruz.
Dean Aufderheide, a forensic psychiatrist who runs Florida’s inpatient mental health program for prisoners, said there needs to be a new way to examine angry young men and determine who could be a killer.
“I think we’re measuring the wrong thing. We’re looking at mental illness alone,” Aufderheide said “We’re not looking at the key ingredient that’s probably the strongest predictor for identifying individuals who commit mass murders. And that’s sociopathy, better known as psychopathy.”
In a surprise to some mental health advocates, President Donald Trump came closest to the solution when he called last week for more institutions to deal with mental health, noting there is “no halfway” between jail and those who need help on the streets.
“We have to confront the issue and we have to discuss mental health and we have to do something about it,” the president said. “You know, in the old days we had mental institutions. We had a lot of them. And you could nab somebody like this, because they … knew something was off. You had to know that. People were calling all over the place.”
Scott is pushing for $50 million to expand community mental health programs across the state. In addition, he wants to add a case manager to every law enforcement agency. House and Senate plans closely mirror the governor’s goals.
“Keeping guns away from dangerous people and people with mental issues is what we need to do,” he said in announcing his plan. “I do know that some are going to accuse me of unfairly stigmatizing those who struggle with mental illness. I reject that. But what I am saying is no one with mental issues should have access to guns.”
The House and Senate plans differ on figures and details, but they focus their mental health funding on school-based mental health care, community mental health services and mobile crisis teams. In total, the Senate would give $138 million and the House would give $102 million to specific mental health measures.
“Everything from coordinating of efforts, additional training to recognizing risk factors and to act on warning signs are different than the status quo. The funding alone for mental health changes the landscape,” said Senate sponsor Bill Galvano (R-Bradenton).
“If he had received the kind of mental health care through [Community Action Teams] and Mobile Crisis Teams, this could have been avoided,” said state Rep. José R. Oliva (R-Miami Lakes). “If he had been Baker Acted, his weapons could have been seized. Many failings and many lost opportunities, which are addressed in this legislation.”
Lawmakers also want more social media monitoring and better law enforcement threat detection, but experts say their plans wouldn’t clearly mandate a uniform system across the state for finding and dealing with this specific kind of violent child.
Perhaps the biggest red flags concerning Cruz were missed by law enforcement. Last fall, the FBI failed to follow up on a tip about a YouTube account linked to Cruz that said he wanted to become a “professional school shooter.” And the Broward County Sheriff’s Office did not aggressively pursue a separate tip that he was a “school shooter in the making.”
Meanwhile, more threats arise daily. The legislation hasn’t passed. And no one is sure what to do.
Since the Parkland shooting, there has been an uptick in people calling in school threats and in arrests of potentially threatening kids.
In Florida’s Panhandle, mental health administrators have identified 24 high school kids across 18 counties, most of whom were arrested for threatening school violence. One of them was Baker Acted, and one was sent to a county jail because he was 18 — both have been released back into the community. The other 22 kids were sent to either a juvenile detention or assessment center, and a handful have been subsequently released.
“Through blind luck and faith in humanity, 99 percent of the time, the threats will not equate into mass murder. But how can we take those chances?” asked Mike Watkins, CEO of Big Bend Community Based Care, which oversees the mental health services for those counties.
Watkins said he believed the mental health community could potentially help prevent other mass shootings but that the pending legislation might not give them the tools to do so and that it could create “a shadow mental health system [in public schools] when the state has already invested $700 million per year in public mental health.”
Watkins said the legislation needs to have a huge “neon sign front and center” to mandate that existing mental health providers would work with law enforcement and the schools to develop a uniform threat assessment tool to identify potential shooters and then to figure out how to treat them and/or limit their access to people and weapons.
“This case showed a huge Achilles heel in that we do not systemically do this,” Watkins said.
Marc Caputo contributed to this report.