Adam Mau-Goffredo at his district court arraignment hearing July 10.
Searching for answers to Tantalus slayings
Widespread ignorance about mental illness adds to the feelings of shame that keep many from getting treatment
THERE IS NO END to the heartbreak and agony caused by the July 6 slayings of Jason and Colleen Takamori and Manh Nguyen. Their deaths have left a searing hole in so many hearts and souls, an anguish that will be relentless.
Is there any lesson we can learn, or anything remotely positive that can possibly come out of this senseless tragedy?
Editor's note: Adam Mau- Goffredo pleaded not guilty Wednesday to murder charges in the July 6 shooting deaths of three people at a Tantalus lookout. Prosecutors allege that Mau-Goffredo killed taxi driver Manh Nguyen and Jason and Colleen Takamori of Kapahulu. Mau-Goffredo has been diagnosed as a paranoid schizophrenic with a history of alcohol and drug abuse. In the column at right, Marya Grambs, executive director of the Mental Health Association in Hawaii, explores the relationship between mental illness, addiction and violence.|
The Mental Health Association in Hawaii is hoping these slayings can shed light on the complex relationship between mental illness, addiction and violence; on the large community of people with mental illnesses and those struggling to care for them; and on the urgent need our state has for an effective, comprehensive system of care that can prevent such acts from occurring.
What is the connection between mental illness, addiction and violence? Most people with mental illnesses are more likely to be victimized by others than to be violent. However, those who are not in active treatment and who do not take their medication are more likely than the average person to commit acts of violence.
And yet, only 5 percent of all violent acts in this country are committed by people who have mental illness.
But why would someone who is mentally ill not be in treatment or not take their medication?
» First, a symptom of many mental illnesses is that the person does not know or believe that he or she is ill. The illness "tells" the person that what he is feeling or perceiving is the truth, not a delusion. So he does not believe he needs treatment.
» Second, treatment is not always easy to find or obtain. For example, there are waiting lists for many residential living programs, and it is often difficult to locate a psychiatrist who has openings for Medicaid patients.
» Third, mental illness is extremely stigmatized, making people feel ashamed to acknowledge they need help.
» Fourth, some medications have such unpleasant side effects -- such as sedation, cognitive problems or extreme weight gain -- that these can seem to outweigh the benefits.
When addiction is added into the mix of mental illness, it is called "co-occurring disorders" or "dual diagnosis." This can come about in several ways. Some people turn to alcohol or drugs to "self medicate" their mental illness. Unfortunately, substance abuse only makes things worse. Some people who are addicted to drugs or alcohol develop mental illnesses through their addiction.
Whichever is the pathway, the result is that the person might be doubly incapacitated, treatment is difficult and the potential for violence grows exponentially. Further, a major symptom of addiction, like that of mental illness, is that the person does not believe he has a problem. For family members, it might be nearly impossible to figure out what is going on, let alone how to handle it.
How can the state assist family members by providing responsible and effective care for those with mental illnesses and/or substance abuse? Through an interlocking network of crisis services; hospitalization, residential facilities and supportive housing options; and case management, medication management, clinical treatment, psychosocial rehabilitation and supportive employment. At every step, this system must be caring and compassionate, while balancing the needs of the patient with the needs of his/her family and public safety. Coordination with the criminal justice system and substance abuse treatment programs also is necessary. And, finally, such a system requires more financial resources.
Hawaii has historically found it difficult to provide such a system of care. This has resulted in court intervention, both with regard to children and adolescents (the Felix case) as well as to adults served at the Hawaii State Hospital and in community programs. The complex issues illustrated by the Tantalus slayings show just how challenging it is to meet this responsibility.
But there is something we can all do, and that is to work to overcome our own stigma and misconceptions about mental illness. We need to understand that mental illness is a disease of one organ of the body, the brain; that it is not a result of poor moral character, laziness or lack of will, but originates in genetic flaws and can be sparked by environmental triggers. It is not the person's fault, any more than having cancer or Parkinson's disease is someone's fault.
To the extent that we can all understand mental illness and be alert for the symptoms when they occur, people will be more likely to get the treatment they need because they will feel less ashamed and more supported.