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State of the Union

Interview With Dr. E. Fuller Torrey, Dr. Lisa Dixon; Interview With Representatives Napolitano and Murphy

Aired January 16, 2011 - 09:00   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

CANDY CROWLEY, HOST: In the aftermath of the Tucson shootings, it was a week of harsh reality and overriding mystery, what happened to Jared Lee Loughner?

(BEGIN VIDEOTAPE)

UNIDENTIFIED FEMALE: Back then he was completely different, very caring, very sweet, a gentle, kind, all together pretty great guy.

UNIDENTIFIED MALE: He was just a great kid, and it seems like he just snapped somewhere in high school, and went down from there.

UNIDENTIFIED MALE: He was definitely off. He had a grin about him.

UNIDENTIFIED MALE: He would laugh at things that were sad. He just didn't seem to be aware of what was going on.

UNIDENTIFIED MALE: I was scared of what he could do. I wasn't scared of him physically, but I was scared of him bringing a weapon to class.

(END VIDEOTAPE)

CROWLEY: Did anyone, could anyone have foreseen the downward spiral of Jared Lee Loughner from the nice kid some people remember to the mass murderer he is now accused of being? Could treatment have stopped the Tucson killings?

(BEGIN VIDEOTAPE)

CROWLEY: Today, two psychiatrists who specialize in severe mental illness, Dr. E. Fuller Torrey and Dr. Lisa Dixon.

TORREY: This is a psychiatric failure. It's not a political failure.

DIXON: I don't think that changing the tenor of political dialogue would have really made any difference.

CROWLEY: Then, author Pete Earley, a father who battled to help his son through the mental health maze, and psychologist Fred Frese who himself has been institutionalized for schizophrenia, and the two members of Congress who founded the Mental Health Caucus, California Congresswoman Grace Napolitano and Pennsylvania Congressman Tim Murphy.

I'm Candy Crowley, and this is "State of the Union."

(END VIDEOTAPE) CROWLEY: The community college Jared Lee Loughner once attended has released a video he apparently shot on the Pima County campus.

(BEGIN VIDEO CLIP)

JARED LEE LOUGHNER: All the teachers that you have are being paid illegally. Any illegal authority over the Constitution of the United States under the First Amendment. This is genocide in America. Thank you. This is Jared from Pima College.

(END VIDEO CLIP)

CROWLEY: The vast majority of people diagnosed with a serious mental illness are not dangerous, but how do you tell? And where is the legal boundary between forcing a troubled, potentially dangerous person into treatment and the rights of an individual? Joining me now to discuss this and more, Dr. Lisa Dixon, professor of psychiatry at the University of Maryland School of Medicine, and Dr. E. Fuller Torrey, research psychiatrist and founder of the Treatment Advocacy Center.

Doctors, thank you for joining us. Let's just -- I want to take a look at Loughner, because you've watched it as we all have watched it, and we should say you haven't examined him, and we understand that.

How do you tell? Because the first thing whenever I talk to anyone in the mental health industry, they say, just remember that the vast majority of schizophrenics and anyone with a serious mental illness, they're not dangerous. How do you tell?

TORREY: The strongest predictors of violence are, No. 1, past history of violence, Candy. That's true of non -- people who don't have schizophrenia, too. No. 2, substance abuse. These are the two single biggest predictors. Being a male is also a predictor.

Beyond that, once a person has schizophrenia, there are a few symptoms that increase the violence a little bit. One is if you are paranoid and you think people are trying to hurt you. Another is if you think people or the government are trying to control your mind. A third one is if you have voices that are commanding you, telling you to do things. These are the kind of things that will increase the risk a little bit.

CROWLEY: But you know, I know you both know the case of Wayne Fenton, who is a nationally renowned doctor who dealt with schizophrenics, well revered in the world of schizophrenic treatment, who was treating someone who killed him. I mean, here is a man who is an expert in this, who was alone with a patient who clearly was very dangerous, and must not have known.

DIXON: I think that underscores -- there's good news and bad news here in terms of our ability to understand. We do have some knowledge. We know there are risk factors. We know that substance abuse contributes to risk. We also know that there are additional experiences people who have been victims of violence, people who are homeless. There are risk factors.

But in the end, it is impossible to predict with 100 percent certainty. And so what one needs to do in addition to recognizing risk factors is talk to the person, if you can, and communicate and try to get a fuller understanding of how they see things and what their intent might be.

CROWLEY: This is a pretty fine line here. You all are experts in this field. If you are a parent, if you are a classmate, and we have classmates saying I thought he was scary. How does a -- what does a layman look for? If you think this person is in trouble and you're about to take a step that maybe would be to report this person, you got to have something to go by, so how does anyone watching think, OK, this has crossed the line?

TORREY: I think most lay people have a great deal of trouble understanding enough about the disease to be able to make that assessment. I think partly you have to make it on your gut, and partly you have to make it by getting as much information as you can from family, from other people. I think the example in Tucson is a good example where a series of people had some of the information, but nobody had all of it to put together. When you put it all together today, we can see, yes, this young man not only clearly had schizophrenia, but he was also potentially dangerous. But at the time, nobody took the -- made the effort to gather all the information and put it together.

CROWLEY: And so are you then arguing that it's almost impossible to stop this sort of thing?

DIXON: I think that the way I would look at this is, if you are, you know, a person, you have a classmate or a student or a friend, you shouldn't hesitate to seek help, and not feel that you have to be the one to make the decision. I think if -- the mistake that people make is to think that they have to know that this person is dangerous. What they -- what I think our own -- our obligation to ourselves and to our community is to ask, and to seek help. And our obligation as, say, a mental health system and as school teachers and as heads of institutions is to try to make it safe to ask.

CROWLEY: Did you, when you were watching this unfold, Dr. Torrey, did you see a piece of information that you came across and you thought, that, that's the sign?

TORREY: Absolutely.

CROWLEY: And what was it?

TORREY: Absolutely, this young man had a very pronounced thought disorder. There's very few other conditions other than schizophrenia that give you the loose, rambling, illogical thinking that he was described as having and apparently on his Youtube -- this is very characteristic of schizophrenia. Also, the delusions that somebody is trying to control your mind. And also the bizarre delusions that somehow the government was trying to control his mind by grammar. That's what we call, at least to me is a bizarre delusion, almost no other condition do you have these kinds of symptoms on it. So that really within the first day of what I was listening to, you know, I've seen several hundred people with this disease, and he just fit a textbook case.

DIXON: But there's a difference between having a symptom of the disease of schizophrenia and then -- and having a higher likelihood -- of being able to know that there's a high likelihood of violence.

CROWLEY: Right. And that's what I'm trying to get at. Was there a point where either of you, and first to you, Dr. Dixon, was there a point you thought here's what should have told people this is a dangerous -- obviously we know he bought a gun, but no one was with him. Was there some sign you thought this is a red flag for danger?

DIXON: I think when people feel threatened, that would be a big red flag for me, and access to weapons.

TORREY: The fact that people were frightened of him, that had this reaction, that's a little unusual. Usually people with schizophrenia don't elicit that kind of reaction. And then the key thing, of course, is he was not on medication. Medication makes all the difference in the world. People on medication -- there's no increase in violence by people with schizophrenia on medication. This, unfortunately, this young man was not treated.

CROWLEY: And -- but the truth of the matter is that there are people who don't want treatment. People can be so sick they don't know they need treatment. Then what?

DIXON: In that case, you know, that's a very complicated situation, and I think that when someone needs treatment and is unwilling to pursue it, we have to ask the question, of whether -- what is the case to be made for treatment? Because many, many people can live safely without treatment, and it's a choice they're making. The treatments that we have are not free of side effects, and in that situation, I think most of us would say in our society someone should be free to make that choice. However, in the situation where a person has symptoms that are dangerous or that a good evaluation would suggest would bring harm -- potentially bring -- that this person could bring harm to themselves or to other people, so in that case...

CROWLEY: Which is kind of great in hindsight, because then you know they have a tendency to be violent, but since it's so difficult to figure out, do you think that the system, the mental health system, mental health policy in this country failed this young man and in this case 20 people who got shot?

TORREY: Well, I think the system failed miserably on it and I think Arizona has among the worst mental health services in the United States. There's only one state that has fewer public beds and that's Nevada on it. So even if someone tried to get treatment for this fellow, it may or may not have succeeded in Arizona because they have cut many of their outpatient services. This is true all over the United States. There's not a single state in the United States that I would say people could go to today and are likely to get decent care in the public sector for schizophrenia.

In Arizona, in fact, the law is pretty good. You could have gone and you could have gotten involuntary treatment. Other states you have to have proven dangerousness before you can get an involuntary evaluation.

CROWLEY: And that's tough for someone who hasn't yet been dangerous.

TORREY: That's right. That's right. Until you are either killing yourself in front of your psychiatrist or killing your psychiatrist, you can't get care.

CROWLEY: One of the things I noticed in some research that I was doing about a decade ago, you expressed hope that a cure for schizophrenia might be within the next decade, next 10, 12 years. We're kind of there now. Where are we now in a cure, and then in the treatment of?

DIXON: I wish that I could say we were closer to a cure. I don't think we are even close to a cure. I think we are getting closer to treatments that can possibly prevent the disability associated with schizophrenia.

We certainly have medications that target the acute symptoms. And I think we have approaches, for example, supported employment or vocational rehabilitation that assist people with these illnesses in actually getting and keeping jobs.

CROWLEY: It sounds good, but it's not available to a lot of people.

TORREY: I'm more optimistic than that, Candy. I think we are -- I think we're closer than that to having some very definitive medications that will treat the symptoms much more accurately than anything we have right now.

CROWLEY: And finally, when a lot of people watched events unfold in Tucson, they blamed the lack of civilized dialogue, a lot of people looked at it and saw, you know, civilization that's deteriorating, they found a number of people looked and said, well, it's the gun laws. When you look at the totality of what happened in Tucson, what do you see?

DIXON: I think -- I think that in general, we should restrict access to guns. And I do think that giving every -- you know, having access to guns overall is a problem.

CROWLEY: But did you see this as a gun problem? DIXON: I think that it's really a problem with mental illness, and lack of access, lack of services, and lack of engagement. I don't think that changing the tenor of political dialogue would have really made any difference in this situation.

TORREY: I think political dialogue had nothing to do with it, quite frankly. I think gun laws -- yes, I don't think someone ought to be walking around with a Glock that has a -- can shoot 30 bullets at once.

I'm from Upstate New York where hunting is important. I don't think we're ever going to have complete gun control. We could have better gun control, but it wouldn't have made a big difference here.

People have killed with knives -- he would have killed fewer people, but it's not going to stop the event.

CROWLEY: And so if you don't immediately go to "gun laws are at fault," and if you don't immediately go to "civilized dialogue" is at fault, just your whole -- and we've seen this before, let's face it, in either -- maybe less headlined people, fewer people, what is this a failure of?

TORREY: This is a psychiatric failure. It's not a political failure. It's a failure of our ability to provide basic care for people who have brain diseases that are seriously mentally ill. If these people had kidney diseases we wouldn't stand for it. But they don't understand the brain well enough and we have completely failed them.

CROWLEY: Dr. Torrey and Dr. Dixon, thank you very much for joining us today. I really appreciate it.

TORREY: Thank you.

DIXON: Thank you.

CROWLEY: And when we come back, more of our discussion on the state of mental health in the United States with two men who have been impacted personally.

(COMMERCIAL BREAK) CROWLEY: In the end, mental illness is not an individual struggle, it's a family struggle made more difficult by stigma, fear, and a mental health system often unable to meet the need.

Former Washington Post reporter Pete Earley wrote a book about his son's illness and efforts to work a system where those in need are more likely to get help in jail than anywhere else.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: We should not require a person who has a brain disorder to commit a crime in order for them to get treatment and medical help.

(END VIDEO CLIP)

CROWLEY: When it comes to confronting the stigma of brain disorders, few have been as brave as Frederick Frese, a Ph.D. in psychology, he has been an advocate for the mentally ill for 30 years, and there is more.

(BEGIN VIDEO CLIP)

FREDERICK FRESE, PSYCHOLOGIST: I'm a psychologist, I'm a Marine, and I'm -- I'm schizophrenic. I know, this is (INAUDIBLE), you have got to be politically correct so I'm also a person with schizophrenia.

(LAUGHTER)

(END VIDEO CLIP)

CROWLEY: Fred Frese and Pete Earley are next.

(COMMERCIAL BREAK)

CROWLEY: Joining me now in Washington, Fred Frese, a psychologist and former director of psychology at the Western Reserve Psychiatric Hospital and former Washington Post reporter Pete Earley. Gentlemen, thank you both so much for coming.

We brought you here because not only are you experts having studied this field you have personal stories that are truly amazing. You have a son who is schizophrenic, wrote the book "Crazy" about trying to get him through the mental health system, trying to get him help.

And you, sir, are a diagnosed schizophrenic. You had been hospitalized against your will, I guess at certain points. But have not been hospitalized for 30 years. A father of four?

EARLEY: Very good.

CROWLEY: Four, and so you just bring to this table such a wealth of experience so many of us don't have. And I think as you saw in that first segment and sometimes I think we're arguing against ourselves here because we always say the majority of seriously mentally ill people are not violent yet we can't seem to get our hands around how do we tell and what do we do.

Can we start by asking you from your experience as a diagnosed schizophrenic or a person with schizophrenia, whichever is PC, did you find yourself having dangerous thoughts?

FRESE: Well, a very appropriate question at this time, I think. I've been picked up by the police a number of times, so obviously I was doing something that triggered my being picked up. I remember once I was picked up and they were kind enough to ask me in their words did I want to go to jail or the looney bin and I said well I've been to the looney bin before. I prefer the jail, thank you. And that's where they put me. Now, let me say this, I teach this to the CIT policemen all the time. And here's the way I put this, what is it like to be schizophrenic? From you chronically normal folks, I mean you don't have experience with this, so what are we like? And you never talk about us. I mean, it's taboo, you don't think about it. I mean, we're 1 percent of the population.

Policemen have and everybody has some experience with alcohol, drunk people. There are different types. You have happy drunks, you have sad drunks, and you have mean drunks. It's the same with us. The neurotransmitters get going. Fortunately I happen to be a happy psychotic, I start singing and dancing, weaving the world's religions together. I'm not really threatening. But some of my brothers and sisters, some get very, very sad, and some, when they get symptomatic engage in behaviors that are quite threatening.

Now, once you've had this, I would say a delusion is a major symptom of schizophrenia, but obviously a delusion of false belief. If the person with the delusion knows it's a delusion, then it's not a delusion, is it? And so those of us who have this condition cannot know that we're going into that psychotic state.

CROWLEY: And sometimes you can not know that you need medication.

FRESE: Oh, 50 percent of us, because -- are you talking to me? There's nothing wrong with me, huh?

CROWLEY: From a parent's perspective and please, I want to you take that thought first but I also want you to ask, was there ever a time with your son early on that you were afraid physically afraid?

EEARLY: Absolutely. But see the law forces you to be that way. Until a person becomes dangerous, then they will not intervene. So as a parent you're caught. I know parents who have agitated their children to get them to a state that they can get them committed or get some kind of help for them.

CROWLEY: So it's really made it worse...

EARLY: Oh, yeah, absolutely. The last time my son had a break I ended up calling the police and they shot him twice with a taser. They took him away to a community treatment center which is the normal process.

Before he saw the doctor, he had calmed down. See you have to understand, Candy, that most people that I've dealt with who have a mental illness are not psychotic all the time, or they can control it, and you'll see this a lot when you go into court and this is what happened with my son. By the time he was ready to see the doctor he had calmed down so I intentionally went in and agitated him because I knew if she didn't see him in this state, that she was not going to say, we're going to hold you, and then luckily he always has voluntarily committed himself. Otherwise he would not have met that criteria. And I would have taken him home. Can you imagine taking home somebody shot twice with a taser, has no shoes on and is angry at the parent. And the doctor says well, I'm sorry, they're not dangerous, you take him home. That's the reality parents live with.

CROWLEY: And if you cannot tell as a parent, who knows this child better than anyone else, it's difficult for society to make that, so it sounds like the rules need to change a little bit if it's so difficult to help people who may want help but don't know enough to ask for it, because they're that sick.

EARLEY: But why should you -- this is the dilemma: you want to protect someone's civil rights, and where do you draw that line? Now, I took my son to an emergency room.

My son had told me, asked me, dad, how would you feel if somebody killed himself? He was having tremendous mood swings back and forth. And by the way my son has been diagnosed as having bipolar disorder, schizoaffective early onset schizophrenia and that's another problem the parents face. These are tough illnesses to determine, okay. But anyway I took my son into an emergency room. The doctor said he's not sick enough, bring him back when he tries to hurt you or hurt someone else.

I took him home. He was sitting in front of a television set, tin foil wrapped around his head because the CIA was reading his thoughts. As a parent, why should I have to sit there and wait for him to become dangerous when I love him and I know he's hurting?

CROWLEY: So what's the answer?

FRESE: I've got the answer here. Do you want the answer?

CROWLEY: Yes, I do want the answer.

FRESE: You've got a million people out here listening, I'm ready. I've been working on this. Here's the thing, you got -- I want to say something to everybody out there. One, sorrow, I mean when John Nash won the Nobel prize, paranoid schizophrenia, I was so proud, one of us had won the prize, but this is a disaster.

I'm so sad, so sorrowful but most of all, now I cannot speak for the whole mental health, but if I could I would want to say we apologize, because it is our responsibility, it is our duty to take care of these people. It is not the lawyers. It is not the gun people. It is our responsibility and we have messed up here collectively. We have not -- we focus on other things. We need to seriously focus on the rules you mentioned being changed. He should not have been dropped. He was dropped. This broken heart, he's on marijuana, marijuana increases likelihood of schizophrenia, we know this. The school, we get rid of him. Well, get rid of him to where? The army doesn't want him. To where? They're abandoned.

We, the mental health community cannot abandon these folks anymore. We've got to establish relationships, to keep up with them. Jared, how are you doing? How are you doing, Jared? That relationship.

Now, thank you for letting me have that message. That's it.

CROWLEY: And I would assume that you would agree, and i know that you had trouble with the school.

EARLEY: Absolutely. Well, I think that we, again, it goes back to what you first talked about, which is a very complicated civil rights issue. You know, when do you intervene? When do you say I'm going to step in and you need treatment? And we're going to require you to get treatment.

And Arizona has the dangerousness criteria, Arizona has gravely disabled. You know, I'm going to disagree with a lot of the professionals, as a parent I've read everything I could about this case and I'm telling you as a parent I don't think his parents could have gotten him into any kind of treatment. It is almost impossible to get treatment in this country if you have somebody who wants to get it. Now, imagine somebody who doesn't want to get it.

And I'll give you a quick example. Fairfax County, fabulous mental health services. It's one of the wealthiest counties in America, it's a suburb of Washington, D.C., average household income more than $100,000 per household per year. And yet "The Washington Post" reported there is a two week wait to get any kind of treatment program. There is a six month wait to get a case manager who is responsible, like for saving my son's life. There is an 18-year wait to get housing.

FRESE: But it is our fault, because if we got together and made our demands on the system, they would move but we don't do it.

EARLEY: I disagree with you, Fred, because incidents like this scare people. They get people alarmed but when it comes down to making decisions about money, comes down to making services, comes down to including people, everybody goes I want roads...

FRESE: People always want to focus on the money part. It is not a matter of the money. We always want more money. What we need is to keep our eyes on the problem, the problem is focus with psychotic conditions. We need to take care of them.

FRESE: And if we start taking care of them, we won't have disasters like this.

CROWLEY: When you were...

FRESE: (Inaudible).

(LAUGHTER)

CROWLEY: When you were -- when you were -- early on -- and again, we say you haven't -- have not been hospitalized for...

FRESE: Yes, since I was married...

CROWLEY: Since you got married.

FRESE: ... 33 years ago.

CROWLEY: And so kudos to her.

(LAUGHTER)

Did you know, when you were involuntary committed, that you needed help, or -- because we're talking about -- yes, you?

FRESE: "You know, help from who? Why are these people locking me up this way. There's nothing wrong with me."

Now, they told me I had schizophrenia, this deteriorating brain disease, and I'll probably carry it for the rest of my life (inaudible) but my own perception is, why are you doing this to me?

CROWLEY: And yet, what you're saying is that it was easier to commit you 30 years ago, right...

FRESE: Oh, yes.

CROWLEY: ... than it is now.

FRESE: That's why they haven't touched me in 33 years.

(LAUGHTER)

CROWLEY: And, you know, someone gave me, I thought, a really good example. They said, if a person with Alzheimer's was sitting outside in the snow without shoes on and a coat, we would do something.

EARLEY: We sure would. And normally they do.

CROWLEY: And yet it doesn't happen when it's a schizophrenic.

EARLEY: No, three weeks ago you had someone with a mental illness who died frozen to death up -- right outside of...

FRESE: Philadelphia, two of them in the last two years.

EARLEY: Yes, and a week before the shooting here of the -- in Tucson, the first police officer murdered in 2011 was shot to death by a person with an untreated mental illness.

So, again, it goes back to when do you intervene. And predicting dangerousness is impossible, because the person has a mental illness, so you're really -- like, for instance, with my son, when he has a mental illness, you're dealing with the illness. You're not dealing with that person who you love and adore and want to help. You're fighting the illness.

FRESE: It's so much more than that. We keep preventable tragedies on our website for our treatment advocacy center. Projecting from that, we have one of these tragedies, more than one per day. Ten percent to 15 percent of us commit suicides. This is tragic. We have -- we are 10 times as likely to be victims of violence as we are to perpetrate it, and we get in the headlines when we are the perpetrator.

So if you look at the stats, it's several times a day somebody is dying or seriously hurt because of this. We need to get together, realize this and do what you're doing now. Let's focus on this problem, long-term, not news cycle one week -- long-term, get together and take this problem seriously.

CROWLEY: Because it is treatable, if not curable. Your son is doing very well.

EARLEY: My son's doing great.

CROWLEY: You clearly are doing very well.

FRESE: Thank you.

EARLEY: And I -- I -- you know, I absolutely believe, in my experience doing research, that we know how to help many, many -- most people with mental illnesses. We know the medication works in many cases. We know that jobs work. We know that housing works. We know that community support works. The problem is trying to get the person into those services.

And then where Fred and I might disagree is having those services available. And they're not available in this country.

FRESE: One more thing very important, because I promised the NIMH people. The relationship between taking marijuana, particularly when you are an adolescent, and increasing probability for having schizophrenia symptoms is very clear.

If this -- if we had known that as a probability factor with this young man taking all this marijuana, that would have sent out signals as well. So hopefully we'll begin to get that word out that these illicit substances for certain vulnerable individuals increase that likelihood.

CROWLEY: In our final moments, give me your best piece of advice for what's being called the chronically normal, a friend, a child, you know. What should they do?

EARLEY: Well, first off, as a parent...

CROWLEY: What should they do?

EARLEY: First off, as a parent, realize you're not alone. Contact groups Mental Help America, the National Alliance on Mental Illness. Get to know your state commitment laws; talk to your child, your adult child, and try to become their partner. Don't argue with them when it comes to their delusions, but try to become their partner, and be aware of how you can help get this person into services.

(CROSSTALK)

FRESE: I just wrote an article on Canada psychiatrists and psychologists and others with schizophrenia, and what we thought about that, what should we do? We disagreed on everything except one thing, and that is we all agreed the stigma and discrimination, the use of the "N" word, as in N-U-T-S by you normals all the time is something that we need to take a second thought about.

CROWLEY: Because the stigma contributes to the fear. Does it not? Were people not afraid of your son?

EARLEY: Yes. People are -- were afraid. But you have to understand why -- I think -- why are we afraid? We walk by somebody on the street who is ranting and raving. We don't want to believe that's an illness, because if it's an illness, it can happen to you.

CROWLEY: Right. And a lot of people still don't think it's an illness -- you know, something the parents did or didn't do. And I think both of you actually stand as just great examples for working through this.

EARLEY: The hero is my son, and I had to form a partnership with him. And that is part of the key to his recovery, is listening to him, instead of just trying to tell him what to do. And that's another part that you learn along the way. But when he's psychotic, then I'm going to step in. I'm the parent.

FRESE: Candy, thank you so much for having us.

CROWLEY: Thank you so much for coming. We really appreciate your stories and your expertise in this.

Up next, we'll look at what role the government could play in the fight against mental illness.

(COMMERCIAL BREAK)

CROWLEY: Mental illness is expensive to treat. Many suffers turn to government-funded programs and institutions to help, but the well dries up in hard times.

In the last two years, while demand for community crisis services and screenings has jumped, states have cut an estimated $2.1 billion in mental health services out of their budgets, and that's a conservative estimate.

In 2003, Representatives Tim Murphy, a Pennsylvania Republican, and Grace Napolitano, a California Democrat, founded the Congressional Mental Health Caucus on Capitol Hill to educate colleagues and constituents. Napolitano proposes that schools provide licensed mental health professionals to students in her Mental Health in Schools Act.

(BEGIN VIDEO CLIP)

NAPOLITANO: We know treatment is very effective. We just know that we don't have sufficient funding to allow for that treatment to be made available to everybody that needs it.

(END VIDEO CLIP)

CROWLEY: Murphy spent decades in child psychology and co-wrote a book for parents with troubled children. We will talk legislative solutions with Representatives Napolitano and Murphy, next.

(COMMERCIAL BREAK)

CROWLEY: Joining me now from Pittsburgh, congressman Tim Murphy and in Los Angeles Congresswoman Grace Napolitano. Thank you for being here this morning.

And obviously you're here because both of you have shown an interest throughout your careers in mental illness and in remedies that might kind of ease the struggles of so many. What I'm wondering is if you look at policy making in Washington and policymakers do you see the same dedication that you have any place else across the political spectrum?

NAPOLITANO: Certainly not, Candy. Unfortunately, it does not hit the radar scope in Washington or almost in any state house. And I can tell you I've been on this for over 20 some odd years and it's always something you don't talk about, you don't discuss because of the stigma and I think we need to address that heavily.

CROWLEY: Congressman Murphy, in your former life you were a child psychologist so you come to this with a good deal of expertise as well as a politician. There is no constituency here that votes. And isn't that the problem?

MURPHY: Actually the constituency are the parents, those with mental illness and everybody else in society. This is something we have to pay attention to.

Look as we're trying to piece together what happened in Arizona, unfortunately, people are going at the low hanging fruit and they're blaming political discourse, which may have some role in the underlying aspects here, but we also need to look at there will be other things that come out, the music, the video games, the social ways that people handle anger.

But it goes up to the other levels, too, in terms of are we acknowledging and appropriately treating mental illness. And in a case like this, are there also aspects of drug abuse, which by the way are the most predictive of violent behavior.

Now, members of congress hopefully will be motivated by this as will people in the state houses and state senates to look carefully at their mental health systems and their involuntary commitment system laws and make some determinations do we need to do some things so that these things can be prevented in the future. CROWLEY: Congresswoman, to be totally honest here, there's no more money in the budget, and I find impossible the notion that state houses who have cut billions nationwide out of services for the mentally ill or that the federal government is going to pony up any more money. NAPOLITANO: You are so right. And unfortunately, it's not something that we focus on that brings votes as you've heard before. These youngsters don't vote. The parents, there's not been enough cohesiveness to say to them, treat them like the illness it is.

You do diabetes, you do asthma, you do heart disease but do you not do mental health. And unfortunately that has been the case for many, many decades. And I think we need to begin to impress upon both the state and federal governments the urgency of this, because every time there's a tragedy, there's a lot of there's hoopla for a month, two months. It dies down, goes away, everybody forgets about it and we're on to the next thing.

CROWLEY: And because Congressman Murphy we're not talking about - and again we have not officially diagnosed this man, but it appears to all the professionals to have been suffering from schizophrenia. Having said that, whatever his illness was, if he had one, we're not talking about one man, we are talking about one man who shot 20 people, killed six of them, and all of the friends and the family and all of those and a country in this case affected by this. Why is it so hard to get people to focus on it?

MURPHY: Well, let's look at a couple things here. One is that we don't know if things would have been different if we could have prevented this tragedy. We do know that appropriate and timely mental health treatment has prevented tragedies and will prevent tragedies.

Part of what congress needs to do is look at this as we do, we put money into things and resources. We need to understand when you have a chronic illness, you're twice as likely to have an accompanying mental illness. When you treat that mental illness, you can reduce health care costs massively. And this is what we need to be looking at, not just where we spend resources but where we save resources. Unfortunately we also have a system that Congressional Budget Office always scores things in terms of how much money is spent but never scores things in terms of how much money is saved.

But I believe this issue has touched the hearts of so many members of congress who are constantly stopping me and saying is there something else we could have done, is there something else we can do? And I believe so, by looking at some of the laws here, and looking at some of the ways we do have health care spending and we are looking at the aspects of mental illness as a treatable thing, but if we have to pay attention to those things.

CROWLEY: Let me -- I want to show you a Quinnipiac poll that was out in the field between the 10th and 11th of January. And the question was, what do you think is the main reason for the Arizona shooting? 40 percent said it couldn't have been prevented. 23 percent said the mental health system. 15 percent said political rhetoric and 9 percent said gun laws.

When you look at that, can you tell me, first to you Congresswoman Napolitano, where do you stand on this? What do you think is the reason behind the shooting? NAPOLITANO: I think the ability for the parents to get their children help, know where to turn to, know what the symptoms are, maybe to the education institution to be able to help them understand what their roles should have been or should be, the friends, to be able to call somebody, be able to not hide this anymore, because if there were warning signs and people didn't know they couldn't step forward and be able to help this individual, I believe, I don't think it was political. I think we are political and we are targets. I know I've received threats in my office. You tend to take those minimally because if you're scared, then you shouldn't be in politics.

It's one of those areas where I believe that we are not informing and educating the public enough to be able to help them make the decisions to help those that they love. And I'm not saying it would have prevented it but certainly would have been able to have as Tim eloquently stated help for the individual before it got to this point. All this is not something that happened yesterday. It's been going on for years.

CROWLEY: Congressman Murphy, when you -- a little earlier you said that you sense among your colleagues who have come to you and said what else could we have done let's take the money off the table because I think we're all realists here, what else could congress do other than increase funding for states to provide services, is there something else? Is there a change in the law that's needed here? Is there something else you could do?

MURPHY: I think there's a lot of things the states can do. Although what Grace and I want to do, and perhaps in the energy and commerce committee which I sit on, do some hearings and go through this piece by piece. I think there are some things in state laws and questions of were they applied and federal laws. In particular, the involuntary out-patient commitment law that Arizona has that something that state's ought to be taking a look at.

If this rose to the level for the school to say they needed to contact police on campus or other places to have this case reviewed, to bring this to the attention of parents, the question becomes, why wasn't the next step taken for involuntary outpatient commitment? Why was not the step taken to have this young man evaluated?

This is a question that schools all over the country and parents all over the country are asking, should they go to that next step. But there are things that can be done, and these are legal procedures that can take place. That's something I want to know, where things stand on a state and federal level, what can be done.

But in general, the federal government does not get involved in these involuntary commitment cases unless there's an actual threat or contacting (ph) about a federal employee. But we do want to know what happens and what else we can do on the federal level to provide assistance.

CROWLEY: Congressman Tim Murphy, Congresswoman Grace Napolitano, thank you so much, both of you, for your time. We will be watching those hearings. Thank you. NAPOLITANO: OK. Thank you, Candy.

CROWLEY: When we come back, a check of the top stories. And then, what a chilling photograph tells us about its subject.

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CROWLEY: Time for a check of today's top stories. A man who was shot but survived last week's Arizona rampage is being held in a mental health services unit after making a death threat at a Tucson town hall meeting. 63-year-old James Fuller told tea party member Trent Humphries, quote, "you are dead," as Humphries was making comments at the gathering.

Humphries says he has not decided whether to file charges against Fuller but is leaning toward that action.

Funeral services are being held today in Tucson for one of the six people killed in the Arizona shooting. Dorwan Stoddard died after trying to protect his wife from a spray of bullets. His wife, Mavy, was shot three times but survived.

Also set for today, a walk for peace to honor all those who were injured or died.

Congresswoman Gabrielle Giffords is off a ventilator and breathing on her own through a tracheotomy tube. It is the latest milestone for Giffords, who still remains in critical condition.

Another person wounded in the incident, 56-year-old James Tucker, was released from the hospital Saturday.

And just one week after the shootings, thousands of people attended a gun show in Tucson. A gun show spokesman says the mood at the gathering was somber. Donations are being taken at the two-day event to assist shooting victims and their families.

Those are your top stories here on STATE OF THE UNION. Up next, what two psychiatrists see in the face of Jared Lee Loughner.

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CROWLEY: For the two psychiatrists I talked with at the beginning of this show, serious mental disorders are not just a matter of the brain but of the heart. Both grew up with schizophrenic siblings. Toward the end of our interview we talked about it.

(BEGIN VIDEO CLIP) CROWLEY: So you have some personal history to this. A lot of people, when they saw that prison picture of the suspect, saw evil. A lot of other people just saw a mass murderer. When you saw that picture, what was your first thought?

TORREY: Well, I could tell you what I thought, because I looked at that and I said, that is absolutely classic schizophrenia. It's inappropriate affect. The young man's being booked for six murders, and he's smiling. Looks very happy. This is very bizarre. This is inappropriate. And inappropriate affect is one of the symptoms of schizophrenia.

DIXON: I think that the picture that was publicized on the news was a frightening picture. It really was. And no one could fail to respond to that. However, when you look back at the pictures of him as a younger person, you see him as a potential brother, as a friend.

And I think that's what's so sad about this situation. And all of us that, you know, either have friends and family members, you strive, even when they're very, very ill and seem not like themselves, to stay connected to that part of them that really is your brother or your sister or your friend.

(END VIDEO CLIP)

CROWLEY: We asked all our experts this morning where you can go for more information on dealing with mental illness. Their suggestions are on our Web site, cnn.com/sotu.

Thank you for watching STATE OF THE UNION. I'm Candy Crowley in Washington. Up next for our viewers here in the United States, "FAREED ZAKARIA: GPS."