If New York is to be the stage for mad people to commit their spectacle acts of violence, then we need to talk seriously about mental-health reform.
The Nevada gunman who opened fire in midtown Manhattan last week, killing a police officer and three others, should never have made it to New York.
A competent mental-health system would have stopped him years ago and 2,000 miles away.
The 27-year-old shooter had been hospitalized involuntarily twice in Nevada, first in 2022, at the age when serious mental illnesses tend to manifest, and again in 2024.
In between those short-term holds, he had police encounters, including an arrest for criminal trespassing and exhibited troubling behavior like driving unregistered cars.
Just a month before the shooting, in June, a tip was reportedly called in that he had bought excessive amounts of ammunition at a gun show and an aftermarket trigger, a gun piece designed to give a shooter better control and accuracy.
In a rambling suicide note blaming the NFL, the shooter believed he had chronic traumatic encephalopathy, though reports of his history of any concussions are mixed.
The NYPD found antipsychotic medication prescribed to him in his car. His violent behavior, which antipsychotics effectively reduce, suggests he hadn’t been taking them.
All this suggests a young man experiencing signs of early psychosis and who had deteriorated enough to draw the attention of government systems.
As is all too typical with these cases, though, there appears to have been no supervision or oversight, no mandated treatment and no long-term hospitalization.
The shooter’s deterioration, from his first involuntary commitment to his purchase of ammunition and firearms, all happened in Nevada.
So did his release — twice — from holds that should have promoted more sustained interventions.
Nevada ranks 43rd in the nation for inpatient psychiatric bed capacity. With so few beds, hospitals can only admit so many patients, which means some patients won’t be committed, even when that’s precisely what they and the community need.
Short-term stays of 72 hours or less fix little. They don’t set up a care structure around a person to facilitate stability.
Upon discharge, there’s no guarantee of treatment compliance, especially in a state where court-ordered outpatient care is rarely used.
Some have asked how the shooter, with a mental-health history, was able to get hold of a gun. But gun laws are only as good as the mental-health records that inform them.
And if a mental-health system fails to intervene forcefully enough, scant service records will ever be generated.
A mass shooting requires a greater degree of organization than a subway pushing. But like the subway violence New Yorkers have become tragically accustomed to, the Midtown shooter’s victims were strangers to him, and he was known to the system, which failed him and the public.
Those mental-health systems failures were Nevada’s, not New York’s. But the shooting tragedy provides lessons relevant to the debate here.
First, untreated serious mental illness, though more visible in New York City, is a national problem.
If New York continues to strike the fancy of ambitious murderers looking for the largest stage on which to perpetuate their atrocities, New York has a uniquely large stake in national mental-health reform.
President Donald Trump’s recent executive order on homelessness called for more use of civil commitment nationwide.
Progressives blanch at that, but it’s what will be needed if we’re to make headway in reducing mental illness-related violence.
Second, in the case of most such violence, the problem isn’t stigma or insufficient public empathy for the mentally disabled. It’s insufficient engagement with those who are most sick and most at risk, many of whom don’t believe they are sick at all.
Third, while asking mental-health systems to stop all violence somehow related to untreated psychosis is unrealistic, asking them to help reduce the risk is, or should be, a core responsibility.
But systems tend to go about that task in completely the wrong way.
Too many taxpayer-funded mental-health programs claim to prevent mental illness but do so by conducting mass screenings of the population for general distress.
Examples include Mental Health First Aid and school-based programs, which have expanded dramatically since COVID.
When everyone is marked for concern, the system floods with noise, making true signals of danger harder to recognize.
A more effective mental-health system would be both smaller and larger than the one we have now.
It would be more ambitious and certainly involve the robust participation of the national government.
But it would be more focused on the hardest cases.
Stephen Eide is a senior fellow at the Manhattan Institute and a contributing editor of City Journal. Carolyn D. Gorman is a Paulson Policy Analyst at the Manhattan Institute.
