The case of Nikolas Cruz, who carried out the 2018 shooting at Marjory Stoneman Douglas High School in Florida resulting in 17 deaths, has brought renewed attention to the relationship between mental health treatment and violent behavior. This article examines the documented mental health history of Cruz, the consistency of treatment he received, and the implications for mental health care systems. The available information reveals a pattern of untreated or inconsistently treated mental health issues that may have contributed to the tragic outcome.
Early Mental Health Indicators
Evidence indicates that Nikolas Cruz exhibited mental health challenges from an early age. According to testimony from a psychologist who treated him when he was 8 years old, Cruz was described as a "peculiar child" with numerous behavioral and developmental issues. His developmental delays began in toddlerhood, when he was often violent toward other children and experienced teasing and bullying due to his small stature, unusual appearance, and odd behavior.
Cruz's birth mother was identified as a street prostitute who abused cocaine and alcohol during pregnancy, which may have contributed to his developmental challenges. These early indicators of mental health difficulties suggest that Cruz's problems were not sudden onset but rather developed over time with limited intervention.
Behavioral Patterns and Warning Signs
As Cruz grew older, his behavioral problems became more pronounced. He was expelled from school for fighting and/or carrying a knife, and he exhibited anger management issues that frequently led to property destruction. Neighbors, preschool teachers, and elementary school special education counselors contradicted claims made by his mother that he was friendly and got along well with his peers.
In the years leading up to the shooting, Cruz's behavior was described as strange but not necessarily criminal. He appeared fixated on guns and killing animals, and his mother sometimes called the police on him in an effort to manage his behavior. These patterns of behavior, while not diagnostic in themselves, represent significant warning signs that require professional attention.
Inconsistency in Mental Health Treatment
A critical factor in Cruz's case was the inconsistency of his mental health treatment. A psychologist who began treating him in 2007 suggested weekly sessions, but over a 13-month period, his mother only brought him 15 times. This lack of consistency extended beyond professional treatment to his home environment, where his mother reportedly felt embarrassed by her sons' behavior and believed people were judging her.
The treatment Cruz did receive was not sustained. It was reported that he did receive mental health treatment at one point but stopped for reasons still unknown. This pattern of starting and stopping treatment is not uncommon but represents a significant barrier to effective mental health care.
By the date of the shooting, Broward County sheriff's deputies had been to the Cruz home more than 40 times for calls that included "mentally ill person" and "domestic disturbance." Cruz was a client at a mental health clinic where he was "dealing with mental health issues" and experiencing "voices in his head." Despite these clear indicators of need, his treatment remained fragmented and inconsistent.
Professional Diagnoses
Mental health professionals who evaluated Cruz provided varying diagnoses. A psychologist who treated him at age 8 noted behavioral and developmental issues but did not provide a specific diagnosis. Later evaluations yielded more specific conclusions:
- Dr. Denney concluded that Cruz has borderline personality disorder and antisocial personality disorder based on neurological testing.
- Dr. Charles Scott, another expert witness, also diagnosed Cruz with these two conditions.
- Antisocial personality disorder was characterized as a condition where the individual consistently shows no regard for right and wrong and has no guilt or remorse for their behavior.
- Dr. Scott also found that Cruz was malingering—intentionally faking or exaggerating a condition or illness.
These diagnoses provide insight into the complex mental health challenges Cruz faced, though the defense argued that he suffered from a fetal alcohol spectrum disorder (FASD) that contributed to his actions.
The Relationship Between Mental Health and Violence
The Cruz case has prompted discussion about the relationship between mental illness and violence. Research indicates that:
- There is a direct relationship between anger problems and violence.
- Only about four percent of violence is caused by mental illness according to the American Psychological Association.
- Anger can be a component of various mental illnesses and personality disorders, including bipolar disorder, oppositional defiant disorder, conduct disorder, schizophrenia, and borderline personality disorders.
- Many people with anger issues do not have a mental illness.
- Mentally ill people are more likely to carry out acts of violence if they aren't being treated—hospitalized or medicated—for their mental illness.
These statistics highlight the complexity of the relationship between mental health and violence, suggesting that while mental illness is a factor in some violent acts, it is not the primary cause in most cases.
Impact of Inconsistent Treatment
The case of Nikolas Cruz illustrates how inconsistent mental health treatment can contribute to negative outcomes. When large state psychiatric hospitals were closed approximately 50 years ago, the funding saved was intended to support community treatment and housing. Instead, many states and the federal government redirected these funds, resulting in a situation where jails and prisons have become the largest mental health facilities in the country.
This systemic failure has compounded the risks posed by individuals with untreated mental illness. The general public has a legitimate interest in protection from the consequences of mentally ill individuals who are either off their medications or not being treated at all. However, the solution lies not in incarceration but in consistent, accessible treatment.
The Question of Prevention
A critical question raised by the Cruz case is whether consistent mental health treatment could have prevented the tragedy. While it's impossible to say with certainty what the ultimate outcome would have been, evidence suggests that Cruz's suffering was evident and that professional intervention might have altered the trajectory of his life.
Cruz evidently struggled with anger and emotional problems that were possibly components of other mental health issues. The complexity of anger problems in adolescence requires professional intervention, which Cruz did not consistently receive. Had he received and continued attending mental health treatment, the outcome might have been different.
Systemic Implications
The Cruz case highlights several systemic issues in mental health care:
Inconsistent treatment adherence: Even when individuals receive mental health services, consistent attendance and follow-through are essential for effective treatment.
Family involvement: Family members play a crucial role in supporting treatment, but in Cruz's case, his mother's embarrassment and inconsistent follow-through undermined therapeutic progress.
Early intervention: Early identification and treatment of mental health issues may prevent more severe problems later in life.
Resource allocation: The redirection of funds from community mental health services to other priorities has created gaps in care that affect vulnerable individuals.
Stigma: The embarrassment felt by Cruz's mother reflects the broader stigma surrounding mental health that prevents individuals from seeking and maintaining treatment.
Conclusion
The case of Nikolas Cruz represents a tragic example of how inconsistent mental health treatment can contribute to devastating outcomes. While mental illness alone does not explain violent behavior, consistent treatment might have altered the trajectory of Cruz's life and prevented the suffering of so many others.
This case underscores the importance of accessible, consistent mental health care and the need for systemic changes to support individuals with mental health challenges. Until we address these gaps in care, we risk continuing to see preventable tragedies like the Parkland shooting.
For individuals experiencing mental health struggles, the message is clear: seeking and maintaining treatment is of utmost importance. For society, the message is equally clear: we must provide consistent, accessible mental health care to prevent future suffering.