Students signs say “Never again” to gun violence at a Wednesday protest at Cambridge Rindge and Latin School. (Photo: Jean Cummings)

When a troubled student guns down fellow high school kids, or a former “sweet boy” in the neighborhood knifes a girl in the town library, it can be comforting to focus on “missed warning signs,” thinking that if they had been noticed, things would have been different. But in our country, where quality acute mental health care almost doesn’t exist unless you’re wealthy, that focus misses the point entirely.

The truth is, people probably did notice. In Winchester, the entire neighborhood was aware of the deteriorating mental health of the neighborhood boy who apparently began to hear voices as he moved through adolescence.

The problem is, there’s not much to be done.

When he was in his late 20s, my late brother was diagnosed as manic depressive. In retrospect, it was clear he had had symptoms for years. He had self-medicated by alternatively abusing alcohol and drugs, or going cold turkey on substances and walking for hours on end. He was very smart, intellectually curious, a prolific musician, often tremendously self-centered, sometimes incredibly sweet and sentimental, sometimes angry, biting and out of control. There were many times we feared for his life. At times, we feared for our own safety.

Boy, did my parents notice the “warning flags.” Our whole town did. But there was little we could do.

The few affordable centers that would even consider taking Peter had no beds and long waitlists. Private facilities cost thousands of dollars a month, and that was 20 or 30 years ago.  The hospitals could only pump his stomach and, if we were lucky, find him a bed in a state-run facility that usually kept him for only 48 hours. Only a tiny portion of the cost of therapists or psychiatrists was covered by insurance, if at all.

Medications don’t always work. Drugs that helped can stop helping. The drugs’ side effects, coupled with the symptoms of the mental illness, can lead someone to simply stop taking them.

When my brother was arrested in Massachusetts for drunken driving, the sentencing judge recommended a mental health facility – we were so relieved – but was ignored by criminal enforcement, who sent him to jail instead. It wasn’t lost on us that celebrities arrested for drunken driving were sentenced regularly to high-quality treatment centers.

And all of this assumes a troubled person is willing to get help. Anyone who has tried to get a sullen, unwilling teenager to clean his room or cheer up for company can perhaps imagine what it is like to get a troubled kid to go to a stranger for therapy. My brother had complete control over this process.

Also, once a kid is 18, parents lose any pretense of control anyway. You can’t force an adult to get treatment; they must want it. Protecting an adult from forced institutionalization is a critical component of our principles of freedom and privacy. You can’t get an unwilling person help unless you can prove that they are a hazard to themselves or others. The pivotal word here is “prove”: Ending up in the hospital several times a month with near-toxic alcohol levels was not enough to convince my brother’s therapist that he was in danger of killing himself. Looming in an out-of-control rage over aging parents was not enough to prove they were in danger. Because, in the therapist’s words, he “hadn’t actually done anything yet.” Things have hardly changed.

Until we have a real mental health system in this country, I don’t want to hear more talk about “missed red flags.” They are not likely to have been missed. It’s just that there was no effective help available.