18 December 2012

On Mental Health

In my previous post, I mentioned that several issues are bound up in mass shootings, including access to mental health services. I'd like to emphasize that I'm not an expert on mental health. However, I've worked in the mental health field long enough to have some educated perspectives on the issue. There are so many aspects packed into the lack of mental health care in this country. I'm going to discuss a few here.

The current mental health system in many states are inadequate to handle mental health crises, as the I Am Adam Lanza's Mother article clearly articulates. Emergency rooms, often individuals' only option when in crisis, are not equipped to deal with most mental health issues. Often, doctors prescribe something and discharge the patient. Or, those who experience serious mental health issues are not addressed properly and they land in prison.

In Colorado, the legislature has considered funding a comprehensive statewide mental health crisis initiative for several years. Metro Crisis Services is the only organization in Colorado providing crisis services. Two years ago, MCS launched a 24/7 crisis hotline and has been experiencing a significant increase in calls. MCS is moving toward creating a crisis system for the metro area and potentially the entire state - depending on funding from the state. This week, Gov. John Hickenlooper asked the Colorado Legislature for $18.5 to establish a crisis system. With a crisis system in place, individuals and families would have the option to access appropriate mental health services in a crisis.

It is so important to note that in a majority of cases, mental health crises involve individuals threatening harm to themselves, not to others. Most violent crimes are committed by individuals who do not have a mental illness. However, part of the stigma associated with mental illness is perpetuated by these high profile murders in which the media and experts suspect that the perpetrators have a mental illness.

Even with a crisis system in place, the stigma associated with mental illness, and especially severe and persistent mental health issues, creates an invisible barrier to treatment. Often when individuals experience a mental health crisis, their support system erodes for a variety of reasons, including erratic behavior, loved ones not knowing how to help, etc. This is the complete opposite of what happens when most people experience a serious physical health problem. Many organizations in Colorado, including Mental Health America of Colorado, offer (often underfunded) programs that train people on how to address a mental health crisis - and where to refer people for appropriate help. It also opens the conversation about stigma.

Additionally, issues of workforce, diagnosis, treatments and drugs are also at the heart of the issue. There are not enough psychiatrists to fill the demand in this country. Often, individuals experiencing persistent mental health issues are not properly diagnosed and diagnoses vary substantially as do treatments. Finally, psychotropic drugs typically do not have the potential to produce much of a profit, so drug companies are cautious about developing new and effective drugs.

In terms of mental health professionals and their responsibility to report past or potential crimes to authorities, it is stated in many codes of ethics that therapists may breach confidentiality if they think their patients may harm themselves or others.

I'm not claiming that if this country addressed mental health in a different way that mass shootings would end. And I'm not trying to minimize the responsibility of the individual shooters. These are heinous crimes. But, if we don't address these issues - along with many others - we will continue to mourn more and more victims without any hope of ending this epidemic of violence.

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