Identifying And Treating Severe Mental Illness
http://thedianerehmshow.org/shows/2012-12-20/identifying-and-treating-severe-mental-illness
The vast majority of mentally ill people are not a danger to themselves or society, but for those who are, treatment is critical. Diane and her guests discuss the challenge of identifying and treating severe mental illness.
Guests
Dr. Liza Gold
clinical professor of psychiatry at Georgetown University Medical Center and vice president of the American Academy of Psychiatry & The Law.
Pete Earley
father of an adult son diagnosed with Bipolar Disorder, author of "Crazy: A Father's Search Through America's Mental Health Madness," former Washington Post reporter and author of several others books, including "The Hot House."
Dr. E. Fuller Torrey
president of Treatment Advocacy Center.
Leslie Weisman
client services entry bureau chief at Arlington Community Services Board.
Comments
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Diane-
Until the stigma of mental illness in American society is lifted, there will always be those who suffer but do not seek adequate treatment. We need to talk about mental illness the way we talk about cancer.
-David
I am a psychiatrist on the faculty of Johns Hopkins and University of Maryland in Baltimore. I have just published a book "YOU NEED HELP: A STEP-BY-STEP GUIDE TO CONVINCE A LOVED-ONE TO GET COUNSELING." published by Hazelden Press in September. The book is a guide about how to work with a troubled person in your life, especially a family member, who is having more problems than you know how to personally handle, and you feel could use professional expert help. The goal of the book is to convince that person to have an evaluation by a mental health professional. The book reviews the many reasons why people do not show up for treatment, why such a book is needed at all. It then starts with tips on how to approach such a person, when, where, and techniques of persuasion with this goal in mind. If that doesn't work, it teaches you how to effectively work with common allies such as primary care providers, clergy, and important family members in your mission. If it becomes necessary, the book shows you how to use the often untapped power in family relationships to engage in "therapeutic coercion" in order to steer people towards the help they need. Finally, it acquaints you with when and how to mobilize involuntary evaluation systems that exist in every state, and how to work with that system to get the most optimal outcomes.
I wrote an Op Ed Piece summarizing this is in today's Baltimore Sun Paper. (12/19/12)
More information about the book can be found at: www.youneedhelpbook.com
Mark S. Komrad M.D.
TREATING PERSONS WITH SEVERE MENTAL ILLNESSES EFFECTIVELY REQUIRES BOTH HOSPITAL & COMMUNITY-BASED SERVICES...
Successfully treating persons suffering from biologically-caused, cyclical mental illnesses such as schizophrenia (and manic depression) requires not only hospital-based methods but also a comprehensive variety of community-based therapeutic services...
Without
1) govt subsidized psychotropic medications;
2) adequately funded and staffed so-called "community mental health teams/clinics";
3) govt subsidized, supported housing- including 24-hour staffed boarding homes;
4) sheltered, drop-in centres that are open 7-days-a-week; and to a lesser degree,
5) rehabilitative programmes...
... available to persons-with-illnesses-such-as-schizophrenia who are deemed well enough to be discharged from a hospital setting, their capacity to remain sufficiently stable to remain out of hospital is all too often egregiously compromised...
As a condition of receiving federal money to pay for health care services, every U.S. state should have to allocate a specific percentage of their annual public health budget to community mental health services...
Roderick V. Louis,
Vancouver, BC, Canada
How much funding per 100,000 of population is estimated to be required annually for a state's hospital and community-based mental health services system to be functional and effective and universally accessible to adults suffering from severe mental illnesses?- especially those who are indigent and/or unable to work??
Roderick V. Louis
Vancouver, BC, Canada
If a discussion on the bad effects of psychotropic medications is not included in a vital way, this will have been an incomplete discussion. There are other ways, more empowering, to recovery from extreme mental distress than psychotropic drugs.
A first responder on yesterdays show urged us to deal with issues of mental "Health". I second that. We are unhealthy when we don't make others feel visible and responded to. We are unhealthy when we don't provide outlets for youth and adults to use their bodies for joy and metaphor and dance. We are unhealthy when we cut budgets for after school recreation, but open up YMCA's for those who can maintain the 'life style.' When you see anyone walking and talking to him or herself on the street, remember, it may not be schizophrenia, but rather the 'accoustics' of the city or locality's attitude. And many conditions beside's schizophrenia involve speaking to one's self. Exhaustion, back injury and damage to nerves. But the sting of the slap to ones nervous system can bring on shame or rage. Let the Bravo Channel shoppers be nice to the people they pass this holiday season.
As I told a father with brain injured son, that the peripheral vision picks up all movement and attitude, and is always on, even in brain injured, so don't think your attitude is not a kick to these people.
Oddly, whether your insurance covers mental health care at all depends on where you work (shouldn't they be unrelated?). Small business and individual plans are not included in the Mental Health Parity Act. Luckily the Affordable Care Act will ensure that starting 2014 coverage will be mandatory for small groups and individuals. Large companies are still not required to provide mental health coverage.
I hope outcomes for the treatment of serious mental illnesses will be discussed. Sadly, it is the norm to relate inspiring anecdotes in lieu of empirical data, "Let me tell you the story of Billy ..."
We face a burgeoning population of individuals who receive treatment yet end up on disability. This despite long standing representations that treatment has been transformed. It is worth considering that a recovery rate of 80% has long been claimed for treated depression despite the National Council on Behavioral Health Care's statistic that less than one-third of people who seek help receive minimally adequate care. This paradox is corroborated in no small part by the outcomes reported by Minnesota, i.e. a recovery rate of 4.5% after a year of treatment (2010). [More recently Minnesota's health care programs found that Minnesotans with serious mental illness do not live past an average age of 58, while those without mental illness live to an average age of 82."]
Do we have a mental health system which reflects President's Bush's remarks when he announced the President's New Freedom Commission on Mental Health more then a decade ago , “America's citizens with mental illness deserve our respect, and they deserve excellent care” or do we have the one described by the members of his commission, "Our review for this interim report leads us to the united belief that America's mental health service delivery system is in shambles."?
I hope the panel will address the behavior of Nancy Lanza who knew her son was mentally ill but had guns around the house and had, apparently, taught him how to use them.
I am 61 years old. When I was growing up we had crazies but we did not have repeated mass shootings.
All that I can think that is different is video games and mass distribution of antidepressants to children.
Nobody really knows exactly how antidepressants work except that they affect several different brain chemicals including at least 20 known serotonins in the brain.
According to the drug companies' own literature they cause agitation, psychosis, hallucinations, dream-like states when awake, sleep disorders, and suicide warnings for those under 26 years of age.
Over the past week I have heard much talk about involuntary treatment and commitment of people who have the potential to be dangerous to themselves or others. In my own experience, mental health services are not available even for individuals who go to the hospital for assistance to deal with suicidal or violent impulses, EVEN WHEN those individuals have already hurt themselves or others.
Two of my friends have been turned away from hospitals under these circumstances -- one was taken to an emergency room in an ambulance after slashing his own wrists; the other was taken to a hospital by his housemates because he was despondent and suicidal after killing his own puppy for no apparent reason. Both of these young men were living in households with small children, but the hospitals sent them home with no medication or follow-up care. In the second case, the hospital ignored my young friend's obvious remorse and suicidal intentions and called the police, who charged him with animal cruelty.
Fortunately, both of these young men had a stubborn advocate in the form of a neighbor (not a mental health professional, not a social worker) who was determined to get them help. Without his unrelenting pressure on the system, either or both of them would probably be dead or in jail by now.
How will the availability of mental health services be affected by the implementation of the Affordable Care Act?
I was reminded by my local NPR program that the mental health system was dismantled,and made ineffective years ago,during the voluntary/involuntary commitment debate.
Here for profit charter schools send troubled children back to the public schools. Budget cuts,including funding private and charter schools from public school funds means,less or no help in public schools either.
We`ve paid our taxes here in Ohio. However,"small" government policies have shifted the tax revenue from the people and services normally provided,to more tax breaks to the wealthy and their corporations. SMALL GOVERNMENT SUCKS...
Sandy Hook
“In what furnace was thy brain?”
“The Tyger”
William Blake
In their numbers,
They lie waiting to be buried.
They are all six or seven,
Or were,
Or always will be,
Six or seven.
There are twenty of them.
And there are six more:
Their teachers,
And the principal,
Who tried in vain
To restrain Adam in his wildness,
And he would not, could not,
Be restrained.
And the last Lamb to lie down?
The last child, and the first,
Was Adam,
Whose life rushed forth,
Whose madness flashed before his eyes.
He was the last victim,
Gone now,
Into the forests of his night.
December, 2012
Joan Barasovska
put the blame exactly where it belongs...the GOP trying to save a buck . Reagan closing the state facilities in the early 80s because running institutions costs money and by God the GOP hates spending money on throw away people, 30 years later they are at it again. You want a better country stop spending on war and spend on health and life
Thank you for this discussion. I am a clinical psychologist in private practice in Herndon and McLean, VA. I am a clinical supervisor at GW and have also worked in community mental health in Virginia. I would like to point out that it is very easy to misdiagnose a young person with an autistic spectrum disorder who actually has prodromal schizophrenia. The flat affect, the obsessive thinking, the lack of eye contact and social difficulties -- as well as other symptoms -- are the same for both disorders. However, an individual with an autistic spectrum disorder won't "snap" into florid psychosis, whereas an individual with paranoid schizophrenia, for example, may do so right around the time that Adam Lanzer committed his awful crime. I am not trying to diagnose Adam in the absence of information, but this is an important consideration for this mental health discussion.
Police are called when someone is dangerous, to themselves or others. Although your guest claims that police do not feel they are trained to handle someone who is dangerous due to a mental health issue, the average mental health worker is not trained to handle a dangerous person either. When someone is dangerous, you sometimes need the resources a police officer has (handcuffs, a police car with locked doors and split cab) to keep that person safe. If a mental health worker has a client who is clearly threatening to harm themselves or someone else, I'd like to know how a mental health worker is supported to handle that better than the police. The police are called, but, at least in my town, they are simply transporting that individual to a psychiatric facility.
This is an excellent program today, wonderful guests. Thanks Dianne!
It would be sad indeed if all mentally disturbed people were stigmatized as violent murderers. This would be just as wrong as stigmatizing all firearms owners as a bunch of whacko Rambos.
De oppresso liber.
Diane,
Asperger Syndrome is not a mental illness. It is a neurological disorder. Please, educate your listener about the difference. As parents of an adult son with AS it disturbs us to hear
it described as a mental illness.
I am the older sister of an amazing person who suffers from a terrible illness. My brother suffers from schizophrenia.
My brother has the same disease that the mass murderer at Virginia Tech, the murderer who shot Gabby Gifford’s, and the Aurora movie theater shooter are afflicted with. We can see that so many of these mass shooters suffer from this and other terrible mental illnesses.
In our past my brother got into a physical altercation with my father. He went to jail and was later released without letting my family know and he walked across the city BAREFOOT in the winter to get home.
My parents paid for the lawyer to represent their son. Yet the prosecutor called my father the victim. My father could not stop the charges against his son. He did not need jail he needed a mental hospital to go to for stabilizing treatment.
We need:
1. A federal list for anyone diagnosed with a very serious mental illness that bans them from purchasing a firearm. This list could be taken directly from the social security list for those on permanent disability for a serious mental illness and enacted TODAY!
2. A federal standard for mental health holds, all hospitals, regardless of insurance status, should be required to hold anyone who has threaten themselves or others. The hold should be long enough to have a full mental health evaluation. If the person is deemed seriously mentally ill they should be treated including medication. Yes by force.
3. A mandated reporting system for school officials, health care works, public officials, etc that they have to report severe mental illness behavior. Then a hospital hold until they can be evaluated and treated. This alone could have stopped the murder that shot Gabby Giffords, the Aurora movie theater murder, and the Virginia Tech murder.
I am not alone in struggling for too long to see a change in the way the system deals with our loved ones.
Is it possible that the focus on controlling the mentally ill is a way for the general society to avoid exerting control on itself, the ways in which it sanctions violence, and allows weapons of war to find their way in the hands of the general public? Your guest points out that half of such attacks are perpetrated by those suffering from mental illness. What about the other half? What about the violence committed by those who are not mentally ill? Are we trying to wish away our society’s need for self-examination by rendering violence as the realm of mentally ill who must be identified, labeled, controlled? This is not a new question, Michele Foucault raised similar questions in Madness and Civilization.
My daughter has multiple diagnoses and I have been working for years to get her more help, including hospitalization. She had a major psychotic episode in June and I begged her doctor to admit her at least long enough to get her back on her medications, which she admitted she was not taking. She has threatened me, and her psychiatric rehabilitation advocates have asked me not be to alone with her. I have no hope for her future. She is so likely to hurt someone before anyone does anything, and I am the most likely target. We clearly all know that, but there is no action even being contemplated that might prevent a serious tragedy.
If we have not already done so, I hope we will stop to remember that it was Ronald Reagan who repealed the Mental Health Systems Act in 1981 cutting support to a segment of our population we could no longer be burdened with helping and thereby setting the tone for our country's views regarding mental illness up until... now.
I have yet to see ANYONE in this ongoing gun debate explain in any meaningful way, the appeal and/or need for responsible gun owners to own weapons that fire dozens of rounds in split seconds.
The resounding silence, I guess, speaks for itself.
Are these folks, then, attempting to compensate for psychological inadequacy through ownership of “WMD’s”?
If so, then YES, mental health issues ARE definitely a large part of the problem.
And these gun owners need help-
Soon!
NPR (Colorado, maybe not national) had a story the other day about all the prisons closing, due to drop in the incarceration rate. The prisons stand empty, jobs are lost. Perhaps these facilities, often modern, could be converted to mental care facilities?
see http://www.cpr.org/article/Prison_Closings_Lead_to_Job_Losses
Diane, I am an attorney in a firm that handles approximately 600 cases a year in rural Missouri and Illinois. About 40 percent of our cases are mental health. We have a terrible problem getting our mental health cases paid, even those in which we have excellent reports from psychiatrists and psychologists and long medical histories. Social Security judges are poorly trained in mental health and frequently deny cases that should be paid. We are forced to spend years appealing to the Appeals Council and the Federal District Courts. During that time many of our mental health clients drift off, part of the vast world of homeless people. The problem is compounded by the fact that many mental health clients are poor and must seek care through free clinics and community health centers. They have no choice in a provider and often see Advanced Practice Nurses. Though these APNs provide excellent care, the Social Security Administration gives no weight to their opinions.
Terrell Dempsey
Quincy, Illinois
I have worked with people with Asperger syndrome for over 20 years, and one thing that I find is important in the question of whether Lanza had AS is the symptomotology. People with AS have difficulty solving problems, especially social problems, and have deficits in understanding the world from another's perspective. It would then become very difficult for someone with As to plan such a complex attack - interpreting where people might be at that time of day, what thier reactions would be when he broke in, which window would best serve his purpose, etc. The demands of planned agression of this magnitude do not fit with the AS profile. I want to make that clear, since so many people with AS need services as adults as well as as children, and incorrect media hype do them a severe injustice. There is, to my knowledge, no formal diagnosis on Lanza.
Mental illness has increased in both number of cases and in severity of those already diagnosed in the last 60 years as we've come to eat mostly processed food, as our use of technology has increased, and as we've become more disconnected from each other in face-to-face relationships (hugs, eye contact, in person support). During these same decades, obesity, diabetes, heart disease, and autoimmune diseases like chronic fatigue and chemical sensitivities have also increased. I think that our culture is in denial about the severity and variety of effects of these cultural changes in the last 60 years.
As a health educator, I watch my clients reduce symptoms that could be interpreted as mental illness: anxiety, fatigue, feeling bad about self, by reducing lifestyle stresses.
We have a problem with mentally ill people owning guns and we want people to keep their guns. Now mental illness requires money just like other medical treatments so why dont we tax the gun sales and use that to fund mental treatment
Basab Chatterjee
Dallas, TX
I want to know what your guests tried to do with their kids BEFORE attempting to have them committed?
Mental health professionals are highly skilled in explaining behavior after the fact, hopelessly bad at predicting behavior. Mental health laws are constructed, like criminal laws, to protect the rights of the accused. Mental hospitals were closed in the fifties as thorazine medications offered hope to control mental illness in a better way that the snake pit hospitals of the era. The Lanza situation was apparently complicated by a wealthy family that supported the young man, kept him out of the system and provided him with military grade weapons and training. These speakers are nice people that are using the opportunity to argue for more resources, none of which would have addressed the issues of Newtown.