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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Re: billtmore comments
Amen! Our memories are short and willingness to own our mistakes almost non-existent. I made similar comment before realizing you had already addressed it and so well.
DR TORY IS CORRECT. WHERE HAS HE BEEN? He is the first one that I know who sees the real problem. I am a nurse/socialworker that has been working in the mental health field for 25 years. Our mental health system has been nearly completely dismantled. It started with the Civil Rights legislation with President Johnson when the state mental hospitals were closed and the mentally ill were transferred to community housing (little treatment accompanied the move) to the present time where the lack of federal and private dollars earmarked for the assessment and treatment have nearly eliminated access to care. Your guests are correct. We have little outreach and treatment in place to catch the 1% to 6% of violent people who are capable of mass killings and the deterioration of services rests with our Congress and Health and Human Services in an effort to save money.
It is true that our prisons are full of mentally ill inmates and state laws do not support involuntary commitment. Note that people who are psychotic will not voluntarily agree to treatment and even if they do, there are few hospital beds or treatment programs available. I have been fighting this issue in Congress for 15 years. Rather than getting better, the situation is getting far worse.
DR TORY IS CORRECT. WHERE HAS HE BEEN? He is the first one that I know who sees the real problem. I am a nurse/socialworker that has been working in the mental health field for 25 years. Our mental health system has been nearly completely dismantled. It started with the Civil Rights legislation with President Johnson when the state mental hospitals were closed and the mentally ill were transferred to community housing (little treatment accompanied the move) to the present time where the lack of federal and private dollars earmarked for the assessment and treatment have nearly eliminated access to care. Your guests are correct. We have little outreach and treatment in place to catch the 1% to 6% of violent people who are capable of mass killings and the deterioration of services rests with our Congress and Health and Human Services in an effort to save money.
It is true that our prisons are full of mentally ill inmates and state laws do not support involuntary commitment. Note that people who are psychotic will not voluntarily agree to treatment and even if they do, there are few hospital beds or treatment programs available. I have been fighting this issue in Congress for 15 years. Rather than getting better, the situation is getting far worse.
Around the time of the Colorado mass shooting, a friend of mine was dealing with a family member who had suffered a psychotic break. He had threatened his wife and baby, threatened someone from his work with a knife, and had many guns in his home. My friend and her husband took the guns from his house and hid them in their own. He broke into their house and took them back. He was delusional and paranoid. He would start fights everywhere he went. He was arrested 6 times in an 8 week period of time. One of these times he had beat someone with a baseball bat. My friend contacted local health organizations, magistrates, psychiatric hospitals and law enforcement but could not get help for him. He finally was arrested for armed robbery and is now in prison (still delusional - he has not received any medical treatment!). This was a good man who provided for his family and kept out of trouble. Now he has a felony on his record, may go to prison for years, and his family are without their father and main provider. We are grateful that he ended up in prison wihtout killing anyone but how ridiculous is it to be grateful for ruining someone's life in prison?
The problem I see is that prisons are a for profit business and mental health is a not for profit system and as long as this is the case you will see which gets the most attention.
Folks,
You all make valid points regarding treatment, for me that is like preaching to the choir but -
I am a Ph.D. cross licensed in TN. and VA. I completed residency in a medical school. I have completed the training program in the Psychiatriy and the Law program at the University of VA. and have attended training by virtually every expert in Forensics in the U.S. My wife is the director of a psychiatry services for a six hospital chain. I have testified as an expert in a number of captial murder cases.
The problem I have with this discussion and the point to which I strongly disagree is the suggestion we have the ability to accurately determine dangerousness. Yes, there are correlative markers, but they are far more likely to misdiagnose than to accurately predict dangerousness. There is then a substantial risk to overestimate (false positives).
I am concerned that those of us who will be required to make these determinations will end up being sacraficial lambs to the system as I believe happened in the case of the unfortunately Virginia Tech shootings.
Was it perhaps Dr. Torrey who referred to the mentally ill as "these people"?
I think it's a big mistake to think of the mentally ill as a single unit, each one much like the other. They are individuals who are just as different from one another as healthy individuals are. Instead of thinking about groups, we need to show the energy and ability -- finally! -- to treat all people as individuals. The tendency to treat us as part of a category exists also in the world of physical medicine and, god knows, in our politics.
'MENTAL HEALTH OMBUDSPERSON' (or ADVOVCATE) POSITIONS NEED TO BE ESTABLISHED IN ALL U.S. STATES!!
.... the U.S.'s federal govt should make a condition for providing health funding that individual states agree to accept the establishment within the respective state of a federally funded 'Mental Health Ombudsperson' ( or similar position) whose job would be to evaluate and report annually in writing* on the respective state's mental health services; IE: availability, accessibility, sufficiency; adequacy, efficacy, etc...
Additional duties of a state's 'Mental Health Ombudsperson' should also include direct and indirect advocacy for persons suffering from severe mental illnesses and their family members...
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* to both the federal Senate and the respective state's legislature...
Roderick V. Louis,
Vancouver, BC, Canada
The elephant in the room is age/gender......all 61 mass shootings in the last 30 years were comitted by young men. does treatment for mental illness take this factor into account?
How deeply offensive to suggest we have a mental health problem when we all know, having listened to your Monday show, that we have a gun control problem and the NRA is the source of all evil. Clearly, if mental health were even a remote cause behind last Fri's shootings, your idol-in-chief would have used all the resources of his office to immediately explore what to do about it, but instead, as his primary initiative, he appts Joe Biden to head up a gun-control task force. Also, if mental health were truly as significant as you seem to indicate, certainly your idol-in-chief would have ensured it's inclusion in his massive overhaul of the health care system. Why don't you have your dear friend Ms Sebelius return to explain to us all how the ACA addresses this most important service?
Diane, Can your guests give a specific examples in the last ten years of one of these mass murderers not getting treatment either due to cost or problems with the mental health system? Secondly, can you have your guests address when a person is forced into a hospital, should they have a right to a jury trial before being committed long term, or should the decision just be left up to one psychiatrist and one judge? Also can your guests, if they haven't already, explain the type of mental disorders these mass murderers usually have. Thank you.
I am a young adult who has suffered from a mental illness for roughly 13 years and have only within the past few months been able to begin the process of straightening my life out. I just wanted to thank you and your guests profusely for addressing this topic today. I believe that because of discussions like this, we, as a nation, are on a much needed and well overdue path to a mental health revolution.
Thank you panel and Ms Rehm for discussing this important topic. Stop stigma! Peace be with you.
Sincerely,
Psychiatric RN
Ottawa County MI
A major problem is the inadequate training of relatively recent psychiatrists.
I am a board certified psychiatrist, with additional training in Child and Adolescent Psychiatry and psychoanalysis. Our group has tried to hire psychiatrists in recent years, and the last 2 have been more concerned about ordering lab tests,focusing on medico-legal issues, and in ensuring medication compliance by getting serial blood levels. Neither, besides in their written treatment plans, do anything to establish a trusting, empathic, and understanding relationship such that a severely ill individual might become inclined to participate in the treatment process. So much of modern psychiatry focuses on biological and legal concerns instead of on the psycho-social and/or interpersonal aspects of psychiatric treatment.
I am an adult and child psychiatrist in a wonderful community mental health clinic that supports me in my clinical practices. However, this comes at a cost, as it is difficult to pay the bills when (particularly private) insurance only pays for the time I spend writing a prescription, but not for all the time I choose to spend getting to know my patients, educating them and their families, and talking to their teachers and other supports systems. I can not bring myself to see patients in 15minutes, as they are so ill by the time they make it through the long waiting lists and into my office. But I understand that it is difficult to stay financially afloat if one doesn't. I feel we could help more, and often with lower doses of medication, if we were allowed to be more that a prescription pad - without penalty of going out of business, or only treating wealthy patients.
I have a specific question for the mental health professionals: Does the diagnosis of Autism adequately fit the mental health profile of Adam Lanza, or upon speculation, is there another diagnosis that would warrant his violent behavior?
One of the guests just brought up AOT as an option for dealing with people who are not compliant with medications in the community with prior hospitalizations in NY. It's hard to get AOT for someone who is not acting out violently and is merely engaged in a self destructive pattern of behavior and increasing isolation, even with many hospitalizations. Meeting the criteria on paper is not the same thing as being able to get a court order, especially for someone who is otherwise highly functioning. AOT is a great idea but I question how many people who need it who actually get it.
Also another major problem is a lot of the programs (in NYC at least) are only for Medicaid. There is no followup or support system for noncompliance (with medication or appointments) in the community for people with private insurance.
There are repercussions for a society built upon fascism...
The chemical companies(DOW) cause the disease through reckless creation of the deadly chemicals responsible for the strange influx of neurological diseases, that are all, strangely and of a sudden popping up everywhere....
Big Pharma, ramp up sales of ssri drugs and the medical association push them as a 'cure-all' miracle drugs that are being used as a panacea against all ills caused by these same Chemical companies......
and main stream media is too stupid (or sold out) to put 2 + 2 together.
Brilliant!
Years ago someone got into a drugstore and poisoned some aspirin that was on the shelf and someone died and packaging changed all over the world from it.
Not that many years ago some guy put a bomb in his shoe and nobody died and security checks at the airport changed instantly.
Someone shoots lots of people and nothing changes.
why are there so many of us "mentally ill". we need to find why it's so much more prevelant than ever... diet, pollution, does it happen in utero or once a child is born?
Primary care providers have mandatory reporting responsibilities. For example, if you are diagnosed with epilepsy, it must be reported to the DMV. Could we be possibly have a weapons registry that PCPs could report their concerns about a patient's mental/emotional state, refusing those individuals access to purchasing weapons?
Our nation state in its policy and economy behaves like a heavily armed psychotic entity. It self-medicates with war, chemicals, electro-shock (Naomi Klein) and Austerity toward the poor. This malaise was contracted by exposure to ruaway corporate capitalism and now has been spread around the globe.
We can see how differently the deaths of the socioeconomically comfortable children in Sandy Hook is being presented as contrasted to collateral damage overseas and in our enclaves of poverty where gunfire never stops. "Who profits from this violence?" is the first appropriate rational question. But now the bulk of our citizens are put upon and overstressed by economic and social chaos. The same few profit from that condition.
Our mammoth mental patient (USA) denies it's dementia and is so panicked with fear that it can't even pause a moment to examine the causes of its own fragmentation. Saturation with assault weapons and widespread mental illness (mostly untreated) are symptoms of something much larger. Now the planet is running a fever as the frenzy intensifies. We gotta take a break from profiteering and tell the crazy element NO. Don't be bullied by the NRA and other oligarchic institutions. They are illegitimate. Compassion for the poor and the mentally disturbed would be the best first step after we stop the bigger madness.
This morning's discussion is inform-ationally excellent. This is a cultural-class phenomenon: the no child(person) is left behind. If one is 'out of mind, one becomes 'out of sight;' once 'out of sight,' the person becomes 'out of (the community's) mind.' These now out-of-sight persons want to be seen, and are smart enough to create and do a truly dramatic episode. We need to truly care about all of our community members to be a healthy, safe community.
Excellent discussion. I viewe the gun issue as a red herring since at some level the weapon was simply within reach and unfortunately capable of severe damage. What I hear is the sad state of the insurance support, health infrastructure, and inadequate resources for mental health. It seems the most positive outcome of this tragedy would be to focus on providing more mental health care resources. The prisons are full of those incapable of adapting to modern society (drugs, domestic violence, murder, etc., etc.). There would be fewer homeless. There are thousands of soldiers returning with severe issues that are not being addressed. It is not the gun but our diminished ability to help those with mental health issues. Thanks for a great show.
I fully concur. As a LCSW from the 'old school' where we truly listened to our clients' stories, to make the connections, we had a much more effective approach to positive life change-behavior. Now, the interviews are done by questionnaires on the computer and most clients seeing psychiatrists are there for EBT and prescriptions-medication: 15 min. consultations.
This is so sad: about the numbers today, not about the persons.
urbyrag- A caller on WBAI yesterday afternoon blamed increased mental disorder on electromagnetic radiation from cellphones, antenna, and other devices. Add the chemistry you mention and that's quite a cocktail.
You've hit on something. And the pharmacology for depression and other disorders has proven dangerous in side effects too. I think you and I would both enjoy a good "talkking cure."
I'd like to steer the conversation to include the underlying cultural trend of accepted violence in the majority of video games, movies, and television shows that these mentally ill people have grown up with.
As with any problem, there will be multiple factors involved with the mass murdering our country has experienced over the last couple of decades.
I hope the experts and legislatures actively pursue dialog regarding this phenomena to minimize sensationalized violence and murder that is exposed to our society.
Bring in the writers and directors of such games and movies and ask them to explain themselves.
My sympathy to all the families.
stephen zegel- Medical profits are way up now that docs see 60 to 100 patients a day. Seems to defeat the purpose, doesn't it, unless you're an exec or big stockholder.
I work reviewing mental cases for an agency (and went into this work due to my experiences with a family member). In most states it's impossible to get treatment for someone with psychosis unless they threaten to kill someone or themselves immediately. In the county I live in they simply get taken to jail and held for a few months without charges even though the state mental hospital has plenty of beds available.
One memorable way one family got their son treatment was to poison him. His discomfort became so great that he agreed to go to the emergency room. Once he was at the ER the doctors medicated him with antipsychotics as well as treating his food poisoning.
The family explained to the doctor what they'd done and why. They knew their son would jump off the roof or set the house on fire if they didn't get him medicated.
Mike Concha- Now librarians can file shooting spree media under "How-To." Looking at wiki-leaks footage it could also be "Vocational."
Diane-
Thank you so much for helping to bring this issue out in the open. As the older sister of a person with an undiagnosed and untreated mental illness I am overjoyed that someone is even paying attention at all. My family has felt isolated over the years as my sister (now 17) has been kicked out of every public school in her district, pushed in and out of the juvenile justice system, and ignored by mental health professionals who claim that she is too young to be diagnosed with a psychotic mental disorder. Otherwise a bright and talented individual, her mental condition has caused her to be completely alienated in society, unable to even finish her high school degree. I hope that this begins a substantive dialogue in communities to get help for these individuals who so desperately need it.