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Tuesday, December 18, 2012

Mental Health continued

I am so relieved that mental health care is finally reaching center stage in our national conversation, though I haven't checked whether the national, liberal "news" outlets who carry water for the Democrat Party's anti-gun aims have climbed on board.

There is a lot to mental health care that is widely misunderstood. For example, a psychologist is not a medical doctor but a psychiatrist is. Psychologists are trained in therapy, which can be quite effective, but do not have power to write prescriptions. Psychiatrists can and often are trained in therapy and in prescribing the appropriate medications, but sometimes they are not trained in every effective therapy method. Other mental health care professionals have less training, such as nurses and social workers.

Mental health is just as widely misunderstood. Just like a physical illness stems from something physically wrong in the body, mental illness can be caused by something physically wrong in the brain. Doctors have done studies with MRIs and found pieces missing in brains that completely explain the type of mental illness a person experiences. This isn't to say there is always a physically-evident underlying cause of mental health, but it's still something that people should understand.

Adam Lanza couldn't feel pain - that's indicative of abnormality. He probably had some part of his brain missing or nonoperational. The brain controls everything from what we sense to how we think and move and what we can feel, how we process information, even our personalities. That's why people suffering from dementia change personalities - their increasingly diseased brains are the reason. I am not a doctor, but this is the way I understand it as explained by a doctor.

Another widely misunderstood part of mental health is the scarcity of effective medications. Quite often, a person will respond to a certain anti-psychotic drug for only a time before it loses efficacy, and then need a different one. There aren't an infinite number of anti-psychotic drugs. The ones we have include serious side effects. Some people respond very well to medication and can live normally in society and others just don't and can't live normally in society and never will, unless future treatments are any better than the ones we've got, which we can't count on.

A psychiatrist, Dr. Keith Ablow, has explained in "Why can't America care for the mentally ill?" that we face even bigger hurdles in America's overall mental health care than most people realize.  Insurance companies refuse to cover long-term psychiatric care beyond meetings with a social worker!
Here is the truth:  Today, even a mentally ill young man with a known propensity for violence, or even a history of serious violence, is likely to receive just an hour a week of counseling (if that) by a social worker. 
He is likely have an unclear diagnosis of his condition and to be on a list of constantly changing, very powerful psychoactive medications prescribed by a nurse. 
He is also likely to be turned away -- repeatedly --by emergency room social workers who act as gatekeepers for insurance companies to restrict access to inpatient psychiatric treatment.
If admitted to a psychiatric hospital, he will likely be triaged quickly through an often-incompetent “tune up” of medications that might accomplish nothing and then be sent back home as soon as he “contracts for safety”—simply promising a social worker that he won’t kill anyone.
That young man’s good parents might well pray that he be arrested for another violent crime so that the terms of his probation might (but probably still wouldn’t) include mandatory visits to a mental health professional (though not always the right one for their child’s needs) and mandatory drug testing.  At least then he can be jailed if he refuses all treatment or gets hold of some heroin that could worsen his hallucinations.
This psychiatrist then detailed eight specific failures within the American health care system. Please read over them to better understand what families with severe mental illness face in getting care. I will jump down to his eighth point.
8) In most states there is no way to arrange court-ordered, involuntary outpatient use of medications (including antipsychotic medications) even if someone is very violent or has reported extremely violent thoughts in the hospital, even if that person is psychotic and also addicted to cocaine or heroin, and even if that person is court-ordered to take such antipsychotic medications in the hospital. 
Once that person hits the streets he or she is too often free to never visit a psychiatrist, again, to never take another medication and to never be drug-tested. 
That is where we are.  And that defines what poses as a mental health care system, but does not merit that label.   
It is a cruel ruse to suggest to American families struggling with mentally ill loved ones that they can receive effective and healing psychiatric care without spending tens of thousands or, more likely, hundreds of thousands of dollars to do it.  
Psychiatry and psychology are amazingly effective disciplines, when properly harnessed and deployed.  And it doesn’t even have to cost billions of dollars to do that.  Within the week, I will post the rough framework of such a plan here on   
The mentally ill need our help. Gun control will not take the violence out of them, and they will remain a threat to themselves and their families and communities unless they get adequate mental health care. I eagerly await his plan. I'm very curious to see whether it will add to the public burden or whether he will build his framework around other funding. I do think this initiative would be worth funding publicly compared to the many wasteful expenditures of the US government (if we can persuade Obama to cut anything or replace anything), and besides that, the US government is bound by the Constitution to protect and defend its citizens.

I would argue that it is high time we defended those who have no ability to defend themselves. Rather than hire security in all public schools, having better mental health care evaluations and access ought to prevent the need for that expensive change. I've also seen elsewhere some suggestions about how schools could prevent similar incidents without hiring a single person even in the absence of reformed mental health care. However, I hope that this new conversation about mental health leads to real and meaningful changes in mental health care.

1 comment:

  1. I agree with your post -- I hope mental illness gets more liberal attention too, and not just think it's all about guns.