Following Newtown and other recent random mass shootings, demands for gun control have drowned out pleas to fix our broken mental health care system. But taking steps to improve our mental health care system not only would do more than gun control to prevent other random mass shootings but also would be a memorial to the victims and good for our society.
The first step needed to improve our mental health care system is to encourage individuals with a mental illness to seek treatment by correcting mistaken views that too many people have about mental illness — views that shame individuals into avoiding treatment and deter others from helping those in need.
Mental illness, like Alzheimer’s disease, is a disorder of the brain. But too many people treat the two illnesses differently. You wouldn’t say that someone chose to have Alzheimer’s disease or developed the disease because of weak character, spiritual weakness, or poor parenting, but that’s what people say about individuals with a mental illness. You wouldn’t expect someone with Alzheimer’s disease to overcome the illness through sheer willpower, but that’s what people expect from individuals with a mental illness.
Organizations like the National Alliance on Mental Illness (NAMI) have succeeded in educating more and more people that mental illness is like other illnesses but have been less successful in changing views that those with a mental illness are incurable and prone to violence.
Fact is, those receiving care can get better and live productive lives. As for dangerousness, study after study has found that individuals with a serious mental illness who are treated for their illness are no more likely to commit violent acts than other individuals (but are several times more likely to be victims).
We need to train teachers and first responders how to spot signs of mental illness and help the ill obtain treatment. Many communities have been giving police officers Crisis Intervention Team (CIT) training, which has been found to significantly reduce injuries to police officers responding to a mental health crisis, reduce the need to make arrests, and help individuals with a mental illness receive proper treatment.
It’s particularly important to identify individuals starting to show signs of having a mental illness because treatment is most effective when begun early. Early treatment protects the brain from additional harm caused by the illness.
If you’re going to encourage people to seek treatment, you have to make it available. Many states have been balancing their budgets by reducing what care they provide. Alabama, Alaska, Illinois, and South Carolina have reduced their mental health care budgets by more than 30 percent over the past several years. Medicaid’s Institution for Mental Diseases (IMD) exclusion prohibits Medicaid from reimbursing states for care provided by psychiatric hospitals.
Money isn’t saved by cutting care. The costs of untreated mental illness to affected individuals and society are staggering: reduced productivity, unemployment, substance abuse, homelessness, criminal activity, incarceration, early death, and wasted lives.
Under certain circumstances, individuals unwilling to accept treatment have to be required to do so. Some individuals, as part of their illness, refuse to believe that they’re ill and don’t understand the consequences of refusing treatment (this condition is referred to as anosognosia).
If such individuals are likely to be a danger to themselves or others or aren’t providing for their basic needs, or their condition is likely to deteriorate and cause them harm, they should be required to receive treatment (and compliance should be closely monitored).
We don’t know much about Adam Lanza. But we do know that people feared that Jared Loughner, James Holmes, and Seung-Hui Cho were dangerous. Yet no one intervened to stop their slide.
That’s often not possible under state laws enacted with the good intention of protecting the civil liberties of individuals with a mental illness. Such laws have forced too many family members to stand by helplessly as their loved one’s life spirals out of control (or lie to the police and courts to get the help their loved one needs). Anyone interested in how frustrating such laws can be for parents should read Pete Earley’s heartbreaking account of his experiences in Crazy: A Father’s Search Through America’s Mental Health Madness.
No one wants to deny anyone’s civil liberties. But when illness prevents someone from making an informed decision whether or not to accept treatment, it’s the illness, not the treatment, that restricts the individual’s civil liberties. Treatment can restore the individual’s free will and permit the individual to meaningfully exercise his or her liberties.
We can’t bring back the 20 children and six adults killed at Sandy Hook Elementary School. But by making needed changes to our mental health care system we can prevent others from suffering the same fate.
David Gibberman, a lawyer, writes about legal and financial matters for professionals, college students, and the general public.
