IMHO: Fixing the Mental Health System

  • Bill MacPhee, the founder and CEO of SZ magazine, wrote in one of his editor's letters that the goal is not to set the bar high.  The goal is to set it.  Period.


    We have not only NOT set the bar for mental health treatment.  We have perpetuated the blatant neglect of our citizens' mental health that leads to the killing of lives.  Either a person is doomed to be mentally ill the rest of his life with no chance of recovery: or he is fated to take up a gun and kill others.


    Why is it that I received immediate treatment and countless others fall through the cracks?  My memoir, Left of the Dial, documents that I got the right treatment within 24 hours the first time; and I was immediately hospitalized the second time.   

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    I got treatment: and I recovered.  As soon as I got treatment, I no longer had the signs and symptoms of the schizophrenia I was diagnosed with when I had the breakdown.


    For every Adam Lanza, there is a Christina Bruni who refuses to speak out.


    It's time to get over the obsession with the stereotyping of people with schizophrenia, with fronting concern for the civil liberties of unstable people, to get over the veneer of silence that afflicts those of us doing well.


    How is it that I got immediate help and countless others do not? This isn't a trend; it's commonplace, and it's the great failure of our society.


    The editorial team at HealthCentral cribbed in a news article something I posted here on my own years ago: "The only real failure is the failure to try."  I was astonished the editorial team had the courage to state that.

    Define "try." It differs for each of us exactly what we do when we try to do something. Yet the point is: do something, do whatever you can; give it your best shot and you can be proud, even if you fail at something.


    In the aftermath of Newtown, I expect nothing less than the dedication to fix what's broken, for each of us to aid in healing the world; to practice Ujima. (see my comment for the definition)


    We need to bear a sense of collective responsibility for this problem.


    It begins at home. If you see something is not right with your child, try to get help immediately.  Keep trying as long and hard and repeatedly as necessary.


    For God's sake, don't keep guns in your closet if your son or daughter is unstable. I knew a guy who killed himself with his father's gun.


    Lobby for a single payer health system so everyone can get treatment. (Research HR 676 - Medicare for All - and write to your congressperson if you think this bill should be made law.  Go on the Thomas website to read about it.)


    Newtown is everyone's problem, and it won't go away unless we demand an overhaul of the mental health system.


    This will involve setting the bar for treatment. It will involve setting the bar for our elected officials.


    We're in this pickle because of the root of the problem:


    Not enough beds to house individuals with chronic manifestations of schizophrenia symptoms who lack the insight to take their meds and stay in treatment.


    We have failed in protecting the basic human rights of people with schizophrenia to be treated for their illnesses in the best way possible (even if it is not the least restrictive way).  Stripping away services has failed to keep them safe and others in society safe.


    When exactly did the iron-clad "immediate danger to yourself or others" criteria become the way to screen people out and deny them treatment?

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    When did allowing human beings to be psychotic become the norm rather than the exception?


    When did individuals working in the system decide to choose to turn people away?


    This is not a systemic problem: It's the problem of the people working in the system and working in elected positions who are fully conscious of the consequences of their actions:  the lack of funding.  The lack of beds.  The massive failed policy of deinstitutionalizing individuals who were severely ill under the guise of protecting their dignity.


    Deinstitutionalization was a bandage on a wound that has long since healed.  Only the cure: leaving permanently psychotic people to roam the streets: was worse than the treatment in the so-called cuckoo's nest.


    At the same time NIMBY exists: Not In My Backyard.  No one wants the so-called mentally ill in group homes as their neighbors.


    Years ago a New York Times article exposed the inhuman conditions in adult homes in New York City for people with mental illnesses.


    Yet as of this week another possibly schizophrenia-induced unstable woman pushed a guy onto the subway tracks and a train killed him.


    We need some kind of institutions for individuals who are so severely ill that recovery might not be possible unless they are forcibly medicated.


    We need ongoing "Mental Health First Aid" as originally adopted in Australia if memory serves to educate ordinary citizens about the warning signs of mental illness so that all of us can be part of the solution of getting people the treatment they need.


    I believe we can prevent most of these tragedies.  I subscribe to Google Alerts for the word schizophrenia and I routinely get in my inbox Internet links to stories about men and women with schizophrenia who kill people.  They often kill someone they know.


    Not a month goes by without at least two Internet articles about a killing.  Can we accept even two killings a month?


    I know one thing: I won't stand near the edge of the platform until the train has completely entered the station.  It's too risky.


    My friend and I joke that St. Elizabeth's in Washington, D.C. is the end of the line for the sickest of the sick.  But is it not so far-fetched that we might need more hospitals like St. Elizabeth's that provide long-term if not lifelong treatment?


  • A solution exists: treating individuals with long-acting injectable medications, or LAIs: depot medication administered as a shot in the arm or buttocks that lasts two weeks or one month.

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    Reputable experts in the mental health field champion LAIs as the first line of defense in treating individuals who exhibit the symptom of anosognosia, or the lack of insight that leads them to be frequent fliers revolving in and out of the hospital.  They go in; they're medicated.  They get out; they stop taking the medication.


    "I'm Not Sick, I Don't Need Help!" is their classic argument and it's also the title of the number-one book (get the 2010 edition) on techniques to persuade your loved one to get treatment and stay in treatment.


    If you read the book, you will see how it's possible for someone who hears voices or is delusional or paranoid to believe nothing is wrong.  Anosognosia is caused by frontal lobe dysfunction in the brain.  It is well-documented in numerous research studies involving stroke victims and individuals with schizophrenia.


    I'm going to end here by making something perfectly clear:


    We haven't tried to solve this problem.  We've let rhetoric and knee-jerk reactions rule public outrage yet no concrete steps have been taken by people working in the system or by elected officials.


    To continue to drastically slash mental health funding is to be complicit in the tragedy in Newtown.


    To allow the sickest of the sick to remain actively psychotic for the rest of their lives is egregious.


    Demand more beds.  Demand treatment.  Don't Give Up The Fight.


    I honestly don't know how most people involved in the turning away of the sick can sleep at night.  I know my mother wouldn't be able to live with herself if she didn't drive me to the hospital within 24 hours and get me immediate treatment.


    We were lucky: I got treatment.


    Something has to change.  I'm willing to speak out to be the change we need to see in the world.  Won't you join me?


Published On: January 01, 2013