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Diane Mufson: Mental illness help is the elephant in the room

Dec. 25, 2012 @ 09:25 PM

The horrific elementary school massacre in Newtown, Conn., made Americans and the world question how this could happen. It also made us want to prevent similar future tragedies.

Our nation has started another dialogue on gun control. That's vital, but it isn't the complete answer to this problem.

A highly significant point is the lack of inpatient treatment facilities for people with violent behavior and severe mental illnesses. It isn't fashionable to talk about this; it is the elephant in the living room.

Our mental health system has changed greatly in the past half century, especially since more effective antipsychotic drugs were introduced. Before that people with severe mental illnesses were institutionalized and often kept in less than humane environments. Those who have seen the movie "One Flew Over the Cuckoo's Nest" know that traditional psychiatric hospitals were not always positive.

By the 1960s, community-based mental health services, utilizing outpatient care, were deemed ideal for everyone with mental health problems. For the majority, this has worked well. However, a small segment of our population ended up worse off -- homeless, living under bridges or incarcerated. They still need inpatient mental health treatment.

Our mental health laws permit anyone to do as they please until there is clear proof that they are a danger to themselves or others. The problem is determining when an individual is truly dangerous and then what should be done.

In my three decades as a licensed psychologist, I have worked with quite a few young people who showed significant violent and/or psychiatric problems. While some of these youth came from dysfunctional families, most had good and caring parents.

Very young children with violent behaviors sometimes can be managed with medications and physical control. When these disturbed children become teenagers, everything changes.

Then physical strength increases and some mental illnesses, such as schizophrenia, emerge. Whatever control or leverage the family had previously is often lost.

These disturbed young people scare family, friends and school personnel. Parents then desperately seek help; psychiatric hospitalization, if it occurs, is brief. The unstable person frequently refuses prescribed medication that might control temper outbursts or irrational thoughts.

Eventually, many people know that the young person (often male) is a crisis waiting to happen. But our mental health system requires evidence that that a person is actually homicidal or suicidal before any involuntary action can be taken.

We want to believe that psychotherapy, counseling, special schooling, a new environment, medication or something else will be the panacea for every disturbed individual. But parents, families, teachers, psychologists, counselors and medical personnel know that is wishful thinking.

Unless one has unlimited financial resources, there are few options for people with severe psychiatric problems. Moderate or long-term affordable or public psychiatric institutions are very limited in number and quality. Private ones are expensive and often not covered by insurance.

The mass murders by James Holmes, Jared Longhner, Seung-Hui Cho and now Adam Lanza and others tell us that there were clear indications that these young men should never have been able to get their hands on any type of gun, but that they also needed inpatient psychiatric care. Now, after the terrible damage is done, the ones who are still alive will receive it.

Until we admit that our nation does not offer adequate inpatient mental health care for the severely mentally ill, and are willing to change this, we will still have that elephant in the living room.

Diane W. Mufson is a licensed psychologist. She is a former citizen member of The Herald-Dispatch and a regular contributor to The Herald-Dispatch editorial page. Her email is dwmufson@comcast.net.

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