Wednesday, August 1, 2012

The Colorado Tragedy: Mental Health System Concerns

By Mike Fitzpatrick, NAMI Executive Director

Last week, I offered reflections on the recent Colorado tragedy in which 12 people died and 58 others were wounded.

At that time, public inquiry had started to focus on whether or not the person responsible for the tragedy had ever sought help for mental illness or whether anyone or any institution had encouraged or required him to be evaluated.

This week, the Washington Post revealed that in years past his mother sought counseling for him—because of his social isolation. Court filings then revealed he was seeing a psychiatrist at the University of Colorado prior to the July 20 attack.

Public discussion initially focused on the wide availability of guns in our society. It has now shifted to the question of whether or not the mental health care system failed leading up to the tragedy. It is an issue addressed eloquently in USA Today by Pete Earley in a guest column, “Massacres No Excuse to Stigmatize the Mentally Ill.”

There are many causes of violence in society. As reported by the U.S. Surgeon General “the overall contribution of mental disorders to the total level of violence in society is exceptionally small.”

When exceptions occur, they are often a sign that something has gone terribly wrong in the mental health care system—which as Pete warns, we ignore “at our own peril.” In specific cases, public authorities or the news media need to inquire:

  • What was the full medical history?
  • Was there ever a diagnosis; if so, what was it?
  • When was he/she seen? By whom? How often?
  • Was treatment coordinated among different professionals?
  • Did the person or family seek treatment, but have it delayed or denied?
  • Was the type of treatment appropriate?
  • Was the person hospitalized and recently discharged?
  • What events may have triggered the psychiatric crisis?
  • Was the person taking medication? If not, why not?
  • Did family members receive adequate education and support?

These questions can help inform specific cases, but they are still only part of a much bigger picture.

Frankly, the nation’s mental health care system is not geared to accurate diagnosis or treatment of early-onset mental illness—assuming that a person has access to treatment at all. It doesn’t matter whether a university counseling center or community mental health clinic is involved. The system is fragmented and grossly inadequate. The chasm between need and care is devastating for persons living with mental illness and their loved ones. 

The U.S. Centers for Disease Control and Prevention (CDC) has found that about half of adults in America will develop a mental illness during their lifetime. One in four adults experiences a mental disorder in any given year, and one in seventeen lives with a serious mental illness like schizophrenia, major depression or bipolar disorder. 

Yet a new report from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) has indicated that only 40 percent of adults with serious mental illness receive any treatment.

When it comes to treatment, one size does not fit all; it often depends on the severity of the condition. Treatment options along a “continuum of care” may need to include medication, psychosocial therapy, housing supports or a combination. To find a treatment provider, a person’s family doctor often is the starting point, but individuals and families then have to contend with confusing referrals or networking among different resources.

For psychiatric crises, hospital emergency rooms may be a default point of admission, but only if individuals consent to treatment—or are judged to be a danger to themselves or others, regardless of other symptoms that may be apparent. Even then, treatment assumes availability of hospital beds.

At a time when mental health care is needed now more than ever, however, many states are cutting both inpatient beds and community services. 

In 2009, NAMI published Grading the States, a report on state mental health care systems. The national average was D, based on 65 specific criteria. Since then, conditions have worsened.

In 2011, NAMI published a report on State Mental Health Budget Cuts, showing a deepening crisis.

Increasingly, emergency rooms, homeless shelters and jails are struggling with the effects of people falling through the cracks—due to lack of mental health services and supports.

No matter what facts ultimately emerge from the Colorado tragedy, Americans need to focus on the fact that the mental healthcare system is already in crisis.


Anonymous said...

Thank you for this official commentary from NAMI.

Has it been posted elsewhere, in the mainstream media? Has it been sent to any legislators?

NAMI needs to be very public about the biological nature of mental illness, the mission of NAMI, and the hope of improved lives through treatment.

NAMI also needs to be very public that most people with a mental illness live quietly with their illness and never become violent against others. It is unfair that people with a mental illness be associated with those who are violent!

Ignorance about mental illness and continued stigma will continue unless NAMI takes the lead in informing the public, PUBLICLY, about mental illness.

I hope this article has been distributed far and wide, and not just to persons who may be reading it on this website.

generic latisse online said...

Americans Really need to focus on the fact that the mental healthcare system is already in crisis.

Anonymous said...

I am disapponted that NAMI and the medical community do not work together with a better voice to educate our society that mental illnesses are due to abnormal brain function. I am a nurse and my husband a physician. We have a 30 year old daughter with schizophrenia. From our personal and professional experience we have learned that health care professionals need to be educated in mental illness and updated neuroscience research. Begin with the psychiatrists themselves. Continued ignorance is the the reason that persons with mental illness succumb to stigma and access to to quality care in our society.

Anonymous said...

Was the person taking medication? If so, why? If so, what is the name of this medication? What are all of the known effects of this medication, including "side effects?"

Did the prescriber check to see what other medications this person might be on? Did they order a full blood work up and physical? Did they check in regularly with this person to see how he was tolerating the medication? What was the method of diagnosis for this person?

Anonymous said...

The Mental healthcare system is in crisis -- an understatement! The question now is who will stand up and loudly demand research, treatment, an end to discrimination by the insurance industry and others and an end to tolerating stigma? Up to now NAMI has been a weak voice - seemingly controlled by the healthcare professionals and pharmaceuticals who profit from the suffering. I pray that changes very soon because we have had enough -- no, too many years of promises -- it is time for action NOW! Take a cue from other advocacy groups who have achieved equal rights and treatment for their people. NAMI please give control and leadership of the movement back to the families. There is a place for professional advise but this is a very personal matter and you can't truly understand unless you love someone suffering from mental illness. The time to be helpless needs to be over. The time for tolerating abuse needs to be over. The time to stop accepting crumbs needs to be NOW!

The whole business of treatment provided by the government is unacceptable. Most folks suffering from kidney disease or heart disease do not get their treatment from such programs. They demand and receive coverage from insurance. They have freedom to choose adequate treatment. The mentally ill are people, human beings, for God's sake -- they deserve better. Where is the voice on their behalf? NAMI has done some good, yes, but they can and should do so much more. I pray they do.

Clinical Psychology said...

Having problems in mentality is never easy and it will greatly affect your life since you are already isolated and will be avoided by people.

Will Savage said...

Great information. Thanks for the posting.

Mental disorders said...

Thank you very much for this write up.was a great read.very informative blog.

Susan Inman said...

There is a lot of great information in this blog.
Readers may also be interested in the recent study by the Treatment Advocacy Center detailing the loss of psychiatric beds in various states; Colorado, for instance lost a third of their beds in recent years.

I've recently written about untreated psychosis and violence:

We now have substantial research on anogosnosia, the lack of awareness of being ill that accounts for many people with psychotic illnesses not receiving treatment.

Current trends to demedicalize schizophrenia, an illness the National Institute of Mental Health calls a brain disorder, are worrisome and make it more likely that people experiencing psychosis will continue to not receive the treatment they need.

Pat said...

I agree with Aug. 9th Anonymous, that the families of people who suffer from mental illness have the motivation to facilitate change. We are supposed to be represented by NAMI, but this organization hasn't done a fraction of the work that the AIDS, breast cancer and other national groups have done to raise $$$ and awareness. As the writer reveals, most of the funding is coming from the pharmaceutical industry and the CURE might not even involve medications. Until research is done to discover the CAUSE of mental illness, all treatment is just a shot in the dark. Can NAMI please step up to the plate or should we form our own group???

Anonymous said...

Hi. I have been treated by high doses of Benzodiazepines and Amphetamines for 5+ years. Recently, I have decompensated from OCD, Anxiety, and Mood Disorders; to Bi-Polar Depression with M.D.D. and treated with monotherapy (SNRI). Finally, treated with Lamictal. I began experiencing auditory and visual hallucinations. During this entire time, only my PCP would treat me. Psychiatrists would not accept me, as I was referred to as a "runaway-train, on a track, that would derail; with any change to medication. My PCP, prescribed Zyprexa due to its "inexpensive generic." At my 2 week follow-up, I was told by the Office Manager, that Dr. P would no longer treat my conditions requiring Psychiatric Meds. I was referred to a Psychiatrist, next door. He refused to treat me. I went home to Cincinnati for family support and was told by my long-time family/family's doctor, to Commit myself at the Christ Hospital. The ER would not accept me. I then attempted to commit myself at the University of Cincinnati; UC Medical Center of West Chester, OH. I was told by the ER Dept that all admits go to the Carl Lidner Center for Hope / The Sibcy House...(a very nice center). After asking if I had insurance, I was told that I would be transported to an old defunct hospital (The Deaconess). It is now the Downtown Cincinnati, Psychiatric Hospital for UC Health and all Criminally committed individuals.

After returning to GA for school, I could not get a FL RX script filled. I had to travel to Jacksonville, FL to attempt a refill; however, was told no...again and again. Jacksonville is out of Walgreen's Orlando Region. When a Pharmacist was finally willing to fill the RX, in South Jacksonville, she called to verify the validity of the script. This is when I discovered, that my Primary Care Physician, who used all of the Psychotropic Medication, had sold his practice without notifying his patients. We were told that he would be out of the office due to a 3 month Family Physician Conference, out of town.

I walked into the Mayo Clinic ER Jacksonville, and stated I wanted to be "self Baker Acted." I stated, I would end it all, if I could not get my medication, refilled or would buy a gun and force a pharmacist to fill the script. They refused to "Baker Act Me" because a social worker spoke to my Mother, 1000 miles away, and felt comfortable, releasing me to her "Virtual" responsibility; with my promise to sleep in a rest area, drive to Orlando to get my RX, then safely drive to Cincinnati.

On top of all of this, my SSDI claim, has reached the Appeal Board level. I have been unable to work, due to mental illness, since May, 2009. The process has been on going since then. Medicaid has been denied since SSA has not approved the claim and Medicare Coverage.

We live in a society, where there is an utter disregard for the mentally ill. It, after so much progression in Healthcare, is still not looked upon as a disease.

We can only hope, advocate, and educate the unknowing; in order to inspire change for the future.


Russ said...

A question that also needs to be asked, very similar to the next-to-the-last question in this article: Was this person taking prescribed medication? If so, why? Unfortunately, the dominant biopsychiatric mindset in our culture assumes that psych meds are a good and necessary thing, when in fact they sometimes induce people with no known history of violence to act out violently toward others and/or themselves.

Russ said...

Here's another question that should be asked, very similar to the next-to-last question in this article: Was this person taking prescribed psychotropic drugs? If so, why? Unfortunately, biopsychiatry dominates our culture to such an extent that we assume psych meds are a good and necessary thing, when in fact they sometimes induce uncharacteristic violence in people with no history of aggressive behavior. Pills are both prescribed and taken far too readily, and understandably from the point of view of a distressed person seeking relief.

Anonymous said...

Great article.

Just a couple of side comments in relation to some other remarks:

1) As a person with Bipolar II, I wish there were a better term for individuals with mental illness. "Consumer" turns my stomach,and even more so, the term "the mentally ill." The latter implies that we are perpetually disabled, perpetually helpless, and perpetually sick. Wouldn't it be nice if people with mental illness could just be people? After all, aren't people with diabetes, cancer, etc., just people, and not exclusively defined by their illnesses?

2) While I agree that NAMI needs to recruit employees who actually have the lived experience of mental illness, whether as (urgh!) consumers or family members, to say that the organization should be exclusively run by family members is incredibly insulting. It would be like saying that white people should run the NAACP. Can't we work together as equals?

3) NAMI stands to make a real difference by sharing the real stories of people affected by mental illness. While this is being done to some degree (and anything is better than nothing), it needs to be done in a much broader way, and at the national level to boot. I have never seen a billboard advertising NAMI, much less a TV commercial. And even though NAMI has an excellent program in the form of In Our Own Voice, in which consumers (urgh) shared their lived experience with mental illness, it has been my experience, at least in my state, that there is virtually no infrastructure to support this program. I don't know if this is a problem limited to my state, or one that is more systemic. In any event, the new standards of excellence, if they don't already talk about it, should discuss implementation of programs, as well as the financial resources required to do so.

In conclusion, as a nod back to family members--I think NAMI should consider developing a speakers' bureau to share that perspective as well. But doing so won't matter if there are only trainings with no resources dedicated to implementation.

Anonymous said...

With all do respect to the (media) can any Experienced psychiatrist say for certain that this person has Schizophrenia? I find that Very hard to believe. The idea that this person could Concentrate and put to gether this drawn out and Time consuming maze of Precise specs, without falter is beyond the scope of reason. What is more likely is this person has some form of Narsacistic Disorder, Drug Abuse, and has researched Extreme mental illness to disguise his lower than expected IQ,anti-social tendiencies,(the spoiled child)who dosent live up to expectations. The only media that attemps to address the social Stigma of this disorder is Dr. Drew, even he questions the diagnosis of Schizophrenia? I can say from Life long Experience from a parent, and two uncles,who are Schizophrenic, That (Complex )Horror could not be possible from a Schizophrelenic! For those of you who live with, grown up with or are good friends with them you know this Not to be true. Even medicated that is not the nature or Capability of that Illness. So we must move on. I guess we are all looking for the What the Why? Well here is my modest opionion, Drug Abuse (as suspected by Dr.Drew) Narcosism, socially-inept, brought on by sadistic and or , self agrandising parent or parents. Please can we all take some time out when (god forbid) this happens and look DEEP! Please lets Stop Assuming the one Easy stereotype (Schizophrenia. I urge everyone, that includes all of you Doctors out there who have No idea what that means. I cant tell you of all the IGNORANT doctors of a variety of practices who are so Clueless to this ilness. Education and tollerance of Schizophrenia in this country is null at best. I thank NAMI for this forum and the pioneer spirit to go forth and Educate!

Anonymous said...

I don't know if the diagnosis of schizophrenia is right either. The man is obviously a sociopath and psychotic. There are different kinds of schizophrenia though and he might qualify. I think they should put him in a institution for the criminally insane because he hurt so many people. He hurt our country with his antics and I don't think that should go unpunished and I don't think that he should just go to a mental hospital and get some therapy. The man is an obvious lunatic and should be treated as such. I think they should put him in a straight coat untill he explains himself. I mean what on earth was he thinking about. Noone knows and he is absolutly insane there is no doubt about that!!!!!!

Anonymous said...

Well as someone that recently checked themselves in for a 72 hour hold in CO I can tell you, you don't want to be in CO and mentally ill w/o insurance like I went through. NAMI ranks CO as the second worst for federal funding for the mentally ill in CO. I was dumped in the first available bed with low functionally mentally ill people and it made me a high functioning person more mentally ill to hear them screaming and talking to themselves in the middle of the night. I was treated like a subhuman until I threatened to sue them and then they did not even try and hold me past 72 hours.

It's no wonder how the Aurora shooting happened people don't care much about the mentally ill in this state. I just found out the hard way.