Thursday, May 30, 2013

NAMI Family-to-Family Gets the Recognition It Deserves

By Teri Brister, NAMI Director of Content Integrity and NAMI Basics

The recent announcement that the NAMI Family-to-Family program is now listed on the National Registry of Evidence-Based Programs and Practices (NREPP) is an accomplishment that everyone connected with NAMI should be proud of. It represents a journey that is not unlike the personal journeys that many of us have lived; the journey from obscurity and feeling lost while trying to find our voice to becoming a confident and effective advocate with a knowledgeable commitment to our common purpose.

NAMI grew from the grassroots need for support and information of family members of individuals living with mental illness. In an effort to meet some of those needs in a consistent, replicable way the Family-to-Family Education program was developed by family member and psychologist Dr. Joyce Burland more than 20 years ago. The program was designed to provide scientific information about the illnesses, research on the latest treatments available and specific skills that would be helpful to families navigating the day-to-day challenges that develop when someone has a mental illness. The truly unique feature of the course is the fact that it is provided entirely by volunteer family members who are trained to channel their invaluable personal lived experience and use it to augment the course curriculum to provide participants in the class not only with information, resources and skills, but with the much needed support, empathy and wisdom that is not available elsewhere.

Just as many of us have consistently stayed the course of our journey to find our way through fragmented treatment systems and the public scrutiny associated to mental illness, the Family-to-Family program has continued its gradual expansion across this country and three others; quietly meeting the needs of family members by letting them know that mental illness is no one’s fault and that they are not alone. These two messages are consistently listed by participants as the most valuable components of the course.

The consistent expansion of the Family-to-Family program has been possible because of the hundreds of committed teachers, trainers and program coordinators who have never given up on taking the phone calls, distributing posters and flyers and raising money for printing program manuals for participants—because NAMI programs are always offered free of charge to participants.

These volunteers have continued to provide the course, year after year, based on the structured curriculum and the co-teacher model in which they each received extensive training. It is this consistency and fidelity to the course model that have allowed the rigorous level of research necessary for the Family-to-Family program to attain the level of credibility that comes with being listed as an “EBP” on the NREPP.

This listing is indeed a milestone in the journey of the NAMI Family-to-Family program. The national recognition of the effectiveness of the course brings a level of credibility that will only enhance the value of a program that we at NAMI have been aware of all along. Whether you were part of one of the three research studies that were conducted on the course; a Family-to-Family teacher/trainer/coordinator; someone who has taken the course; someone whose family has benefitted from the course; or someone who has raised money through a NAMIWalk to help fund the course, you should feel very proud. The pride that comes from being part of a program developed by family members, for their peers to learn from each other in a supportive environment is one that should be shared. The pride that a grassroots mental health advocacy organization now has a program which is listed alongside other well-known mental health programs and interventions, most provided by professionals, is an accomplishment.

The NAMI Family-to-Family program has not only found its voice but that voice now carries an air of credibility that will allow it to be heard with a new level of respect from mental health providers and policy makers for the family members who make it all possible.

Monday, May 27, 2013

Trauma Healing and the Importance of Family and Compassion

By Connee Gorman

Three years ago I left the corporate world to advocate for individuals living with mental illness. And my decision to “come out” as a person with a mental illness has been essential to my work. Advocating has helped me accomplish things I did not know I was capable of. (A wonderful surprise at the age of 60!) One of those things is becoming a children’s book author! I have finished two in a series of five books. My first is focused on bipolar disorder within a family. And my second is about trauma, I Need Dad and Dad Needs Me (a loving lesson about posttraumatic stress disorder (PTSD) for families).

In the book, the main character is a little boy named Hank. Hank’s dad has returned from Afghanistan and is showing signs of PTSD. Hank starts to notice and has a healthy concern about his Dad. They talk, share their fears and physical reactions and through this they come to understand that healing can happen.

We all know there are an incredible number of men and women in our military who are living with (PTSD) and more will be diagnosed. Speaking realistically it is impossible for all of them to get the proper amount of care and type of care they need. I saw a way I could make a small but important contribution toward trauma healing. Because PTSD affects every family member, I decided to write my book for families: to open up a discussion about how PTSD is affecting them.

The discussion begins about what PTSD means to their family and most importantly taking that giant step toward compassion and support and love needed for traumatic healing.

In fact, it is an example of the goal of one of NAMI’s signature programs! The NAMI Family-to-Family education program has proven the importance of a family support system. (I am honored to teach this class that is designed for caregivers of individuals living with severe mental illness.) The 12-week program teaches family members strategies for handling crises and relapses and provides up-to-date information on medications, mental illness and support groups and services within the community.

Shortly before I wrote this book, I also discovered a trauma healing technique called Somatic Experiencing (SE). While forms of talk therapy work for some, for me it only seemed to make me relive my trauma. Somatic Experiencing is a body-awareness approach to trauma. I greatly respect SE because it is compassion based and asks the question “What happened to you?” and not “What is wrong with you?”

My goal is to become a SE facilitator within the next three years and hopefully focus on our veterans. (Yet another way I am surprising myself!)

Memorial Day is one of gratitude to our past and present armed services. But that gratitude must be shown every day. We must show this gratitude by doing everything we can to support these men and women in healing and becoming whole once.

Connee Gorman is a mental health advocate, educator and author of I Need Dad and Dad Needs Me. Her website is www.conneegorman.com.

Thursday, May 23, 2013

Share Your Strength. What Songs Inspire You?

By Bob Carolla, NAMI Director of Media Relations

I always hesitate to write about music. It tends to date me. My kids roll their eyes whenever I mention the 1970s, let alone folk rock. In the car, there’s a constant battle over which radio stations or CDs to play.

Every now and then, however, there’s a song that resonates and bridges the generational divide. These days, the song is "Carry On" by the band fun. It strikes a chord somehow with teenage angst and inspires my own kids to rally forward.

If you're lost and alone
Or you're sinking like a stone
Carry on
May your past be the sound
Of your feet upon the ground
Carry on

“Carry On” strikes a chord in me as well, rooted in past battles with depression. Its message is an exhortation, a call to arms and an affirmation of faith. It also has caused me to remember the song that touched me when I was 16 years old—long before I learned that my moodiness was only a hint of worst things to come. Arlo Guthrie sang Somebody Turned on the Light, which is partly about coming of age in the tumultuous decade between 1961 and 1971.

When the world is wrong better right yourself
It'll make the dark clouds fly
Nobody tall can put out the lights
Just don't let the spirit die
If you never see the sun till '91
Don't you ever give up the fight
Sure be glad when you see the dawn
Somebody, somebody turns on the light
Somebody turns on the light.

Other songs reflect the same theme. In 2001, Gospel singer Yolanda Adams’ "Never Give Up"  was a call for personal perseverance, but also provided encouragement and hope to a stunned, grief-stricken nation after the terrorist attacks of 9/11.

An important distinction is that such songs are inspirational in nature, encouraging listeners to draw on inner strength. They don’t wallow in sadness or pain. I’ve always liked Gilbert O’Sullivan’s  “Alone Again (Naturally),” but face it, the fact that in the lyrics, he is on his way to throw himself off a tower doesn’t do much for inspiring a person to hold on.

From a biological perspective, music can calm stress and elevate mood by increasing levels of serotonin or dopamine in the brain. Music can literally lift and energize a person’s spirits, helping to overcome anxiety or depression.

Tunes and lyrics also stir memories. Music from a pleasurable time and place can therapeutically put people living with depression “back in touch” with important parts of themselves, helping to pull them out of isolation inside their own minds.

Thirty years ago, I was struggling with depression, unemployed and disconnected from most of my friends who lived in other cities. Turning points in my recovery came when a close college friends stopped for a night en route from Vermont to Michigan. As we talked into the night, he put one of my records on stereo—Abbey Road by the Beatles—which we had listened to many times together several years before. One song was particularly apt:

Here comes the sun
Here comes the sun, and I say
It's all right
Little darling
It's been a long, cold lonely winter
Little darling
It feels like years since it's been here

In that moment I realized that it had been over a year since I had listened to music for music’s sake. It had been part of my withdrawal from the world and suppression of my energy and strength.

Turning the music back on helped turn me back on.

It doesn’t matter what decade you’re from. Carry on. Don’t ever give up the fight.

Share your strength.

Tell us the songs that inspire you.

 

Wednesday, May 22, 2013

Providing Support When It's Needed Most

By Laurie Emerson, NAMI Vermont Program Director

(left to right) Thelma, David, Darlene and Dirk of the NAMI
Connection Recovery Support Group in Vermont.

Individuals living with a mental illness need to talk with someone who understands—someone who has been in the same situation they are in, someone who can give them hope and inspiration for their recovery. The NAMI Connection Recovery Support Groups provide that resource for individuals to connect with in their community, but what about individuals who are in severe crisis and have been hospitalized? This is the situation where they desperately need someone to talk to and bridge the gap to recovery.

With the help of our NAMI Connection Coordinator, Dirk Nakazawa, NAMI Vermont has opened doors to begin the healing process in the psychiatric unit at Rutland Regional Medical Center. “In my experience many people living with mental illness are too afraid or intimidated to leave the comfort of their home and walk into a room full of strangers to find support,” Nakazawa said. “What we have been finding since starting about four months ago is that many of the people who end up on the psychiatric unit really lack supportive people who truly understand what they are going through. We hope that when they leave the hospital the chances that they might seek out a support group to attend in order to find people who truly understand them would increase.”

By providing a NAMI Connection Recovery Support Group at the psychiatric unit in one of our community hospitals, it helps participants understand about a valuable resource waiting for them once they are released and can feel comfortable to attend a meeting in their local community. The meetings are flexible so that patients on the unit can come and go as they need to. Hospital staff sit in on meetings and find that many patients open up and discuss their feelings quite freely with the trained NAMI Vermont facilitators who help to problem solve and guide the discussion to a positive outcome.

“We are extremely pleased to have been able to partner with NAMI Vermont in developing this much needed resource on our inpatient psychiatric unit. Participating in the NAMI group while on the inpatient unit provides patients with a connection to the community resources which exists upon discharge providing smoother transition to the outpatient setting. The impact of this group is best described by one of the participants who said, ‘The NAMI group was awesome!’ when asked for feedback upon discharge,” said Dr. Gordon Frankle, Chief of Psychiatry for Rutland Regional Medical Center.

NAMI Vermont has formed a close partnership with Rutland Regional Medical Center who provides space for our NAMI Family-to-Family classes, Family Support Groups, and Provider Education courses. Now we have started a NAMI Connection Recovery Support Group at their psychiatric unit, one of the first in the nation.

I am so proud of our NAMI Connection facilitators, Dirk Nakazawa, David Remington, and Darlene Manning who have made such an impact on people’s lives in their recovery process. They are truly making a difference in Vermont through their dedication and commitment by leading through example and giving people courage and hope for their future. We hope to replicate this same process at other psychiatric units throughout the state.

Friday, May 17, 2013

DSM-5 and Psychosis: Hopes and Limitations

By Ken Duckworth, M.D., NAMI Medical Director

There has been a lot of recent press regarding the National Institute of Mental Health (NIMH) and its research vision. Dr. Thomas Insel, the director of NIMH has recently come out explaining that the NIMH will no longer utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM) when conducting further research. He clarified those remarks in a subsequent joint statement with the president-elect of the American Psychiatric Association (APA), Jeffrey Lieberman.

While that long term process is developing, we are left with the imperfect descriptive system that is the DSM. What follows is my brief take on the historical roots of the DSM as a diagnostic framework in the area of psychosis, and key changes that have been made for this version, the DSM-5, which is due out on May 18, in areas of importance to NAMI members.

The DSM system is designed to produce reliable diagnoses that hold up on different days and across different practitioners. This path to organize symptoms, which impact research, payment and services, isn’t driven by a corresponding neurobiology, however; the field simply does not have the capacity to do that yet. Perhaps Dr. Insel’s researchers can help us get there in the not too distant future. For now though, collecting symptoms into syndromes, a diagnosis can offer some insight into some of the elements of a recovery plan. Pragmatists know that DSM is the only game in town right now to inform clinical practice and research as the underlying work to develop biological roots to diagnosis is years or even decades away.  

A Brief History on Diagnosis

I find it helpful to think about the roots of descriptive psychiatry in the area of psychosis. The work of Emil Kraeplin a German psychiatrist in the 1890s forms the base of our modern day symptom driven framework. His work focused on the course of people who came to a hospital with psychosis. He first organized his framework by interviewing any hospitalized patients who presented symptoms of psychosis. After years of observation, he organized these presentations of psychosis into what we now call schizophrenia and bipolar disorder (his pioneering terms were dementia praecox and manic depressive insanity, respectively).

Kraeplin, like his colleague Alois Alzheimer, focused on cognitive problems at different stages of life. Dementia praecox translates to precocious dementia and was the way Kraeplin first thought of what we now call schizophrenia. Kraeplin’s young patients weren’t demented per se—they could often recall facts and know the date, time and place—but they did have issues with memory and other thinking functions. Interestingly, a recent intervention called cognitive enhancement therapy (CET) has shown potential to improve cognition in people with schizophrenia, thus validating Kraeplin’s original interpretation of the condition. He was a keen observer, and Kraeplin believed we would someday unlock the underlying neuroscience that he was observing in people.

Changes Coming to the DSM

One key change in the area of schizophrenia is that DSM-5 has deleted all the subtypes of schizophrenia. This is a logical choice to me as I did not feel that the symptoms were distinct enough to make these more precise diagnoses. I didn’t find the subtypes to be helpful in informing care and they didn’t add to the person’s understanding of their experience. The DSM-5 replaces these widely ignored subtypes in schizophrenia with a dimensional system that looks at different important areas (such as positive symptoms, negative symptoms and cognition). While I haven’t used these dimensions yet, I am hopeful that a more detailed description of what people are actually experiencing will result in more helpful treatment for an individual over time. The description of symptoms is of course imperfect but better descriptions in this dimensional concept are likely to make incremental progress in getting people better care.

Gene studies have shown us that these conditions may be more biologically related that we have previously thought. Schizoaffective disorder for example, is an under-researched diagnosis that encompasses symptom elements both of schizophrenia and of bipolar disorder. It represents a clinically observed but biologically elusive overlap in the original Kraeplin system of diagnosis. There was talk initially of eliminating the diagnosis from the DSM-5, which alarmed me given its prevalence. In the end, the DSM-5 includes a more longitudinal view of symptoms in the diagnosis of schizoaffective disorder as opposed to a more point in time symptom description for the condition. Given that schizophrenia and bipolar disorder are also best understood over years this change makes good sense to me as a clinician. Recovery is a long term process so it makes sense that this diagnosis is similarly understood over time.

There is a growing interest in the field on earlier intervention in psychosis in order to get people help sooner. The APA studied whether it was possible to identify people earlier in their course, who may go on to develop schizophrenia. The proposed diagnostic concept was first called risk syndrome and later, attenuated psychosis. This is a controversial area of inquiry as overlooking people with this issue presents risks and so does over-identifying people. This remains an important question as we do know from the research and our own survey of people with schizophrenia that it can take nine years on average to get a diagnosis from the onset of symptoms in our current world. This delay adds suffering and missed opportunities to accelerate recovery for people who develop schizophrenia. Proponents of an attenuated psychosis diagnosis cite non-medication (and side effect free) strategies that have been shown to be helpful, and made comparisons to the earlier and helpful diagnosis of hypertension in medicine. On the other hand, psychiatric diagnosis unfortunately can come with a price in society and it is also important not to label something that won’t develop into a bona fide illness process.

The field trial team of the DSM tried to see if they could make this work—if attenuated psychosis could identify young people who were first hearing voices or who had paranoid thoughts to inform who would go on to have a later psychosis diagnosis like schizophrenia. The field trials showed that the proposed diagnosis of Attenuated Psychosis did not accomplish both key tasks of identifying people at risk and not identifying people who were not. The idea of attenuated psychosis as a diagnosis is therefore in the “needs further study” area of the DSM-5 and is not a reimbursable diagnosis. Formal diagnosis or not, I encourage people who are having early symptoms of psychosis to get assessment and help—many of the psychotherapy strategies have shown good results with no downside. There is a national movement to provide services to young adults and teens that are having early psychosis symptoms and information on these ideas and programs is available at www.nami.org/psychosis. I work at such a program in Boston called PREP and I love my time there.

This is a humbling line of work and the DSM-5 reflects that. It doesn’t surprise me that understanding the human brain is going to offer many more challenges than say, blood pressure. We don’t know precisely how our treatments work at the neurobiological level but it is quite helpful to know that they often do work. How exactly does cognitive enhancement therapy or lithium work? We simply cannot say after offering some reasonable hypotheses. I take comfort that this was the state of the field of infectious disease for decades after the advent of antibiotics. The field of medicine knew they worked but we didn’t know why. Thousands if not millions of lives were saved along the way without any detailed knowledge of the underlying process of action. In psychiatry, we need to do both—look for true biological underpinnings for diagnosis and for the linked treatment that will follow, and work to improve knowledge and care now to serve people better today.

Friday, May 10, 2013

How I Put the Happy in Mother’s Day

By Dawn Brown, NAMI HelpLine

When someone wishes me a Happy Mother’s Day they have no idea what it means to me; if you have an adult child with mental illness perhaps you can understand. Before I could have a happy Mother’s Day, I needed to recreate the mother I was and become the mother I needed to be.

When a woman becomes a mother everything changes as we take on the mantle of motherhood. Since there is no job description for mother, we tend to combine different experiences and expectations to create a rosy notion of motherhood. But nothing prepares you for being the mother of someone who develops a mental illness.

As my son began to experience the symptoms of mental illness, I believed as his mother that we could overcome anything, even schizophrenia. I was wrong. I was unprepared. I was doing more harm than good. He was slipping away, and as I stood in the kitchen and looked at the screaming, irrational stranger my son had become, it quickly became obvious that he needed a very different type of mother. Everything changed. My sense of loss was profound. My ability to protect and nurture my child was limited by my lack of knowledge and understanding. I needed to grieve and get my bearings, but mental illness demands action. I didn’t know what questions to ask, what people to see, and where to go. I didn’t know much, but I knew just enough to reach out to NAMI.
Using a nationwide network of NAMI State Organizations, NAMI Affiliates and a large Web presence, NAMI is ready to help you find information, gain insight and get support when mental illness strikes. NAMI was created by and for people like you and me, and today tens of thousands of volunteers offer themselves to help individuals and their loved ones find recovery and build better lives.

Being the mother of an adult with mental illness required me to become an expert on community mental health support services, psychiatric medications and psychosocial treatments. I learned a whole new vocabulary for a confusing, disjointed system that was adequate at best and harmful at its worst. I graduated from the NAMI Family-to-Family education program, plugged in to a NAMI Family Support Group, added the NAMI HelpLine to my speed dial (1 (800) 950-6264) and learned the art of patience and persistence.

It has been over 10 years since my son was diagnosed with schizophrenia, and everything has changed, including me. Today I am strong and assertive in advocating for my son. My boundaries are clear and defined. I respect him and expect respect. Treatment and medication are non-negotiable. I don’t indulge any illusions about what living with a mental illness means. My son and I have been through some very bad times and traveled through many dark places.

I’ve also learned that my son is not a burden that I must carry through life. His life is his own. Life’s lessons are best learned through natural consequences, both good and bad, resulting from our choices. And, I’ve learned that my son desperately needs me to walk alongside him offering love, support and guidance, as he finds his place in life. I love him dearly. He is doing well. I am very happy to be his mother.

This Mother’s Day if I could send every mother who has a child living with mental illness a Happy Mother’s Day card it would have this message taken from NAMI’s Family-to-Family education program.

Sometimes Love Means Let Go…

  • To let go does not mean to stop caring. It means I can’t do it for someone else.
  • To let go is not to cut myself off. It’s the realization I can’t control another.
  • To let go is to allow someone to learn from natural consequences.
  • To let go is to recognize when the outcome is not in my hands.
  • To let go is not to care for, but to care about.
  • To let go is not to fix, but to be supportive.
  • To let go is not to judge, but to allow another to be a human being.
  • To let go is not to expect miracles, but to take each day as it comes, and cherish myself in it.
  • To let go is not to criticize or regulate anybody, but to try to become what I dream I can be.
  • To let go is not to regret the past, but to grow and live for the future. To let go is to fear less and love more.

This Mother's Day, share your video or story and let others know what the day means to you.

Monday, May 6, 2013

Helping Someone When They Don't Know How to Get Help

By Eric Ward

I was in my early 30s with three small children that depended upon me, when I lost my well-paying job. I went on COBRA insurance, but it quickly ran out. I was paying cash for my therapist, psychiatrist and for my prescriptions. Then my money was completely gone. I was losing my home and my therapist told me that he could not ethically take my money anymore. I was devastated. I had nowhere to turn.

I was obviously nonfunctional at the time, as opposed to now where I am considered high functional, but my therapist gave me his email and told me that I could communicate with him via email for free. To sum it up in a few words; he saved me.

I didn’t have the money for phone, computer or internet, but once a week I would ride my garage sale bike to my local library and email my therapist.

This was the hardest time of my life and I needed help.

I applied for social security and was denied again and again. I even lowered my head and walked into my local welfare office. For a proud father, this was the hardest thing that I have ever done. I obviously was doing the paper work wrong. I filled out the forms but my mind was scattered. I tried talking to the over-worked workers, and I know I made no sense. Obviously, I didn’t get anywhere at my local welfare office.

It wasn’t due to the people that work in the office, or even the system. It was due to the fact that I desperately needed help. I needed someone who understood me and my mental condition. Someone who could help me get things in order, help me with the paper work and help me fill out the forms.

I ended up ridding my bicycle around the small towns in my area looking for cans to turn into food money. I would use old plastic garbage bags and pick up cans, cash them in, and then go to the dollar store and buy food for my kids. (I’ll say also it is very hard to ride a bike and not get the plastic bag caught in your spokes!) I survived off of potatoes that the dollar store would sell.

Through all of my mess, my therapist, Conrad Nordquest, was by my side. During the holidays I was desperate for money to buy my children gifts. I was going to sell my bicycle. He told me not to do so because it was my only form of therapy that was working. Conrad told me just to wait and something good will happen. It did, one night I had a knock on my door and it was some stranger. He asked if I was Eric Ward. I of course panicked. I had been off my meds and my schizophrenia and OCD were in full swing. The strange man at my door gave me an envelope and then quickly walked away. When I cautiously opened the envelope it had $200 in it. Even though my therapist would never admit to it I knew that the money was from him. He was the only one that knew of my dire circumstances. Anyway, I was able to buy my children presents.

But more than providing some money, my therapist was kind enough to take a personal interest in me. He would respond to my emails and council me through this very dark time. He got me an appointment with a top local psychiatrist, Dr. Jackson. Dr. Jackson did not charge me any money and did a full psych evaluation. He helped me file the paper work for social security and even gave me free samples of antipsychotic medications. I was approved for social security, and from that moment on it’s been “all downhill” (which is great for a bike rider!)

Since that time, I’ve been able to start my own business, traded my garage sale bike for a new road bike, and have been in over 70 bike races and multiple charity rides. With a new business and three girls to keep me on my toes, I find time to cycle as often as I can. The sport allows me to clear my mind for some time, focusing only on what lies about 15 to 20 feet in front of me. For me, being on a bike is beyond exhilarating. It allows me to let go, gives me some great alone-time and helps me stay fit and sharp.

Of course there are still difficult times, and proper medications and therapy is an ongoing process, but I will never give up! I will never stop, and I owe my success to my therapist and psychiatrist. None of this would have been possible without them by my side, and my wish for everyone is that you have someone, just one person like these two men, there to help and support you.

As humans, it is important that when we see someone on the street, falling on hard times or just in a bad-off spot, that we realize this person may not know how, or may be totally unable, to get that help that is available to them. We need to help, and there are many things, even small things that we can do; at this moment and all the time. We can start by making it a priority to support the charities that are there for people in their time of need. Volunteering is every bit as appreciated as financial support, and as a cyclist and walker I know NAMIBikes and NAMIWalks organizers love seeing me and my family in attendance! If you have the means to support financially than please do. Take a stand! Be a champion and remind people that a mental illness diagnosis is every bit as real as a diagnosis of cancer. Treatment is available and recovery is possible. Fight stigma!

What I want to say is that if I did not have these two people around to help me I would have been homeless. I would have lost my children. I would have lost my life. We cannot turn a blind eye to those in need of help, and there are so many things we can do to help each other.

Friday, May 3, 2013

Guns and Mental Health Care: Finding the Right Solutions

By Ron Honberg, NAMI National Director of Policy and Legal Affairs

"The President reacts as John Brennan briefs him on the details of the
shootings at Sandy Hook Elementary School in Newtown, Conn. The
President later said during a TV interview that this was the worst day of
his Presidency."  (Official White House Photo by Pete Souza)
As you’ve probably been hearing, Congress is at an impasse in the debate over guns. They have retreated, for the moment, from the issues that divide them, including whether limits should be imposed on assault weapons, if the loophole should be closed that exempts individuals who purchase firearms at gun shows from background checks, and other divisive issues.

There is one area though in which the gun control and the pro-gun lobbies appear to have reached an agreement: that mental health background checks should be expanded. Some of the rhetoric has been inflammatory and highly offensive.

For example, in the days following the tragedy at Sandy Hook Elementary school, Wayne LaPierre, the executive vice president of the NRA, attempted to deflect attention away from calls to ban assault rifles and automatic weapons by focusing on what he regards as the “real problem”: the large numbers of dangerous people with mental illness walking our streets.

LaPierre said, “How many more copycats are waiting in the wings for their moment of fame—from a national media machine that rewards them with the wall-to-wall attention and sense of identity that they crave—while provoking others to try to make their mark? A dozen more killers? A hundred more? How can we possibly even guess how many, given our nation's refusal to create an active national database of the mentally ill?”

But these offensive quotes are not limited to the NRA and their allies. Consider this statement by Mark Glaze, Director of Mayors Against Illegal Guns, a leading organization advocating for gun control, that appeared this January in an article in The Washington Post.

“The system looks like Swiss cheese. It stops a lot of bad guys from getting guns, but it lets a lot of bad guys through. Every mental health record that isn’t in the system is a ticking time bomb waiting to go off in another community.”

There is certainly little disagreement that guns should be kept out of the hands of people who are violent. But focusing the debate solely on expanding mental health background checks misses the point. After years of neglect, coupled with huge budget cuts since the recession began in 2008, mental health services are frequently not available to those who need them most. On any given day, six out of 10 people living with serious mental illness do not have access to any mental health treatment.

Moreover, most people living with severe mental illness are not violent. Thomas Insel, M.D., director of the National Institute on Mental Health (NIMH), recently testified on this point at a Congressional hearing:

“Research has suggested that persons with schizophrenia whose psychotic symptoms are controlled are no more violent than those without serious mental illness (SMI). Nonetheless, when untreated psychosis is also accompanied by symptoms of paranoia and when it is associated with substance abuse, the risk of violence is increased. Importantly, the risk of violence is reduced with appropriate treatment. Moreover, people with serious mental illness are 11 times more likely than the general population to be victims themselves of violence.”

Despite these research findings, existing laws take a broad, categorical approach to mental health background checks rather than focusing on predictors of violence. The Federal Gun Control Act states that “persons adjudicated to be mentally defective or who have been committed to a mental institution” are prohibited from possessing firearms and ammunition. And, states are directed to report the names of individuals who fall into these categories for inclusion in the National Instant Background Check (NICS) system. A recent report by Mayors Against Illegal Guns shows that some states have reported thousands of records and others none at all.

NAMI has testified that federal legislation should eliminate highly offensive terminology such as persons “adjudicated as mentally defective” and provide clearer guidance on who should and should not be included, based on current scientific understanding. 

The real solutions however lie in improving America’s broken mental health system. A system that does not enable people to get mental health care until their symptoms deteriorate to the point of constituting acute emergencies is no system at all.

NAMI has recommended a number of steps in the aftermath of Newtown, including:

  • Early identification and intervention in mental health care.
  • Training of school personnel, law enforcement and other first responders on crisis intervention.
  • Implementing school based mental health services and supports.
  • Increasing the qualified mental health workforce.
  • Fully implementing Medicaid expansion and other key components of the Affordable Care Act, including mental health parity.
  • Providing support for families who function as primary caregivers.
  • Achieving proper balance in federal and state privacy laws.

There are several bills in Congress that would take steps towards achieving some of these objectives, including the Mental Health Awareness and Improvement Act, which would put resources into school based mental health services, suicide prevention and other areas, and The Excellence in Mental Health Act, which would establish a funding stream for Community Mental Health Centers (CMHCs) that achieve certain core competencies in treating people with mental illness.

However, at the same time that these new programs are being considered, vital areas of federal funding such as housing and research on mental illness are slated for cuts.

Taking one step forward and two steps backwards is not going to get the job done. And, limiting the debate solely to how mental health reporting requirements can be expanded in gun background check systems will not solve the problem either.