Don't Link Violence with Mental Illness

 Opposing view: Don't Link Violence With Mental Illness

Rather than forcing more people into treatment, dedicate adequate resources toward prevention

By Wayne Lindstrom  USA Today OP ED  January 11, 2013

 

Calls to make it easier to commit people for involuntary mental health treatment will do little or nothing to prevent violent acts. It will only scare people from seeking help voluntarily and fail to increase the number who are committed.

The premise that we can predict or prevent violent acts is unsupported. Even in the case of severe mental illnesses, mental health professionals possess no special knowledge or ability to predict future behavior.

The fact is people with mental health conditions are no more likely to be violent than is the general population. Continuing to link violence and mental illness only stigmatizes people and deters them from seeking care.

Paradoxically, making it easier to commit people to treatment will not lead to more commitments or more people getting care. A chronically underfunded mental health system, which has experienced $4.6 billion in state budget cuts since 2009, does not have the capacity to meet those needs.

When Illinois lowered its standard to allow the commitment of virtually every person with schizophrenia and bipolar disorder, commitments decreased because of the continued reduction in public and private inpatient beds.

In Washington, a study of the state's lowered commitment standard revealed fewer voluntary admissions and a rapid increase in the revolving door of discharges and re-admissions. In fact, the number of people who meet existing commitment standards in every state already exceeds the beds available for them.

It is highly unlikely we will increase the number of psychiatric beds. Nor should we.

Rather than forcing more people into treatment, we should dedicate adequate resources toward prevention and early identification of emotional disturbances in children and fund cost-effective community-based interventions that work.

Just two-thirds of those with severe mental illness and one-third with moderate illness receive appropriate services. When care is provided, there is a gap of up to 10 years between their first symptoms and first treatment.

Expanding access to care under the Affordable Care Act and mental health parity law will serve people better than changing commitment laws that will change nothing.

 

Wayne Lindstrom is the CEO of Mental Health America.

 

The 20th Anniversary of ADA

This week, we celebrate the 20th Anniversary of the Americans with Disabilities Act (ADA).The ADA is a broad civil rights law designed to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities. Like the Civil Rights Act of 1964 that prohibits discrimination on the basis of race, color, religion, national origin, and gender, the ADA seeks to ensure equal opportunity for people with disabilities. It does not guarantee equal results, establish quotas, or require preferences favoring individuals with disabilities over those without disabilities.

When people think about the ADA, they think about removal of physical barriers with ramps and curb cuts. In its first twenty years, the ADA has made advances in starting to remove these physical obstacles. After twenty years, we have still not achieved even the federally mandated physical accommodations. Now, as we face the future, we need to eliminate other, more pervasive barriers-the stigma and discrimination that prevent social integration.

Has the ADA eliminated discrimination against individuals with disabilities? No. It has provided a valuable tool for responding to some forms of discrimination. There are many who opposed the ADA, just as there are still those who oppose the Civil Rights Act of 1964.

I have a “non-visible” disability, which makes it possible for me to “pass” in many situations, but, despite the passage of the ADA, in these last two decades, I have experienced discrimination in employment, healthcare and other areas of my life.

I am a person who experiences severe and persistent mental illness. I will not be cured. Although I am an advocate for recovery, I am not “in recovery” from my brain. I cannot abstain from “being bipolar“, as one abstains from substance addiction behaviors. I am not defined by my illness, but it is a prism, through which I experience the world. This is a fundamental part of who I am, as much as my ethnic heritage. It is a biologically-based disease, like diabetes. I did not survive it, as some survive breast cancer. If I had breast cancer, I would receive substantially better health care and support services.

Most people who experience mental illness are afraid to publicly disclose their illness. Stigma keeps them “closeted” for fear of rejection by family and friends, isolation or firing at their workplace, and discrimination in participating in politics, recreation, housing, religion or in self-determination. Despite civil rights legislation and the public disclosures of many famous people who experience mental illness, this discrimination is commonplace.

Today, we celebrate the civil rights landmark of the ADA, but it is only the first step in achieving true equality. For more information, go to http://www.ada.gov/ for the most comprehensive referral site for information on all aspects of the ADA.

--Kristen Frame
Compeer Coordinator

News flash: You can talk to his doctor even if his doctor can't talk to you

One heartbreaking aspect of loving someone who is struggling with a mental illness is not knowing if his treatment team is seeing the whole picture. Is your loved one able to accurately report his symptoms? (To simplify this discussion, I am going to refer to the doctor or therapist as "she" and the patient (your loved one) as "he.")

Doctors and therapists are bound by strict confidentiality rules, which is why you have to sign those "HIPPA" forms when you go to any medical person, including mental health professionals. So what's a mother (spouse, friend, etc.) to do when there are serious concerns about a loved one's mental health?

Here's a tip: Confidentiality only prevents the doc from giving information to you. It doesn't prevent her from receiving information from you. So, here are some options.

1. Go to the appointment with him. Ask your loved one if it would be OK. It's his decision.

2. Ask if he will sign a release form so you can talk with the doctor or therapist. Release forms usually last from three to six months.

3. See if your loved one would prefer someone other than you to communicate with his doctor. Is there someone both of you trust who might be more acceptable to your loved one?

4. Write a letter to the doctor or therapist (or send a copy to all members of the treatment team). Or call--but in that case you will probably be giving the information to a staff person, who in turn will transmit it second-hand to the doctor. Your letter will probably get through to the doctor without a go-between interpreting it.

If you do write, you have two options:

Option A.--Be up front about it.
Tell the patient what you are doing and why. You might want to give the patient a copy of the letter before the appointment so he can see for himself what your concerns are.

I hear you saying, "He knows perfectly well what my concerns are and he thinks I'm full of it." A succinct letter can help him to better see the big picture from your point of view. Be brief, but be clear and specific, and avoid judgment, blame and shame. Just the facts, ma'am, such as:

"He seems confused and often cannot finish a thought" or "His conversation rapidly flits from one topic to another" (not "he jabbers incessantly").

Point out any changes in his behavior, thought patterns, or moods:

"For the last month, he has been bathing about once a week and hasn't been combing his hair. This is unlike him. Normally, he bathes regularly and is well-groomed." That is clearer and less confrontational than, "I tell him over and over he needs a bath, but he won't listen when I tell him he stinks to high heaven." (And if you are talking that way, your anger is understandable, but talking to him disrespectfully will probably make things worse.)

Re-write your letter, perhaps several times, to make it as clear and helpful as possible.

Option B.--Write the letter without telling him.
If you think your sending a letter will agitate him or exacerbate symptoms like paranoia, explain in your letter why you would prefer the doctor or therapist not disclose that you wrote. But be prepared--there's no guarantee the doc will not tell her patient that you wrote the letter. On the other hand, she isn't required to do so; it's a judgment call.

You will have to balance the risk of agitation against the risk that if you don't give the doc more information, she will be hampered in making the most accurate diagnosis or offering the most effective treatment.

Bless those of you who are making these hard decisions about how to be helpful. I wish every person who experiences depression or another mental illness had someone like you watching over them! Call MHA, (740) 522-1341, or visit our website, www.MHALC.org, if you'd like to learn more about mental illness, violence prevention and recovery, parenting, or volunteering.

--Judith Allee
Parent Support Coordinator

Stop Smoking.... Stop It!

I was recently shocked to learn that a friend has taken up smoking, so that she can feel more confident in social situations. This is a very intelligent woman who is otherwise health conscious. She watches her weight, walks for her health and regularly visits her doctor. She had successfully quit smoking years ago, and has now taken it up again.

She is also a person who experiences mental illness, and it is my great fear that she will become another statistic-one of the thousands of individuals who experience mental illness and are addicted to nicotine.

As a non-smoker, I find it hard to conceive of why, in 2009, with all the facts we know about the dangers of smoking, anyone would start to smoke. The facts about individuals with mental illness who use nicotine are particularly ugly:

About 200,000 of the 435,000 annual deaths from smoking in the U.S. occur among patients with mental illnesses and/or substance use disorders.

About 20% of the U.S. population has mental disorders in a given year. Over 40% of these individuals use tobacco.

Americans with mental illnesses represent an estimated 44.3% of the U.S. tobacco market.

Americans with mental illnesses and substance abuse disorders are nicotine dependent at rates that are two to three times higher than the general population.

Because people with mental illnesses use tobacco at greater rates, they suffer greater smoking-related medical illnesses and mortality.

Why do individuals who experience mental illness smoke more?
Researchers believe that a combination of biological, psychological and social factors contributed to increased tobacco use among persons with mental illness.

Persons with mental illnesses have unique neurobiological features that may increase their tendency to use nicotine, make it more difficult to quit and complicate withdrawal symptoms.

In addition, providers often think that people with mental illness are unable to quit smoking, which is not true. Studies show that people with mental illnesses want to quit smoking and want information about cessation services and resources. Significant evidence shows that smoking cessation strategies work. People with mental illness can successful quit.

Symptom management often takes precedence over preventative health measures. There are clinicians who do not perceive nicotine cessation as a treatment priority, or consider it as too consuming of limited treatment resources.

Historically, patients in psychiatric units were even given cigarettes as a method of reward and control and patients were told that cigarettes could be helpful in their treatment. According to a report by the University of Colorado-Denver, Department of Psychiatry, in the late seventies and early eighties, tobacco companies distributed free cigarettes to homeless shelters, mental hospitals and homeless service organizations. Cigarettes were purchased for persons experiencing mental illness and homelessness, so that these individuals would smoke “clean” cigarettes, not used “butts.”

The tobacco industry also targeted psychiatric hospitals for sales promotions and giveaways.

We talk about the shackles that were used in mental hospitals in the past and the lasting effects of their usage on the national psyche. What of the effects of the knowledge that patients were given cigarettes and encouraged to smoke, when their doctors knew the dangers of tobacco and chose to overlook those dangers in favor of control and submission of patients?

I recently heard a counselor say that he was opposed to a ban on smoking in his consumer-care facility because that is how he builds trust with his consumers-by smoking with them! Imagine if he had said that he built trust through drinking together.

With funding cuts, it is becoming more difficult to find resources for smoking cessation programs. Thousands of individuals who experience mental illness are currently addicted to nicotine and are struggling to find an answer to ending their dependency.

Statistics for this blog was taken from “Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers”

--Kristen Frame
Compeer Coordinator

Three Noses

When I first applied for the position as Suicide Prevention Coordinator, I told several of my close acquaintances. When I got the interview, I told more people about the job. Since my first day on the job, I have told even more people about my job.

Nearly every time I tell someone that I am the Suicide Prevention Coordinator at Mental Health America of Licking County, I am given either strange or sympathetic looks. (Thankfully, I do get the occasional look of admiration, along with the comment that I am doing very tough work.) At first, I understood why people I knew gave me the looks of sympathy or fear. Suicide is one of the last taboos in America. We can freely talk about sex, pedophilia, homosexuality, HIV/AIDS, and abortion. But mention suicide, and people take several steps back, like you’ve just grown a second nose.

This is why I have a job. Since people don’t talk to their friends, parents, children, and so on about suicide, not many people know the truth about it. Unfortunately, this also means that the rate of suicide in America is still alarmingly high. Most of the completed suicides stem from mental illness, most often depression. Depression is a treatable brain disorder (another word for mental illness). Logically, this means that suicide is preventable if depression is caught early enough. Having just attended Gatekeeper training with the Ohio Suicide Prevention Foundation, I would like to impart some of my knowledge about how to prevent suicide to you.

When we encounter stressful or threatening situations in our lives, our brain (three pounds of protoplasm housed in our skulls) helps protect us. With the way the economy and politics are going, more Americans will be facing stressful and threatening situations in their lives. Our brain, or more specifically, our amygdala, releases three different hormones that are related to fight-or-flight. We become equipped to either stand up for ourselves (fight) or escape the danger (flight).

• Testosterone is what gives us strength in our muscles to either fight or run away.



• Epinephrine (also known as adrenaline) moves blood flow from body functions that are not necessary for the fight-or-flight response, like digestion, to our muscles and brain.



• Cortisol soothes the body after fight or flight has taken place. (Ever used hydroCORTISONE cream to make swelling go away?)

There is only one problem. These days, none of us are chased by saber-toothed tigers or giant wooly mammoths; instead, we sit at our desks or on our couches, and when stressful or threatening situations occur, we don’t use up the testosterone, epinephrine or cortisol that are released into our system. As beneficial as these hormones are to our body, too much of them in our system destroy little things in our brains called neurons. Most often, the neurons in the part of our brain that stores short-term memory, mood and emotions, the hippocampus, are affected. The breaking down of the neurons that determine our emotions and moods causes people to become depressed.

Like I mentioned earlier, 90% of people who die by suicide suffer from some form of brain disorder (mental illness), mostly depression. Depression, like other mental illnesses (thanks, Kristen!), is highly treatable with medications and therapy. If we begin to screen everyone for depression, we can catch it, treat it, and prevent suicides.

I do hope that one day, I work myself out of a job, but there is much work to be done until then.

Oh yeah, and exercise as much as you can, and you can help save your neurons from destruction!

--Brittany Schumann

Suicide Prevention Coordinator

Coming Out

A year ago this month, I came out. Not in the traditional sense of the word, I did not announce that I was gay. I told my parents and my friends, (and only some of my friends) that I have a mental illness.

This is National Mental Illness Awareness Week. It is also the time of year that Mental Health America prepares for its Annual Awards Dinner which will be held this year on November 13. Last year, I was recognized with a great honor, as Consumer of the Year. Before the announcement was made, Paddy Kutz, the Executive Director of the agency, where I was then a volunteer, asked me into her office.

When Paddy first asked me if I would feel comfortable accepting this recognition and the fact that it would require me to acknowledge my role as a consumer, I was a bit hesitant. I had not yet come out to my family and friends. I was concerned that people would only see me as my diagnosis and not be able to discern where it left off and my personality began.

A few people I told warned me that I would never be able to find work again, once the secret of my diagnosis was out. I would be socially ostracized. My husband and I like dogs better than most people, so I wasn’t really worried about that.

People have told me to say that I have anxieties-that I experience depression. Both of these statements are true. My friends were concerned that if I told my whole diagnosis, I would suffer social bias and additional fallout from the stigma of having a serious mental illness.

I decided that that I needed to address the stigma of mental illness in our community. So, I decided to state that I am a person who experiences bipolar disorder and obsessive-compulsive disorder.

I feel strongly that it is important to show yet another face of mental illness, to demonstrate that there are many faces of mental illness in our community and they belong to someone you know.

Mental Health America served 1 in six individuals in the county last year, that’s you or someone you know.

An equal number of men and women develop bipolar disorder and it occurs among all ages, ethnic groups and social classes. Approximately 2.5 million Americans live with this disorder, but the number of people affected is even greater.

People living with bipolar disorder experience alternating episodes of mania (severe highs), depression (severe lows) and mixed states, which contain elements of both.
If left untreated, people with bipolar disorder are at great risk for suicide, substance abuse, incarceration, and other harmful consequences. The mortality rate for people with untreated bipolar disorder is higher than it is for most types of heart disease and many types of cancers.

But with accurate diagnosis and treatment, people with bipolar disorder have better treatment success rates than people with heart disease. Essential components of the treatment process for people living with bipolar disorder include medication, psychotherapy, support groups, and education about the illness. It is estimated that 80 percent to 90 percent of people with bipolar disorder can be treated effectively with medication and psychotherapy.

Raising awareness of bipolar disorder is an important step towards promoting early detection and accurate diagnosis, which is why the National Alliance on Mental Illness (NAMI) created Bipolar Disorder Awareness Day, scheduled this year for Thursday, October 9.

The National Institute of Mental Health estimates that two percent of the U.S. population or one in 40 people experience Obsessive Compulsive Disorder, or OCD, in their lifetime. That is two to three times more common than schizophrenia or bipolar disorder.

Many people are familiar with the television series Monk, and its detective with his own form of OCD, but there are many manifestations of obsessive-compulsive disorder and individuals suffer to various degrees.

You never see successful people with bipolar disorder on TV or Film.

Bipolar disorder has caused the most serious episodes in my life, but even with years of treatment, OCD continues to cause me the most daily problems.

I thought that I would try to explain to you what is like to experience OCD, and then I realized that I cannot. Just as I cannot explain to my husband why the simple task of choosing a restaurant for lunch has frequently reduced me to tears, why I can’t eat at a salad bar or buffet, or an office party, why I can’t leave my dog over night, or have people in my house or the host of other rules that govern my daily life.

My husband, Graham, has patiently stood by me for 20 years, confused but supportive, as the rules change suddenly without explanation, it is one of the many reasons I adore him.

I’d like to thank Paddy Kutz for her encouragement for helping me to find the voice to speak. I’d like to thank my parents for continuing to support me. And most of all, I’d like to thank Graham who stands by me no matter what I say.

If you or anyone you know are concerned about depression or anxiety, please contact the Mental Health America office for more information. There is help. And if you experience a mental illness, I urge you to tell someone you know. You may be surprised at their reaction. And they may be surprised to learn that the face of mental illness is not so frightening, it is their roommate, their daughter, their co-worker or friend.

--Kristen Frame

Compeer Coordinator