February 01, 2011

Mental Health Care in America

new janisBy Janis Prince Inniss

Recently, millions of Americans—and people all over the world—have been deeply saddened by the shooting of 19 people in Tucson. The victim receiving the most publicity has been U.S. Rep. Gabrielle Giffords who was shot in the head; we've watched with baited breath as her condition has improved from being “critical”. We have been horrified to see Jared Lee Loughner’s grinning mug shot, the man accused of killing six and wounding 13.

In a tight economy—to understate our current financial reality—mental health services have been on the chopping block across the country, with already overburdened state mental health budgets suffering a $2 billion cut in the last couple of years. In Arizona, funding was cut in half and the state tops the most recent National Alliance on Mental Illness list of top 10 states hurt by mental health budget cuts.

What does this have to do with the shootings in Arizona? (First, a disclaimer: While I am trained as a family therapist, I am not currently licensed nor have I met the accused gunman.) I think the case highlights many mental health issues, given that Loughner’s actions that day and others seem to be evidence of an unstable mind.

How do you think we (as a society) should respond to someone like Loughner before the shooting? What price—literally—do you think is a fair one to provide treatment to such individuals? How should we handle a person like Loughner in their late teen/early twenties who appears “troubled”?

clip_image002According to published reports, Loughner’s demeanor was odd. The emerging portrait suggests that as he got older, Loughner exhibited increasingly bizarre behaviors. Although described as somewhat of a loner in high school, his classmates recall him as intelligent and engaging, if he was sought out. After dropping out of high school as a junior, Loughner seems to have been arrested a few times on drug and alcohol charges. The U.S. Army rejected his bid to enlist. Teachers and classmates from his college classes reported that he stared and spoke out of turn.

Only a few months before the shooting, Loughner was told to leave his community college where he had repeated contact with campus police for disruptive behavior. Many students said that Loughner behaved inappropriately in the classroom. Finally, Lougner was suspended when officials at the school found a Youtube video he made in which he claimed that the school was “illegal”. In a meeting with Loughner and his parents, school administrators said they were willing to have him back with clearance regarding his mental health from a doctor. It is important to note that at age 22, Loughner is of the age (late teens, early 20s) during which many people first exhibit symptoms of certain specific kinds of mental illness.

clip_image004All of this leaves us with many questions about how to respond to someone like this. Do we breach confidentiality and call his parents, in consideration of some greater good such as his mental health and the safety of everyone at the college? What mental health resources should colleges and universities have? And at what point should we be able to force someone into treatment? Would you want someone (even your parents) to have the legal right to make you undergo mental health evaluation and treatment, involuntarily? (In most states, the period of commitment is around 24-72 hours.)

In most states, the only way to commit someone to treatment against their will is if the person is considered a danger to themselves or others. (Florida’s Baker Act, is one example of the kind of statute governing involuntary commitment.) Of course, proving that someone is dangerous is very difficult and no mental health professional can forecast dangerousness with full certainty. The age at which some serious mental health conditions surface or worsen is an age at which people are legally adults, even if they are young; what should we be allowed to do on their behalf or to protect ourselves?

Let’s assume that someone can recognize the need and they want to avail themselves of services. Where will they find them given the budget cuts? Mental health care systems in many states have been in shambles for a long time and many cities have long wait times for any kind of services: to see a psychiatrist, to get a case manager, to find an empty bed in a psychiatric hospital, and to receive supported housing. And how do people pay for treatment? Given the great numbers of Americans without health insurance this is no small question. The newly enacted Mental Health Parity and Addiction Equity Act states that health insurance coverage must include equal mental health services (with exceptions for individual and smaller businesses)—if mental health care is provided by the employer.

Given the budget shortfalls most states are facing—and the rancorous health care debate--how do you think we should better address mental health needs?


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I thought it was great how you took a current story to talk about some issues our government has to work on for mental issues.

I think that a lot of people in high school act how Loughner was acting but not all of them turn out how he did. He may have mental health issues but in my opinion that wasn't an excuse. If he would have been in a hospital for his problems around the time the U.S. Rep was at the store, he still would have found a way to try to shoot her if he really wanted too. I think that under certian circumstances, the parents should be able to admit their child to a hospital if they are over the age of 18.

I think that under certain circumstances, like Loughner's case, when he was younger in high school and college, his behavior should have been more closely monitered due to his run ins with drugs, alcohol and the police. If he is showing signs increasingly strange behavior, schools, teachers and friends should be allowed to step in and take him to a conselor, or be tested or to some mental health resource. At his school and college, he probably didn't seek help or receive any attention because of the lack of mental health resources at his high school or college. Considered if they had the right resources available to the students, and educated them about symptoms of mental problems, whether it be depression, annerexia or a more serious illness, they could have probably prevented and could prevent many kids from developing mental issues. He could have been happy and helped with the same views on U.S. Rep. Gabrielle Giffords, and handled the situation differently instead of expressing how upset he was with her in a violent manner.

The incident in Arizona was sad. I am surprised Loughner made it that far in his life without some sort of care. There is nothing wrong with being a little strange but as it continued and as he got involved with drugs and alcohol I am surprised that he wasn't at least tested. He was probably unaware of his condition and it is doubtful that he willingly sought out any attention. However, given all the events that happened with him leading up to the shooting, I am surprised he was never offered any help.

I agree with Mr. Hummel. It is upsetting when a person makes it far enough in their life without treatment and result in terrible actions. Today it seems that mental health is not taken as seriously today and many criminals use it as an excuse to be bailed out of prison time. Maybe taking a closer look at victims who absolutely need the help and denying the lesser cases. This might cut down cost and budget cuts to certain areas.

Everyone is strange in their own way it is surprising that this person did not get help. If he was that bad off he should of seeked help even if it professional help or just anyone.
Their are services out their to help people and those who need help should get it

these article show us that there is a lot of people out there that need help like loughner. it was surprise that he was not sent to get help. he had problems and if they would off gat him help earlier there was a big chance that the shooting wouldn't happen.

He should have got help with these issues going on during school. His involvement with drugs, alcohol and the police should be enough reasons for him to seek help and be closely monitored. This Arizona incident was sad, it could have been prevented if teachers, friends/family stepped in and took control by sending him to a professional for help. He probably didn't realize how far he was digging himself a whole by not getting help. Not ever body is normal, there are a lot of people that are strange and doesn't mean that he had to do what he did.

Mental health is something that has become less and less of a concern to our nation. 60 years ago, it had a ton of attention, but with today's treatments there isn't as much attention needed. Coupled with the bad economy, the decline of mental health has definitely hurt some people. I think we need to do a better job at diagnosing people who might be of danger to themselves or others.

I feel bad about the shooting in Arizona. The man should of got help when he was in high school and he should of went to counseling to get help with his mental disability. If he was treated or got help then this shooting wouldn't been occured.

This shooting was a very bad incident. People in life need to realize violence is not the way to solve their problems. Using violence only creates more problems and in the end doesnt work. I wish that man could of gotten help and maybe this whole situation would of never happened.

Very useful information. Thanks for sharing this. Your post is really good to the point I have to agree to all of those.

There should be counselling in every educational institution without any exceptions. It is a shame that there is not any in some schools. Children, students and adults all need to talk at some point in their lives and sadly Loughner never got the chance too, and so no one could diagnose him as a sociopath.

Thank you for writing this. I am glad that you brought Mental Health into the same category as government spending. As for the spending, I disagree with the budget cuts pertaining to Mental Health facilities. Being a victim, myself, of OCD and generalized anxiety disorder, I was taken from school at my own choosing to go to outpatient classes at a nearby mental healthy facility. Unfortunately, the place I went to had no room to spare so I could not become a full-time patient.

As for treating someone who is showing strange behaviors, it is of utmost importance to understand how serious depression and anxiety truly is. Mental disorders are rarely taken seriously, and I have experienced the lack of understanding firsthand. A guidance counselor at my school refused to acknowledge that "anxiety was a serious thing". He claimed it was a laughing matter. Luckily, I had known that I needed help and didn't listen to him. My parents helped me a lot.

I believe that if teachers realize strange behavior (if they even take the effort to care for their students) in a student, then they should definitely let the parents know. Chances are a teenager is hiding his or her depression from his parents. If the parents can help their child before it's too late, then they will take advantage of that. I believe that Loughner's parents should have paid more attention to his son, and that his teachers should have informed the parents of his strange behavior. If he had gotten help from his mental disorder(s), then he may not have shot 19 innocent people. Mental health is very important, and it must be taken seriously.

I can sum up our country’s mental health care problem in one sentence: Failure to provide local, high-quality, comprehensive, affordable, evidence-based mental healthcare for every American citizen, at the appropriate level of intensity,

Mental health related issues in America has long been an area in healthcare that has often been overlooked. Various mental health areas such as depression, social phobias, and bipolar are just a few illnesses affect over 42 million Americans.

Mental health is not merely the absence of mental illness, but it also the ability to cope with the challenges in life. Mental health is as important as physical health to everybody

I agree with your conclusions and looking forward to your coming updates. Thanks for sharing

Thanks for sharing some beautiful words about health

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