Beyond Politics: Mental Health

By now, you're all aware that one Joseph Andrew Stack flew a plane into the Austin IRS office, after setting his house on fire and leaving behind a lengthy anti-government screed. And around the blogosphere there's extensive speculation about the "politics" behind the act. Was he a "tea partier" or a "terrorist"? Can we use him to score political points? The same dynamic occurred after the Alabama university shootings, the Ft. Hood shooting, and pretty much every other case of senseless violence in recent years.

But I'm seeing this from a very different perspective. For my newer readers, a bit of background: I was a mental health counselor for about 15 years, working primarily with extremely disturbed and violent individuals. A lot of my work focused on violence prevention, anger management, and suicide prevention (which are usually intertwined), so I'm inclined to look at incidents like this in a different light.

The general narrative when something like this happens is that the person "snapped", and they "snapped" because of "XYZ". It's a narrative that completely misses the actual problem. Almost every time, after further investigation, others reveal that the person had been "increasingly withdrawn", "acting strangely", "expressing paranoia or delusional", or exhibiting other behavioral changes prior to committing the violent act. Signs that, in hindsight, the person was about to snap.

Which brings me to a greatly under-reported problem: our current mental health treatment system is in shambles. Clinics are grossly under-funded, counselors are overburdened with huge caseloads, and treatment rarely goes beyond prescription medications. Counseling often isn't covered by insurance, and only rarely available to the uninsured.

Here's a simple exercise: imagine that someone close to you, a friend or family member (or even acquaintance or coworker), began exhibiting symptoms that had you worried that they might be about to do something extreme (even merely suicidal). Where would you turn? Assuming that you could get the person to agree to "get help"(involuntary treatment is a whole separate issue, so I'm not addressing it in this post), is there any real treatment available? Unless the person is fairly well off, the answer is probably "no". Community mental health centers are grossly under-resourced and overburdened, and are generally limited to crisis intervention, not prevention.

While better treatment won't eliminate all acts of senseless violence (human behavior is not an exact science), could some of these be prevented? I believe so. In the wake of the Virginia Tech shootings, what few mental health records that were released revealed that the shooter exhibited multiple warning signs, but that the treatment was woefully inadequate. A prescription for an anti-depressant, but no follow up counseling. And a lot of dead innocent people.

Sadly, incidents like this are going to continue to occur. Nothing is being done in the current system to prevent them. Regardless of the politics of the person who "snaps".

Another Rethug Idiot on Health Care

OK, it's not news, but Rep. Broun sinks to a new low:

One of the most radical opponents of health care reform is Rep. Paul Broun (R-GA). He has said that a public option would “kill people.” Last Tuesday, Broun was confronted by a constituent at a health care town hall who explained that he has has gone into debt because he can’t afford insurance for his major depressive disorder. In response to his constituent’s story, Broun said that “people who have depression, who have chronic diseases in this country…can always get care in this country by going to the emergency room.” That comment prompted boos from the crowd. Towards the end of Broun’s answer, a constituent yelled, “That’s why we need a public option!” which brought cheers from the audience. (video at link)

http://thinkprogress.org/2009/10/01/broun-emergency-room/

As a former mental health counselor who's suffered bouts of depression myself, I'm outraged at this. Chronic depression (like all chronic diseases) requires long term treatment. Ideally, a combination of counseling and medications are used, but currently it's mostly just medications. They're cheaper. Emergency treatment of depression usually comes as a result of a suicide attempt or serious suicidal ideation. So the congressman was basically saying "go attempt suicide, and you can get treatment". If you survive.
Perhaps the most stunning part of the whole health care debate is how blatant the rethugs have been about there lack of compassion for their fellow human beings. It's one thing to be a cold heartless bastard, another thing to proudly publicly proclaim it.

Another Outrage

When I read this story, I almost could not believe it. This is a total outrage:

WASHINGTON — In a nondescript conference room at Walter Reed Army Medical Center, 1st Lt. Elizabeth Whiteside listened last week as an Army prosecutor outlined the criminal case against her. The charges: attempting suicide and endangering the life of another soldier while serving in Iraq.

Her hands trembled as Maj. Stefan Wolfe, the prosecutor, argued that Whiteside, now a psychiatric outpatient at Walter Reed, should be court-martialed. After seven years of exemplary service, the Army reservist faces the possibility of life in prison if she is tried and convicted.

Military psychiatrists at Walter Reed who examined Whiteside, 25, after she recovered from her self-inflicted gun wound diagnosed her with a severe mental disorder, possibly triggered by the stresses of a war zone. But Whiteside's superiors considered her mental illness "an excuse" for criminal conduct, according to documents obtained by The Washington Post.

At the hearing, Wolfe, who had warned Whiteside's lawyer of the risk of using a "psychobabble" defense, pressed a senior psychiatrist at Walter Reed to justify his diagnosis.

"I'm not here to play legal games," Col. George Brandt, chief of Behavioral Health Services in Walter Reed's Department of Psychiatry, responded angrily, according to a recording of the hearing. "I am here out of the genuine concern for a human being that's breaking and that is broken. She has a severe and significant illness. Let's treat her as a human being, for Christ's sake!"

In recent months, prodded by outrage over poor conditions at Walter Reed, the Army has made a highly publicized effort to improve treatment of Iraq veterans and change a culture that stigmatizes mental illness. The Pentagon has allocated hundreds of millions of dollars to new research and to care for soldiers with post-traumatic stress disorder. On Friday, it said it had opened a new center for psychological health in Arlington, Va.

But outside the Pentagon, the military still largely deals with mental-health problems in an ad-hoc way, often relying on the judgment of combat-hardened commanders whose understanding of mental illness is vague or misinformed.

The stigma around psychological wounds can be seen in the smallest of Army policies. While family members of soldiers recovering at Walter Reed from physical injuries are provided free lodging and a per diem to care for loved ones, families of psychiatric outpatients usually have to pay their own way.

Wolfe suggested the military court might not buy the mental-illness defense. "Who doesn't find psychobabble unclear ... how many people out there believe that insanity should never be a defense, that it is just ... an 'excuse.' "

http://seattletimes.nwsource.com/html/nationworld/2004047625_reed02.html

A soul broken down by war attempting to take her own life is a tragedy. To prosecute her is flat out cruel and inhumane. I've got a piece of "psychobabble" for you, prosecutor Wolfe: Sociopathic sadistic fucks like you are an offense to the honor of America's veterans.

Please, contact your congressperson and senators and demand better treatment for mentally-ill vets.

Mental Health Treatment

The Clinton HQ hostage situation brings up again the lack of adequate mental health treatment in America:

ROCHESTER, N.H. - Leeland Eisenberg was already in trouble before he walked into one of Sen. Hillary Rodham Clinton’s campaign offices.

Three days earlier, his wife had filed for divorce; he was due to appear in court with her for a domestic violence hearing in about half an hour.

Then, the nicely dressed, gray-haired man peeled open his jacket to reveal what looked like dynamite strapped to his chest, authorities said, and things got much worse.

Police say Eisenberg went to the office Friday demanding to talk to Clinton about helping him get mental health care and ended up taking at least five people, including an infant, hostage. Night would fall before the last one walked free and the hostage-taker peacefully surrendered.

http://www.msnbc.msn.com/id/22043358/

I guess he'll be getting treatment now, albeit within the criminal justice system.

As I posted in the aftermath of the Virginia Tech shootings, I'm a former mental health counselor. My degree is in community mental health treatment. I worked in the field for about 14 years, before burnout and frustration led me to leave the field. Our mental health system is virtually nonexistent for the people who need it most. If you're poor, the only way you will receive treatment is if you commit a crime and are court ordered into a system that is so overextended that it is unable to provide even minimal care. There is no preventative care unless you're well off enough to pay for it yourself, and the vast majority of people with mental illness aren't.

Another symptom of the sickness that has become the norm in our society.

Mental Health Treatment for Some

Another article that left me saying "WTF?". Mental health treatment for diplomats:

The State Department plans to create a new mental care office and require employees to take additional time off to deal with a surge in stress disorders among diplomats in danger posts abroad, particularly Iraq and Afghanistan, officials said Tuesday.

The steps were proposed in response to the findings of a survey that found up to 17 percent of diplomats serving at such posts may suffer from post traumatic stress disorder or similar problems, the officials said.

The figures, which some fear could be far higher in Baghdad and Kabul, are to be sent to all U.S. diplomatic missions in a cable as early as Tuesday after The Associated Press reported the results on Monday, State Department spokesman Sean McCormack said.

And Condi will be "personally involved (which would certainly make me crazy):

"The bottom line here is that we are going to do what we need to do to help out our people, if people need help, if they need counseling we're going to do that," he told reporters, adding that Secretary of State Condoleezza Rice is personally involved in efforts to improve the department's ability to assist diplomats.

"She wants to make sure that our personnel have the best possible care if they need it," McCormack said. At the same time, he made clear that Rice wanted "to get diplomats out from behind the desks" at all embassies, including hardship posts to do their jobs.

Still, I suppose it's a good idea to have sane diplomats. Especially when the policies are insane.

_ Creation of a new mental health care office within the department's medical unit. The office would have three full-time employees, including a clinical psychiatrist or psychologist, a social worker specializing in stress disorders and an administrative officer.

_ Requiring diplomats returning from tours at hardship posts to take three to four weeks of home leave to assist employees in readjusting.

_ Revising mental health briefings for diplomats heading to and returning from hardship posts to focus on stress-related disorders.

http://talkingpointsmemo.com/mochila.php?articleId=4733451&channelId=73&buyerId=talkingpointsmemo_com400732

How about the same level of treatment for our troops? And then the plain old Americans who need mental health treatment.

More on Mental Health

I've added BlondSensehttp://blondesense.blogspot.com/ to the blogroll, after reading a great post on mental health by RedStateBlues.

We all would like to see the mentally ill receive treatment, even those, like my
mother for many years, who cannot or do not recognize that they need treatment. We want to see these folks receive treatment from our impulse to help, from a place of compassion. As we struggle to understand what could have been done to help Cho before he went off like the bomb he was, remember why the Supreme Court says that we cannot willy nilly lock people up, that there must be some due process before even the mentally ill are deprived of their liberty. You and I might want to see these people committed for the right reasons, because we want them to be helped. But
as a fundamental matter of our constitutional rights, it would be the wrong result.

Because we must recognize that when we grant the State the power to compel, to restrict and impinge upon one person's civil liberties, there is the possibility (indeed, with current regime, one might say probability) this power may be misused. As we struggle through the questions of why Cho wasn't locked up so he could not have committed this awful act, think of what the Supreme Court said in O'Connor and ask yourself whether you would want it to be easier for the current government to lock people up for being mentally ill? If you answer yes to that question, I'll leave you with this final thought. It was commonplace in the Soviet Union to institutionalize
political dissidents for mental illness. After all, they must be crazy if they disagreed with the perfect political state.

It's a very thoughtful piece.

Some thoughts

In the aftermath of the Virginia Tech massacre there seems to be a lot of debate on gun control, but not enough about the state of mental health care. I'm rather neutral on the gun issue, believing in the right to own guns but supporting the assault weapons ban. I believe that if you own a gun, you should be responsible for what happens with that gun. The old wisecrack that "guns don't kill people, bullets kill people" always made sense to me.
But I'm not neutral on mental health treatment. As I related in an earlier post, I'm a former mental health counselor. One of the reasons that I left the field was my frustration with the chronic underfunding of the mental health system. The lack of resources available to provide proper treatment drove me crazy. To watch people suffering and dying, knowing that it could be prevented or alleviated if more resources were available. With budgets cut repeatedly, case loads grow. Counseling sessions are cut. Medications become the only treatment provided by the system, the only tool left.
Mental health treatment isn't a sexy political issue. As a society, we tend to avoid and shun people with mental illness. It's the victims and their families who suffer.
Would better treatment have prevented this massacre? It's impossible to know, but the lack of treatment was obvious in this case.
added: The weakness in our mental health system is only one symptom of the weakness of our health care system in general, which is itself just a symptom of our fornicated society. With the greedheads in charge, peoples lives don't matter.

Mental Health Issues

The Virginia Tech shooter had mental health issues, and it's a media firestorm. I'm going to throw my 1.5 cents in.
First, some background: I was a mental health counselor for 14 years (yeah, since I gave up mental health I'm feeling much better). My degree is in community mental health, and as a crises counselor I was involved in many involuntary treatment situations.
There's a huge debate in mental health treatment regarding civil rights and when a person can be forced into treatment. The legal standard of "danger to self or others" is subject to interpretation and often hard to determine. For example, I as a counselor could be fairly certain that a client was suicidal based on their case history, but if the client denied being suicidal I would not be able to get them hospitalized against there will. Sometimes civil rights come with risks.
People with mental illness are no more (or less) dangerous than the rest of the population, and they deserve to be treated with dignity and respect. And mental health workers are not prescient. There is no way to know what someone might do in the future.
I will also point out that mental health is grossly underfunded. Even if the young man went to counseling, I doubt that what would be available would be adequate.
Could this tragedy have been prevented? I'm doubtful. But I would hate to see this become an excuse to stigmatize and oppress people with mental illness.