October 6, 2015 update: Stigma and the Oregon school shootings
Advocates have mixed feelings about national attention to mental health careDecember 26, 2012 By Maiken Scott President Barack Obama speaks during a news conference in the briefing room of the White House on Wednesday, Dec. 19, 2012 in Washington. Obama announced that Biden will lead an administration-wide effort to curb gun violence in response to the Connecticut school shooting. (AP Photo/ Evan Vucci) President Barack Obama speaks during a news conference in the briefing room of the White House on Wednesday, Dec. 19, 2012 in Washington. Obama announced that Biden will lead an administration-wide effort to curb gun violence in response to the Connecticut school shooting. (AP Photo/ Evan Vucci) In the wake of the Newtown, Connecticut, shootings, President Barack Obama has said government should make "access to mental health care at least as easy as access to a gun."
So, how available is mental health care in America -- and what barriers block access?
Mental health advocates are weighing in on the conversation -- but not without reservations. Mark Salzer of Temple University has devoted his career to improving the lives of people with severe mental illnesses. Having a national platform for the issue of access to mental health care would usually be a dream come true -- but not right now. "I think it's coming from the wrong place," said Salzer. "Linking mental health issues and access to care to mass killings is flawed thinking." Salzer, who chairs Temple's Department of Rehabilitation Sciences, says that untreated mental illness typically results in quiet suffering, despair and isolation, not violence. "Linking it to the Newtown, Connecticut, shootings actually increases prejudice and discrimination," he said. "And in the end that will keep people from seeking services that they need." Salzer argues that prejudice and stigma remain the biggest barriers to care; people are afraid to seek treatment because they don't want others to know they are struggling with mental illness. But stigma is just one problem on a long list of barriers. Insurance coverage for mental health treatments often lags behind coverage for physical illnesses, despite parity laws in some states. Doris Fuller, who directs the Treatment Advocacy Center in Arlington, Virginia, experienced this firsthand when her daughter was hospitalized during a mental breakdown. Her daughter was in college, and Fuller said her policy had generally solid coverage. "It turned out that there was a cap on in-patient psychiatric care of $10,000," recalled Fuller. "So she had a million dollars in coverage, of which $10,000 was available for mental health care. it's a big problem!" Fuller says a worsening shortage of psychiatrists threatens access to treatment, as well as a lack of research funding dedicated to treating mental illness effectively. For example. Fuller says, there's not enough money dedicated to developing medications for patients with the most severe mental illness. "Those kinds of problems affect everybody," said Fuller. "If you can't find a psychiatrist, even if you have the best kind of insurance in the world, you may not get the treatment, you may not get the care that you need." Fuller's organization is also working on changing in-and out-patient commitment laws that would ease legal barriers on getting people into treatment against their will.* The Treatment Advocacy Center recently published a study pointing to a severe lack of in-patient psychiatric beds across the country. Both Salzer and Fuller agree that recent state and federal budget cuts to mental health service have been devastating. Salzer says a national conversation on these issues is much needed, but it has to be framed in a way that does not increase stigma. * LI OCD Editor's note: We at LI OCD do NOT condone "getting people into treatment against their will". Blaming people with mental health issues is not 'meaningful action"
December 19, 2012 By Mark SalzerThe following is a work of opinion submitted by the author. The shootings in Newtown, Conn., are disheartening and incomprehensible. We seek to understand the mind and motives of the killer in an attempt to regain a sense of control and normalcy after such incidents, but are rarely successful. We also discuss taking "meaningful action," as President Obama is advocating, to reduce or eliminate such horrendous acts. Meaningful action is needed, but will not be successful if we target people with mental health issues. The typical reaction to such events from politicians, journalists, gun and hunting organizations, liberals and conservatives alike, and some mental health professionals, is to cry out for restrictions on gun ownership for people with mental illnesses and for changing how those who are viewed as potential dangers to others are dealt with in the mental health system. Such actions would not be meaningful or successful. In fact, these actions will further alienate, disenfranchise, and harm a large segment of our population — and do so with no perceptible impact on the frequency of such horrendous incidents or general rates of violence in our country. The reality is that between 5 percent and 7 percent of the U.S. population, approximately 15 – 21 million adults, has a serious mental illness, including schizophrenia-spectrum disorders, bipolar disorder and major depression. The reality is that mass murder is incredibly rare. The reality is that, even if the Newtown killer did have a mental health issue, he would represent only 1 out of 20 million people with mental health issues. The reality is that mental health professionals are unable to adequately predict violence, especially mass violence. The reality is that murder in this country is overwhelmingly perpetuated by those who do not have a mental illness, although news reports never state "The accused killer did not have a mental illness." The reality is that people with mental health issues are much more likely to be the victims rather than perpetrators of crime. The reality is that people with mental health issues already face debilitating, dispiriting, and disabling prejudice and discrimination from their government and fellow citizens. The reality is that more prejudice and discrimination keeps people from obtaining needed services. The reality is that coerced treatment ultimately drives a wedge between mental health professionals and patients. Meaningful action in response to such an unspeakable incident would be for our politicians to take the lead in promoting civility, respect for others, and compromise in our culture. Meaningful action would be to have gun laws that may not be politically convenient, but will actually decrease the ability to kill many people in a short period of time and have some impact on the tens of thousands of gun murders that happen every year in the United States. Meaningful action would be to quintuple efforts, using effective approaches, to eliminate prejudice and discrimination that harms so many individuals and loved ones who are affected by mental illnesses. Meaningful action would be to invest in mental health services that promote hope, recovery, and community inclusion, which would attract those who actively avoid services. Meaningful action would be to embrace, rather than demonize, a large segment of our population that is affected by mental health issues. It is time for meaningful action in response to the horrible gun killings in our country. Let's make sure that such actions are fully informed by facts and rationality, and do not perpetuate worn prejudices and political expediency. Let's make sure that our desire to regain a sense of control and normalcy in response to such horrible acts do not lead to bad policy and further harm to an already estranged group of citizens. Psychologist Mark Salzer, Ph.D., is a professor, and the chair of Rehabilitation Sciences, at Temple University. Stop Blaming Newtown Tragedy On Mental Illness If mental illness were the key factor in multiple gun homicides, other countries would regularly experience similar acts of carnage. But they don’t. by Peter Jukes The Daily Beast December 18, 2012 In the wake of the terrible events of last Friday in Newtown, which left 27 dead—20 of them young schoolchildren—social media such as Twitter and Facebook played a key role in communicating the shocking news and expressing an international sense of outrage and grief. But they also spread misinformation and misapprehensions just as quickly. The gunman was initially misidentified, and his murdered mother was erroneously connected to Sandy Hook Elementray School. But while these errors of fact were soon corrected, a deeper misunderstanding took hold over the following few days as a shattered nation tried to understand an inexplicable tragedy. An uncorroborated rumor about the gunman, Adam Lanza, suggested that he suffered from Asperger’s syndrome—a now out-of-use term for a higher-functioning form of autism. By Saturday, a blog post by Lisa Long—“I Am Adam Lanza’s Mother: A Mom’s Perspective On The Mental Illness Conversation In America”—had gone viral, been retweeted hundreds of thousands of times, and republished on Gawker, Britain’s Daily Mail, and on the Huffington Post. Long, the mother of a 13-year-old with behavioral problems, argued, “It’s easy to talk about guns. But it’s time to talk about mental illness.” There are various problems with Long’s impassioned piece when it comes to “talking” about mental illness, partly due to the fact it contained a slew of questionable diagnoses—Autism spectrum, ADHD, Oppositional Defiant, or Intermittent Explosive Disorder—which aren’t officially recognized as mental illnesses at all. Police Inspector Michael Brown, who runs the highly respectedMental HealthCop blog, called it “potentially the worst article I have ever read about mental health and violence following an atrocity.” Other critics took issue with the way Long had publically demonized her son as a potential mass murderer. While some complained that Long herself was being demonized as a bad mother, the author from Boise, Idaho, issued a joint statement with one of her erstwhile critics about the need for accessible and affordable mental health care in the U.S. The Huffington Post published a corrective article, “No Link Between Asperger’s Syndrome And Violence, Experts Say.” But to date, the corrective article has only received 2,500 Facebook “likes” compared to the more than a million received by Long’s original piece. The misinformation had circled the virtual world before the truth had even begun to get its cyber-boots on. By Sunday, the line had grown into a swelling chorus. Erik Erickson, the founder and editor of the popular Republican website Redstate, was averring: “Discussions of gun control are easier to have than discussions about mental health.” The owner of one of the many gun ranges in the rural rolling hills around Newtown, Conn., was telling The New York Times: “A gun didn’t kill all those children, a disturbed man killed all those children.” David Rivkin, a constitutional lawyer who served in both the Reagan and Bush Sr. administrations, appeared on the BBC World Service to tell millions of listeners overseas: “It’s not about gun ownership, it is about mental illness.” “If there’s one unifying feature of all these atrocities,” Rivkin stated in an interview for the popularNewshour program on Monday night, “it’s that they were all committed by mentally unbalanced people who need to be confined for the protection of those around them and other people.” Despite the promise of a conversation about mental health, misinformation and ignorance became the norm in the aftermath of the Newtown tragedy. The only problem with this argument is that it has no basis in fact. If mental illness were the key factor in multiple gun homicides like Newtown, then other countries would regularly experience the kind of carnage visited on towns and cities in the U.S. on almost on a monthly basis. But they don’t. In Britain, an advanced study by Manchester University into “Suicide and Homicide by People with Mental Illness” has found most people who kill more than one person are neither mentally ill, nor mental health patients, As Dr. David H. Barlow, a senior expert in comparative mental health-care systems and Emeritus Professor at Boston University, told The Daily Beast, “the incidence of mental illness is quite consistent across Europe and America.” Yet the statistics for the homicide and suicide rates are much higher in the U.S. than most of the rest of Europe, with Americans 100 times more likely to die to a gun-related death than in the U.K. Despite the promise of a conversation about mental health, misinformation and ignorance became the norm in the aftermath of the Newtown tragedy. British CNN host Piers Morgan suggested that anyone with a history of mental illness should be banned from owning a gun in the U.S., but that would include almost 50 per cent of Americans who are expected to suffer from some condition in their lifetime. The Center for Disease Control and Prevention estimates that about 25 percent of U.S. adults currently suffer from some kind of mental ilnness—though this would include phobias and obsessive disorders. In 2011, government data calculated that around 5 percent of the U.S. population suffered from severe mental illness, while Professor Barlow estimates that somewhere around 1 percent of the U.S. population will be suffering from psychosis—including delusions and hallucinations—at any one time. “But even they show an only slightly elevated risk of violence,” Barlow told The Daily Beast, “with a small increased risk of around 5 or 10 percent above normal.” Meanwhile, those who suffer from psychosis are much more likely to be the victims of homicide or kill themselves. For Dr. Nadine Kaslow, professor and chief psychologist at Emory University School of Medicine—who was recently elected to the presidency of the American Psychological Association—the recent spate of generalized and pejorative statements made about mental illness are “extremely unfortunate” as they “stigmatize a whole group.” “When I talk to my patients after an incident like Newtown,” Kaslow told The Daily Beast, “my patients differentiate themselves from these killers, because they say these people lack empathy.” Though Kaslow acknowledges that those with learning disabilities or mood disorders can be aggressive and display challenging behaviors, this doesn’t translate into calculated acts of violence. “We really do not see any correlation between Asperger’s syndrome and gun violence,” Kaslow reiterated. Those millions of Americans who suffer from mental illnesses and learning disabilities have therefore become collateral damage in the soul-searching since the Newtown massacre. What conditions Lanza suffered from, or didn’t, will take a long investigation, but like other multiple-gun homicides, his atrocity required almost military-style planning and execution, which is unlikely given against the cognitive and emotional deficits of acute psychiatric illness. It was this element of forethought and calculation which led to Anders Behring Breivik, the Norwegian right-wing extremist who killed eight with a bomb in Oslo then shot dead 69, mainly teenagers, holidaying on UtøyaIsland in 2011, being considered sane enough to face trial and a prison term in Norway. Though Breivik’s Islamophobic ideology could be described as crazy, the means Breivik chose to pursue his apocalyptic race war were rational and deliberative given those precepts, and he showed no sign of clinical psychosis. In this light, Long’s imprecation to “start talking about mental illness rather than guns” looks like a distraction from the more probable factor to explain America’s elevated homicide and suicide rates: the U.S. is a complete outlier compared to other industrialized nations in its startling, almost 90 out of 100, number of guns per capita. Apart from the extreme youth and number of his victims, the other hallmark of Lanza’s massacre was the use of a semi-automatic Bushmaster AR-15 assault rifle (which has horrifically doubled in price since the Newtown attack). Assault weapons were banned until 2004, when the Federal Assault Weapons Ban was not renewed—largely thanks to the lobbying power of the National Rifle Association. In what must count as one of the most successful campaigns in U.S. history, the NRA has managed to reduce support for gun control in the U.S. by 50 per cent in the last 20 years. One of its key lines of argument throughout that time has been that, “It’s not guns that kill people, but people who kill people.” On Friday the NRA’s Facebook page was taken down, and its Twitter feed went silent, and the organization seemed to have no response to the mounting calls for gun control in the wake of the most recent tragedy. According to Mark Borkowski, a British PR titan with extensive knowledge of crisis-management campaigns, “anybody in this territory is equipped to deal with extreme events like this, and defend against or capitalize on them depending on what happens.” “The key thing is to sow doubt,” Borkowski told The Daily Beast. “Doubt is a product, and you have sleepers and advocates who are well briefed to construct a counter-narrative in times of crisis.” There is no evidence that the NRA or any of its lobbying arms has been involved in any kind of crisis management in the last few days. However, opponents of gun control are now using a variant of the old NRA adage, “It’s not guns who kill people, but mentally disturbed people who killed people.” In doing so they are perpetuating what is effectively a slur against millions of Americans who suffer from mental illness, and stigmatizing a group who already suffer enough.
http://www.thedailybeast.com/articles/2012/12/18/stop-blaming-newtown-tragedy-on-mental-illness.html ------------------- In Gun Debate, a Misguided Focus on Mental Illness By Richard A. Friedman, M.D. New York Times December 17, 2012
In the wake of the terrible shooting at an elementary school in Newtown, Conn., national attention has turned again to the complex links between violence, mental illness and gun control. The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides. Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ” Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.” But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness. This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence. One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all. Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts. It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.” But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness. Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridlypsychotic. They tend to be paranoid loners who hold a grudge and are full of rage.” Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless. Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence? ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.” It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.” Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records. How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.” Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people. All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.
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Speculating About Adam Lanza's Mental State By Dr. Harold Koplewicz Child and Adolescent Psychiatrist; President, Child Mind Institute Huffington Post December 17, 2012
As we struggle to come to terms with the tragic shootings in Newtown, Conn., the hardest thing to grasp is why anyone would be moved to kill small children and the teachers trying heroically to protect them. We search for clues that would make this horrific act understandable, and we do not find them. We do know that whatever was going on in the mind of 20-year-old Adam Lanza when he went on this appalling shooting spree, it did not come from a place of good mental health. But to blame this violence on Asperger's or a personality disorder, as many media outlets currently are, is a serious mistake. At this point, any comment on the psychiatric profile of Adam Lanza, the 20-year-old man responsible for these murders, is complete hearsay. We don't know whether he had a history of psychiatric illness or if had been exhibiting signs of a psychotic breakdown. Unfortunately, that hasn't stopped extensive speculation that Lanza had Asperger's disorder, or a personality disorder, and even obsessive-compulsive disorder. Much has been made of the reports that Lanza was a smart but quiet kid who carried a briefcase to class instead of a backpack and felt at home with computers, perhaps more so than with his peers. By themselves these traits do not indicate any diagnosis at all, although we have been quick to dissect them in the search for meaning. These amateur diagnoses based on unconfirmed information are very harmful. To my mind perhaps the worst is the suggestion that the unimaginable nature of this violence -- the fact that children were targeted -- somehow indicates a lack of empathy that can be associated with autism spectrum disorders. This is completely untrue. Individuals on the spectrum are in no way predisposed to this kind of violent behavior. Ample research proves otherwise. And while individuals with autism may be less adept at picking up nonverbal social cues, they are just as capable of experiencing emotional empathy as anyone else. I have known many autistic children who would be crushed knowing that a sibling, a parent, or even a spider was suffering. Trading in rumors and misinformation sensationalizes real disorders and leads to stereotypes and bigotry. It fuels the stigma that mental disorders are dangerous or scandalous and prevents people from seeking the life-changing help they need. And because untreated psychiatric disorders are more likely to result in violence, it makes tragedies like this one more likely to happen again. So let's stop speculating about the things we don't know and start focusing on what we do know. We know that when we see someone suffering, we shouldn't look away. And when we see young people coughing, wheezing or bleeding, we insist that they get attention. But when we see young people with disturbing behavior, or young people in clear emotional distress, we ignore them and hope these problems will go away. The first signs of 75 percent of all psychiatric disorders appear by the age of 24. We need to be on the lookout for signs of distress in young people to get them help as soon as possible. Research shows that early intervention improves the outlook for anyone with a psychiatric disorder -- and drastically reduces the likelihood of violence. As a nation, we need to change our attitude about mental illness. We need a better plan for giving mental health care parity with other medical care. Improving access to the best evidence-based interventions should be a national priority. The economic cost as well as the human cost of untreated mental illness makes that clear. Finally, we know our first graders should never fear for their lives when they sit down in a classroom. We know we need to do everything we can to make sure this never happens again. Harold S. Koplewicz, M.D., is a leading child and adolescent psychiatrist and the president of the Child Mind Institute. For expert advice on how to help children cope with frightening news, go tochildmind.org, which offers resources on trauma and resilience as well as a wealth of information on childhood psychiatric and learning disorders.
http://www.huffingtonpost.com/dr-harold-koplewicz/adam-lanza-mental-_b_2311778.html ========================================================================
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