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Mental health care a crucial need

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The erratic behavior of Jared Loughner -- the alleged gunman who killed six people and injured others, including Congresswoman Gabrielle Giffords, in Tucson, Ariz. -- in the months leading up to the shooting was certainly bizarre and probably by any measure insane. He had been suspended from Pima Community College after multiple run-ins with school police for disruptions on campus. According to a report from CBS and The Associated Press, he and his parents were informed by the school that he would have to get a letter from a mental health official indicating his presence at the college would not present a danger to himself or others. It is unclear whether he sought that mental evaluation.

But even when individuals are evaluated, the process may not red-flag a client as being dangerous. Such was the case in 2007 of Seung-Hui Cho, the Virginia Tech gunman who took more than 30 lives after a psychiatric evaluation led a judge to determine that the man was a danger to himself but not to others. Thus, he declined to commit the man to an institution, instead recommending outpatient treatment.

Evaluating and treating mental illness is an imprecise science that relies on subjective assessments from qualified professionals. The system is rife with cracks that a sick individual may slip through. Add in the easy availability of guns and we have a prescription for chaos.

That said, it remains crucial that states and the nation provide for screening and public education, and for treatment programs -- inpatient and out -- to help those in need of mental health care and their families.

For decades people afflicted with severe mental illnesses were housed in large public institutions. With the advent of improved psychiatric medicines in the 1950s, hundreds of thousands were released back into homes and communities. The plan was to institute and support local public mental health centers that could monitor drug compliance and general health.

Such programs must be in place to help the mentally ill. Too many mental health institutions have been closed or dramatically downsized in favor of less costly outpatient programs. Too often the severely mentally ill, many of them homeless, are incarcerated.

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Although those mentally ill people who wreak havoc capture the headlines, far more who have been helped by treatment programs go about their lives without causing harm to themselves or to others. Indeed, a person with a mental health condition is no more likely to be violent than any other person.

There was even a kind of romanticization of mental illness in the 1960s and ’70s. In books and movies like One Flew Over the Cuckoo’s Nest -- a book Loughner listed as one of his favorites -- and “King of Hearts,” insanity was shown as an appropriate response to an immoral, out-of-balance society. A number of court cases made it nearly impossible to commit mentally ill people to a secure treatment facility without their permission.

This makes it even more difficult to properly handle those few who might be inclined to violence. Institutional commitment laws vary from state to state and even in how they define “danger to yourself or others.” One of the key symptoms of schizophrenia, one of the major mental illnesses, is a lack of awareness and denial that anything is wrong, and this could mean that even as a person’s behavior spins increasingly out of control, they refuse treatment.

Without treatment, the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives. The economic cost of untreated mental illness is more than $100 billion each year in the United States.

The best treatments for serious mental illnesses today are highly effective: Between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.

Mental health care in America is in crisis. According to the National Alliance for the Mentally Ill, the foremost advocacy group in this area, the nation’s mental health care system gets a dismal D. As the nation confronts a severe economic crisis, demand for mental health services is increasing, but state budget cuts are creating a vicious cycle that is leaving some of our most vulnerable citizens behind.

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August 29-September 11, 2014

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