INCLINE VILLAGE, Nev. - In last week's article we introduced the idea that access to adequate mental health services both here in the Tahoe Basin and nationwide can be sketchy at best. Against the backdrop of our Nation's crucial debate on gun violence we also took a quick look at what might lead someone to a destructive course and some indicators that someone might need urgent treatment. In this article we will try to examine some of the root causes of our current mental health dilemma, the impact that adequate treatment can achieve, and a quick look at available mental health resources.
The first question for many people is "How did our society get to this place where random violence seems almost commonplace?" Although it should be clear that most mentally ill people do not commit violent crimes, part of the answer may have roots in mental health policy changes over three decades ago. When the mentally ill were deinstitutionalized in the 70s and 80s, the plan was for the money to be put into a cohesive outpatient treatment program with medication and rehabilitative services. This never happened.
Our mentally ill tumbled onto the streets or ended up in correctional facilities. In fact, prisons have become our "new asylums" (Frontline, 12/19/12). There are many complex reasons for this that go beyond the scope of this article, but any, even small changes, would require tremendous political will, which Washington and State governments (at least in the past), have proven incapable of possessing.
In his seminal piece for Medscape (12/20/12), James Knoll, M.D. defined a system as "an organized, regularly interacting set of principles forming a network ... for the purpose of distributing something or serving a common purpose." By this definition, we do not have a mental health system in the United States. The Surgeon General's report on U.S. Mental Health called it the "de facto mental health service system." So by the Surgeon General's report, the mental health system in the United States is at best unofficial and at worst, illegitimate (James Knoll, M.D., Medscape, 12/20/12).
Without a functioning mental health system in place it is important to recognize that as individuals we can still play a part in prevention and referral. In a recent example from the Midwest, the mother of Blaec Lammers of Bolivar, Missouri, contacted police when she became concerned about her son's increasingly erratic behavior and violent obsessions. The police interviewed the son and found a stockpile of weapons with the intent of hitting several theaters premiering the final Twilight episode. He had a plan and the means to kill scores of people. He also had a mother who had the courage to turn him into the police and get him the help he needed.
Help may come in the form of residential treatment, counseling or medications. For severe mental illness, medications are often extremely effective. Take the shooters of John Lennon and Ronald Reagan - after adequate treatment for their mental illnesses, they expressed great remorse and despair over their actions. If only they could have obtained that insight before their desperate and violent acts.
We have effective medications for the treatment of psychoses, mood instability and depressive illnesses, which can potentially prevent a downward spiral into paranoia and despair - the kind that sometimes leads to violent acts, such as suicide or homicide. Therapy can help with coping skills, correcting cognitive distortions and improving reality testing.
What resources are there for those experiencing psychiatric difficulties? First, families should check their insurance and confirm that it is comprehensive and covers mental health treatment (not all do). Second, find out what kind of treatment it will cover: only outpatient services, or will it cover acute hospitalization or residential treatment? For those without mental health coverage or the uninsured, there are still options to explore.
In Northern Nevada we have Northern Nevada Mental Health Services (located in Reno). For outlying areas, there is the Rural Clinic system that accepts both patients with Medicaid or without insurance. We also have nonprofit organizations like Tahoe Family Solutions in Incline Village that accept patients on a sliding fee scale. Lastly, there are many national organizations that can help in directing families to the appropriate services.
These include the National Alliance on Mental Illness, the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association, amongst many others. The main point is that you CAN be an advocate for those you love, even within an imperfect "system."
- Kristin Hestdalen, M.D., is a board-certified child and adolescent psychiatrist, is a staff psychiatrist at Tahoe Family Solutions and chief psychiatrist with Sierra Mental Health Associates. Learn more at www.tahoefamily.org.