Sunday, January 16, 2011
David Shern of the Health Affairs Blog looks at the Tucson attack through the prism of mental health policy. As somebody who has had unfortunate occasion to explore our system of health care finance in connection with behavioral disorders, I absolutely agree that our system for treating mental illness is far less advanced than for physical ailments. This, notwithstanding that many, even if not all, mental health problems are originally physical.
The ugly truth is that Americans often over respond and over spend for medical health problems (that is, getting a poor return for money and time spent), but largely ignore mental health problems until they do damage, whether that damage is to the patient, his or her family, or innocent people at the wrong place at the wrong time.
Amen. But mental health care is expensive, quite labor intensive. And as lack of insight, and therefore reluctance to be treated, is one of the primary symptoms of several illnesses, one has to bring in a fair bit of attorney time as well - also expensive. There is considerable incentive for most people to not see reality.
I'm not seeing easy solutions here.
"The ugly truth is that Americans ... largely ignore mental health problems until they do damage."
Absolutely right; and the great shame of it is that many (or, as you say, perhaps all) such issues can be addressed medically. Depression and other disorders can be helped! It can take time and lots of effort, but normal lives are possible in many cases.
Excerpt from Never Waste a Crisis by Warren Meyer (Coyoteblog):
It would probably be logical here to end on Benjamin Franklin's famous homily about freedom and security. But this tragedy presents us with an even better quotation. Christina Green was born on the fateful day of September 11, 2001 and died last Saturday at the age of nine, murdered by the same man who shot Ms. Giffords. I will leave the last words to her devastated father:
This shouldn't happen in this country, or anywhere else, but in a free society, we're going to be subject to people like this. I prefer this to the alternative.
While I don't know the specifics of the gunmans treatment record I can mention my own experience with mental healthcare.
In my town, my dad (a police office) was killed by a mentally ill woman who was utterly failed by the mental health professionals in the area. With a long history of doing harm to herself and others all the signs of trouble were ignored by her caregivers until it was too late.
We need to find a better balance between individual rights (the right not to take your meds) and responsible public safety. For some, failed to medicate should mandate custodial care.
We also need to hold terrible caregivers accountable. Which my locality refused to do.
Yes, antithaca, we are aware of the public's perception that once vaguely defined "mental health professionals" have come in contact with a person, we are responsible for every bad thing they do after that.
I've known hundreds of paranoid schizophrenics who sounded more dangerous than Loughner did before he started shooting. That question comes down to "How many false positives for dangerousness do you want to lock up? And are you willing to pay ten or a hundred times more than we do now?" Because those are the numbers we would be talking about.
Again, I can only speak from experience.
Imagine giving your self a c-section on a sidewalk after going off meds. Multiple, repeated instances of being taken into custody for various reasons only to find that - yet again - the woman involved had gone off her meds without any supervision.
And so, after a 2 decade history of this - you bet your butt I think the mental health people should know that hey, when this lady goes off her meds, she gets into legal trouble, is a danger to herself, and others...and so when a caregiver watches her go off her meds and off the rails and does nothing that's unacceptable.
It's downright negligence is some cases (including the episode I have experience with). A jury said so. And yet, people refuse to hold healthcare institutions accountable.
The solution is clearly (as was done here) to form a tactical police unit.