Tuesday, December 18, 2012

Mental Health System Insanity

I had originally planned on a nice Christmas related blog post for this week to make up for all my time away due to the publicity and such for Illusions, which, by the way, is doing very well!  I had planned some more catch up, including discussion on my upcoming "Bayside Romance" series, of which my next book, Paramour, is the first book.
The Cover Of My Upcoming Book, Paramour
Unfortunately, the Connecticut shootings changed that.  Friday, December 14th, was my birthday. It started out a great day and ultimately evolved into something sad and tragic. Even though I live in Florida, the shootings at Sandy Hook Elementary affected those where I worked.  
Someone at our school is from the Newtown area, her mother teaches in one of the other schools in the area. She actually knew some of those killed.  We had parents who were shocked and in tears over the tragedy, their fears for their own children’s safety magnified.  I will always recall exactly where I was when I got the text about the shootings – in a room full of prekindergarten students.  Nothing focuses you on your job more than knowing you have twelve lives in your hands.
For the next several days, of course, there was the inevitable  media explosion, I don’t need to recap that, we were all there in one form or another. Of course, there was an anti-gun explosion prompting arguments on Facebook, fisticuffs in bars across the country and one actual shoot-out in a mall parking lot. There’s been much talk regarding gun control and death and for some it’s gotten to an overwhelming point. Interestingly, I find myself walking another path in the tidal wave of grief and shock that has stemmed from this horrible occurrence.

If you haven’t the time to venture over to check it out, the long story short of it is that Ms. Long is the mother of a violent mentally ill child. A child she lives in fear of and wants desperately to help yet she knows that what there is ultimately cannot be changed.  And this is no twenty year old, this is a child.

I found this blog extremely interesting – it was actually the only to the point discussion that I found regarding mental illness coming from the media in regard to the Sandy Hook Elementary tragedy.  This blog post quickly went viral, showing up all over Facebook and then certain news outlets picked it up, but, by and large, the mainstream media continued to focus on the fire arm aspects of the tragedy – they still are.  A quick perusal of the major media outlets this morning revealed stories about the NRA being silent, the question of violent movies causing more violence and of, course, more gun control.  There was only one article regarding mental illness and it was extremely small compared to the others.  This concerns me.

Within the venues that run our country very little discussion seems to be  going on regarding the real issue here – the shooter was obviously mentally ill and this country’s mental health system is wretchedly broken.  Interestingly, the discussions regarding mental illness are going on in real time. It’s being discussed at length in many a work place and amidst friends or family. Social networks are ablaze with discussion regarding Adam Lanza’s mental state and the state of the mental health system in this country.  Many people on the street, a lot of us who work in the helping professions, are discussing this part of the Newtown tragedy at length because there are some very obvious mental health issues within this situation.  During one discussion someone stated that "nobody really had a right to say anything about Adam Lanza’s mental state because there had been no diagnosis mentioned”. 
From where I stand, we do not need to see the nuts and bolts of this man’s diagnosis. A mentally stable person doesn’t go gunning down a school full of children the week before Christmas.  The act alone tells us that there was some sort of mental illness involved. This was no ‘revenge’ shooting, Adam Lanza wasn’t fired or bullied by a bunch of five and six year olds.  Something was wrong within this man’s brain.

As both a former minister’s wife and a social worker, I have far more experience with mental illness than most. I also have more personal experience with the subject than I’d like to as well. I grew up with an un-medicated mentally-ill mother that pretty much made my childhood hell.  Much of what Liza Long wrote about in her blog post is not unfamiliar territory for me, sadly.  The violent outbursts, the cruel and abusive behavior, the mood swings that have family members walking on eggshells a great deal of the time – it’s an uncomfortable and unsettling way to live, especially when the patient is the parent.  As hard as the situation is for her, Mrs. Long, as the parent of the patient, has some limited control over her son given he is a minor. 
Adam Lanza’s mother didn’t have control over her son at all when it came to his mental health. He was twenty.  Here is one of those ‘wrong’ parts regarding our current mental health situation and a reality that most people don’t even know about the system.  Once a mentally ill child is an adult, all bets are off.  In giving the mentally ill rights, Ronald Reagan gave them the right to say “no” and that includes them saying no to their medication.  So, if Mr. Lanza was even actually prescribed medication he didn’t have to take it, nobody could force him.

Saying ‘no’ also includes removing any and all family members from official health paperwork – if there even is any.  Thanks to HIPAA, once the mental patient removes a parent or guardian from their medical contact sheet, those people can no longer be privy to the patient’s condition or treatment.  This practice alone is exceedingly dangerous and detrimental to the seriously mentally ill patient.  Unscrupulous therapists can manipulate them, unconventional treatments can be used without the patient’s true consent and patients can eschew therapy or treatment all together without anybody being the wiser other than the doctor’s office.
It should be pointed out that in most states that until a mentally ill person actually hurts themselves or others there is little most medical professionals will do and even then their definition of “hurting one’s self or others” is fairly narrow.  Committal is rarely heard of any more because those hospitals barely exist anymore. What we have now are lock-down wings in hospitals where seventy-two hour holds take place for the most part. It’s rare for a mentally ill person to be held in the hospital for longer than a week, two at the most.  The process for removing their rights is costly and time consuming – and many times only happens after a serious crime has been committed.

And those are just a few of the basics of what is wrong with our mental health system…keeping those in mind, let’s look at the Lanza situation going on in the myriad of discussions out there:

Yes, Adam Lanza’s mother kept many guns in her home and she probably didn’t store them properly. She knew her son had problems, yet she taught him to shoot anyway (hence the reason that I don’t hold a lot of sympathy for the woman).  Teaching a mentally ill person to handle a gun is like passing them a stick of dynamite – it will explode and when it does it will not be pretty. Yes, the man killed way too many people with said guns, but, had Adam Lanza been locked up inside a mental institution, I wouldn’t be writing this article right now and the aforementioned blog poster, Liza Long, wouldn’t have to be scared to go to sleep at night because her son would be locked up in the juvenile ward of the same sort of institution.  

This is the number one problem with the mental health system in the United States today. Not the lack of medication, not the lack of accessible care (although affordable care, of course, is still nowhere near on the horizon), not the lack of support resources available. The number one problem with our mental health system is the lack of storage space for human beings.
Danvers - Horrible Asylum, Awesome Kirkbride
I know a lot of people who work in the mental health field. I see what they go through with their clients, I know how hard they fight for the rights of the mentally ill. I have participated in advocacy for the mentally ill and I fight just as hard as they do to reverse the stigma regarding mental illness.

Yet, at the same time, there are different levels of insanity, if you will. Mentally ill people with a history of violent behavior need to be handled and treated differently.  It is not one size fits all in the mentally ill world. I understand that there will be those who do not agree with this statement but given what I’ve seen over the years – not to mention experienced – I believe the safest location for a mentally ill individual with violent tendencies is behind a locked door with no access to the outside world.

State hospitals were intended to house mentally ill people. The problem was, though, in the beginning, is that there was little to no differential assessment as to what was and what was not a mental illness. From the late 19th Century into the mid-20th Century, anybody and everybody who was slightly off kilter landed in the mental hospital, along with those who were indigent.
All of the major state hospitals in this country became warehouses for the unwanted of all forms. Revelations of all forms of abuse and neglect brought about their closures, which, at the time, seemed like a good idea. Had Ronald Reagan been able to foresee the ultimate outcome of that decision I think he would have tried to do things a little differently.

Examples Of A Violently Mentally Ill Patient's "Work"
Let’s fast forward. This is the 21st Century. Times have changed.  In the area of assessment and diagnosis alone we now know that those with Downs Syndrome and forms of autism can function happily in society. We know that clinically depressed people can receive medications that can help them function.  People with epilepsy are in the clear as well. Homosexuals, cross dressers and transgender people get a pass now too.  Children born with encephalitis and other varying forms of debilitating birth defects would now receive proper care at home until their deaths. There are now specialty clinics for people with disorders such as anorexia, bulimia, alcoholism and drug addiction, treatment for these disorders could remain standing on their own.  People with tattoos and piercings are no longer considered mentally ill, nor are people with BDSM fetishes. The homeless who are not mentally ill have programs that can help them get back on their feet. Fifty years ago, literally thousands of people just like these could be found inside the walls of mental institutions. Today such admissions wouldn’t even be considered.

That leaves us with, even though it’s not even out yet, hard cores of the DSM V – Schizophrenia, personality disorders that can cause major issues such as Narcissist Personality Disorder or Borderline Personality Disorder for example, severe forms of Bipolar disorder, ODD, rage disorders and certain dissociative disorders. Sociopaths could be added to this list as well if they’re found and diagnosed properly – might cut down on the serial killings around the country. Veterans with violent forms of PTSD such as what my late husband suffered from could also be considered on an as needed basis since the VA does next to nothing to help them when they’re having a psychotic break.  These are people who have little to no control over their mental condition. There is something broken within their brain, end of story.  We either eliminate them or we house them as we used to.
An Old Cage Bed - Used In 19th Century Mental Hospitals
I can hear people saying “wow, that’s harsh!”. Perhaps, but do we want a rerun of this past weekend? Had Harris and Kleibold been properly assessed and locked up, Columbine would have never happened. Had the Virginia State shooter been properly assessed and locked up, that situation would have never happened.  Had Gaby Hayes’ shooter been assessed and locked up she wouldn’t have had to suffer as she did.  Mental health advocates often complain about the stigma that affects the mentally ill and it’s important to know that it does exist – but people like the aforementioned are part of what creates that stigma. I am well aware of fully functioning mentally ill people. I’ve worked with literally hundreds over the years who’ve lived productive and good lives. Yet those lives are constantly tainted by the bad behaviors of the violently mentally ill ‘on the loose’.

In giving the mentally ill ‘rights’ Reagan did those who are seriously mentally ill a great disservice.  A large chunk of seriously mentally ill patients from the big close downs of the 80’s went right out into the streets because they had nowhere else to go. Just as large an amount ended up in group homes, which they quickly took off from.  You cannot provide somebody options when they’re not mentally capable of considering them. It’s like handing a three year old a lollipop right before they know they’re going to eat lunch and saying “here, you want this?”. You know they’re going to say yes.

Bear in mind I’m not talking about somebody who ‘goes postal’ because of stress. That is NOT a mental illness, it’s a brief mental state whereby if they kill somebody they deserve to go to jail. I’m talking about people with real mental illness track records who cannot hold jobs, cannot keep themselves clean, cannot even eat sometimes because the voices in their head tell them not to and have a track record for violent behavior.  Just as an example, within a properly run facility a Schizophrenic could actually have a productive albeit somewhat limited life. Left to their own devices they almost always get into trouble.

Just a couple of examples:  I was once a family support facilitator for mental health support group.  We had an extremely violent Schizophrenic young man whose mother was just positive that his medications were going to cure him. She came to a meeting on a Monday all excited about how great he was doing and by Friday he’d stabbed her to death. He was prescribed the meds but nobody could force him to take them.  A writer colleague who writes for one of the major  television crime shows has written her own experience with mental illness into that particular show by having one of the characters explain how her fiancĂ©, an aspiring attorney, fell to his Schizophrenia and ended up homeless. Another episode showcased how that same man went on a major crime spree, killing several innocent people and kidnapping a little boy because he thought the child was his son.  She couldn’t help him, his family couldn’t help him, nobody could force him to take his medications so he was left to do what he wanted which, obviously, was not a good idea.

Now, before I receive a plethora of hate mail, yes, there are Schizophrenics who take their medications and they manage to function – that is because there is somebody right there hanging over their every move and they are willing to cooperate and take their medications. An overwhelming majority do not and an alarming amount of Schizophrenics are either homeless or incarcerated. 

Which is, ultimately, where a large amount of our mentally ill population is being housed these days: in prison.  To be blunt, this pisses me off. Prisons are for criminals, not the mentally ill – but when a family has nowhere else to turn, they’ve exhausted all other options, many don’t even fight to try to get their loved one off if they end up committing a crime.  Behind bars they’ll be “safe”.  They’re no more safe behind bars than they are living on the street.  Our prisons are overcrowded as it is. Take the mentally ill population out of the prisons and we’ll have more room for actual prisoners.

I can hear somebody saying “well where would we put the mentally ill that need to be locked up?”.  As I said before, it’s time this country revisit the notion of reopening the mental institution.  I’m sure that conjures up pictures of American Horror Story for some but the reality is that, if run properly such locations could provide safe haven for those who must be “kept” for no other reason than their brain makes them a violent individual. I’m not saying build a Kirkbride and go backwards in time, I’m saying take a hospital already in existence, bar the windows, provide all the amenities of home only have solitary rooms for outbursts and medication schedules that they aren't allowed to deny.  

Training for employees would be paramount, paying those employees properly to deal with the violence and pain they would see every day would be required as well. Medication regimens would be necessary and patients would be required to follow them. Care plans would be created, developed and followed with state oversight the same way preschools around the country are watched over.  Budgets would need to be strict, no research should be allowed on site (it’s long been determined that lobotomies are now unnecessary…) and treatments such as ECT (electro shock therapy) would be closely monitored instead of ‘at will’.  There could be therapists on site but therapy would not be required because, frankly, there’s no point for some of these types of patients, they cannot be reprogrammed. Those that can be redirected properly could be allowed supervised visitations. Birth control would be provided because forced sterilization is never a good idea.  These are just a few basic ideas of how a hospital such as this could be implemented in the 21st Century. The seriously mentally ill could still function within its walls but they couldn’t hurt anybody except possibly themselves or a caretaker that lets their guard down.

Personally? As the child of a violently mentally ill person I would have rather grown up knowing my mother was in the hospital. It would have been far easier to go visit her on holidays knowing she was medicated and ‘happy’ as opposed to living with her free range where her mood was never stable, her anger issues legendary and I was made to pay for her mental illness by family members and so-called friends alike.  This brings up a valid point regarding the stigma of mental illness that shadows all mentally ill people.  No family member is ever to blame for their mentally ill family member’s issues. EVER. The father and brother left behind in the Lanza family aren’t to blame for the shooter’s mental state. People don’t cause true mental illness – a broken brain causes true mental illness.
A Particularly Disturbing Piece Of Artwork
By A Seriously Mentally Ill Patient
All of this said, I can hear people grumbling, well that was unpleasant. Yes, it was. Mental illness IS unpleasant. For all involved.  The point of this blog is to open some doors into the heart of this horrible tragedy. This is not about guns. This is about a seriously mentally ill man whose rage consumed his soul and he took that rage out on innocent children – and the people there to protect them who died valiantly trying to do so. Had this man been in a mental institution this needless tragedy would have never happened.

In the days and weeks to come, as the gun debates loom and grow longer, remember this blog. Remember the heart of the matter and the brain of the killer – neither of which had anything to do with fire power and everything to do with being so severely ill that being locked up was the only way to truly protect society from him.
The Sandy Hook Elementary School Victims

In conclusion, I was just notified of this story on FOX News - who I don't follow but if it's true, my point is proven.

Fix the system before it's too late for anybody else.


  1. Clapping my hands LOUDLY Mia! Thank you for saying what needed to be said about MEBTAL ILLNESS. Deinstitutionalization put mentally ill people out walking the streets or with family members who had no idea how to handle or help their loved ones. And this should be the number one priority with our government to help stop these tragedies from recurring.

    Insurance companies including Medicare/Medicaid funding has been cut down to bare bones for treatment for the mentally ill. It's our nations way of saving money, not lives. Fourteen days of treatment for someone who has threaten a live or their own barely stabilizes them. We need better treatments for these people.

    I also believe in gun reform. There is no reason for Joe Blow citizen to have in their possession any type of semi-automatic weapon. These are assault weapons made for only one reason, to assault people. They are NOT used for hunting animals.

    And no one should allow a person to possess a firearm in their home if anyone in that home has any type of mental condition. That should be common sense to all.

    It time for our government to step up to make our country safe. I tried of all these shootings! Fixing our broken mental health system and gun control is a good start!

  2. Thank you Diane - my inbox is overflowing with emails from parents of mentally ill patients and they're in agreement as well. This system HAS to be overhauled. If we never take a chance out of fear of making mistakes we will never fix the problems in existence.

  3. If only the powers-that-be would take this to heart. Some people are broken and cannot be fixed. If they are dangerous, they need to be contained in some way.

    How do we make this a public priority?

  4. Intense, post, Mia. Thanks for making the point, but I'd go you one better. Adam didn't get to be 20 with no one recognizing he had problems.(If the FOX article is correct, it seems to me his mother took a long time before taking action to get help.)

    As a former elementary school principal, I can attest to the numbers of students the staff was afraid of. Afraid at the time and afraid of what they'd do as they got older. Even dealing with minors, public schools don't have the power to insist parents take their children to see a counselor or psychologist or psychiatrist. Then there's the problem of whether that service is accessible.

    For the most part, our schools for troubled kids don't start until 3rd grade. So these little guys (most of the time guys) are in our elementary schools, maybe in the principal's or assistant principal's office when they have a melt-down. There aren't lots of options. Administration and the state government don't want to accept that we have messed up little kids, but we do.

    As the principal, parents expected me to keep their children safe (we're talking-4 & 5-year olds), from the child who hit and threw things at the other students. Let me assure you there are not many options if the parents of the troubled child are in denial.

    I had parents who were afraid of their children. I get that. How absolutely horrifying that must be. My heart goes out to them. But somehow we have to be able to work through the problems of balancing the rights and responsibilities of parents and the rights of the mentally ill against the safety of the innocents.

    So I totally agree with you, Mia. The problem is not just gun control, and in fact the first part of the problem is lack of enough affordable accessible mental health treatment and the method for making sure troubled youth(and adults) recieve treatment.

    I think ABC news is looking at the mental health issue. We can only hope and pray others will focus their attention here and not just on gun control. That's only part of the problem.

  5. Awesome post Marsha - I agree wholeheartedly. I currently work in a preschool, I know EXACTLY what you're talking about.

    I recently finished an inservice that was attended by teachers from all over the county - every single one of them had a horror story about a student with sociopathic tendencies. I know of a few myself and believe me, it concerns me. Parents want us to keep their kids safe yet, you're right, are options are growing more and more limited.

    Sadly, heavy duty assessment for true psychotic behavior isn't really allowed within schools - at least not here in FL. We have to convince the parent to take their child to an outside source that has to do the determination. If school psychologists were allowed to do the initial assessment based upon the concerns of the teachers - not to mention the complaints of fellow students who've been victimized by the student in question - there might be some hope of discovering someone like Lanza much earlier on an official basis.

  6. Excellent post, Mia. I fully agree with you and have said the same to others. In the two mysteries I've written, my protagonist's mother is a schizophrenic and I've included in the books laments about the health system...or lack of. I hope, if nothing more, this last incident brings the topic to the forefront.

  7. Good for you Maris! I've been thinking about adding some information in my next mystery on the mental health system as well

  8. Excellent post, Mia! Today was the first day I had to be buzzed into my children's school. My girls are now locked inside the school every day, which means they are safe but is disturbing nonetheless.

    I grew up with a tragic killing of a childhood friend by a young man who would probably have turned out to be a serial killer if he hadn't been caught quickly after her murder. He was living with his grandmother, down the street from my house, and everyone knew there was something mentally wrong with him. I have always blamed these senseless killings on the individual, not on the method they used to kill. Video games and guns are handled by millions without causing a person to step out of reality and turn manically violent. It seems obvious to me. Why doesn't the media look at these homicides like they do serial killers? People are fascinated with the psychology of a serial killer and to me, that although the mental illness is different, the way you view these killers should be the same. One stalks a victim, the other openly slaughters them. The victims are still dead. The killers are all mentally ill, although perhaps these young men that slay innocents so openly are more observably mentally ill. Diane Kratz had a a great post on how serial killers are good at hiding their illness. As a society we can't prevent all tragedies from happening, but as you said, the prevention comes in taking these sick individuals out of society.
    Thank you for writing this!