This website is no longer actively maintained
Some material and features may be unavailable
Mona ShattellBack to OpinionMona Shattell

Families and the debate on mental health

It’s rare that an entire nation debates mental health care.

I’m a mental health nurse, researcher, and professor.  Through years as a nurse for inpatient psychiatric units, through my research about mental health and illness, and teaching about the research and policy mental health, I’ve long tried to bring awareness and concern about individuals and families with mental illness, to a society that often discriminates against them.  Prior to the Newtown tragedy and ensuing national debate, I felt virtually alone.

Mental health activists have made strides in the U.S., but the gains are relatively small and have been slow to obtain. Now, the general public is talking; at last, the Newtown tragedy has brought mental illness into the spotlight.

The national debate this past week included President Obama’s call for more funding and training for mental heath services and national organizations, such as the National Council for Behavioral Health and the National Alliance on Mental Illness, have also weighed in.

I encourage the national debate, yet I have a few concerns.

For one, this new spotlight is based, in part, on fear. People fear for their own safety. They are afraid of being the victim of violence perpetrated by some “crazy person” with a mental illness. However, the majority of those who are mentally ill are neither violent nor dangerous. I’m concerned the national discussion of mental illness may further stigmatize (putting it “nicely”) or further discriminate (more likely), its sufferers.

Secondly, what’s missing from the debate thus far is a discussion of the challenges faced by families of the mentally ill.  We are currently missing those recommendations of support for them.

As a mental health nurse, I’ve seen families struggle with mentally ill children and seen adults struggle with their mentally ill parents. The Newtown tragedy and the subsequent national debate highlights the dramatic impact that under or untreated or inadequately treated severe emotional disturbance or mental illness has on families (and society)—and the lack of family support services. By all accounts, Adam Lanza was a gifted kid from a wealthy family living a privileged life. Mental illness is not selective; it’s a public health problem that touches many of us, in one way or another.

The family of the Newtown shooter, like all families struggling with mental illness, lives in a country with a mental health care system that is far from perfect.  In the 1900′s, individuals could simply be taken to an asylum because their family did not want to cope with them. Women who refused to comply with their husband’s demands (for something as banal as not washing the dishes) could also be locked away in an asylum. Thankfully this is no longer the case. This doesn’t mean, though, that we’re in an altogether better place.

Today, laws meant to protect the human rights of individuals with mental illness make it very difficult to involuntarily commit someone for psychiatric treatment. A person has to have thoughts and intentions to kill themselves or others, but this is often hard to determine, until it is too late.

State laws vary but physicians or judges often make involuntary commitment determinations. Often those with emotional disturbance are not committed because the reasons for commitment are so narrow, leaving a huge gap. Many people could benefit from treatment but because they are not “sick enough”, they don’t get it. This is particular true for “school shooters.” A recent study published in the Journal of Police Crisis Negotiations in a special issue on school violence reported that few school shooters had received mental health services in the past. Despite this, of the school shooters that were profiled, 78% had attempted suicide and 61% had a history of depression. According to the authors, “the picture [of school shooters] emerges of a mentally disturbed person who has not received adequate services and who is depressed and/or suicidal.”

Too often, families are left to try to care for the person who is mentally ill alone. This is not easy. A mentally ill individual places  stresses and strains on families who have few places to turn to for help, particularly if the person with mental illness is an adult who refuses treatment, which is often the case. I’ve talked to countless mothers who have not known what to do for their mentally ill, adult children, often who were emotionally distressed and using, abusing or dependent on substances.

We no longer place adults in asylums when their behavior doesn’t fit societal norms and I’m not advocating that we change the commitment laws. Rather, we need more support services, more family care, and an examination of the wide gap in mental health services for those who are seriously mentally ill. The Mental Health Parity and Addiction Equity Act of 2008 may have positively impacted funding for mental health care and we hope the Patient Protection and Affordable Care Act will help,.  This week, new legislation introduced by Rep. Ron Barber (D-AZ) and Senator Mark Begich (D-AK) would authorize grants for Mental Health First Aid programs. The legislation sounds good, but we need so much more.

To be sure, this is not the first time we have heard a presidential call for mental health reform. Ten years ago, the New Freedom Commission on Mental Health (established by George W. Bush), made several recommendations, many of which have not been realized.

We owe it to the families of the mentally ill to provide greater access, availability and funding for mental health services and family care.  It goes without saying that we also need a system that provides more services for families in need—more supportive housing, more respite care, and more crisis intervention programs.

Several weeks later, our thoughts remain, rightly, with the victims of the Newtown shooting as well as their families. Care, concern, and our deepest condolences are with those who lost loved ones, with their families and friends, with the whole community of Newtown, CT. As a mental health professional, my thoughts remain with the killer and his family, too.  Somewhere, somehow, the Newtown shooter, like those before him, fell through the cracks. I can only hope that the current public debate will result in more and better care for all.

Mona Shattell, PhD, RN is a Public Voices Fellow with The OpEd Project and a professor of nursing at DePaul University in Chicago.


  • crAzY HoRse

    very insightful, thought-provoking article.,, i hope you willbe invited to join in on the dicussion regarding gun/ammunition control. You are to be commended…

  • Aunt Mona

    Wonderful article and so true. I live this. Just had a bad experience this month with the mental health issues. I too feel sorry for the people who don’t get the right care. It is very hard to find.

  • Kent

    The article mentions “psychiatric treatment”, but neglects to point out that psychiatric treatment is broken, at least in the U.S., where psychiatric treatment appears to consist mainly of experimenting on patients with man-made psychoactive drugs. These drugs are approved based on clinical trials that claim efficacy based on the same kind of evidence that gave the common cold its name, are inadequately tested for short term safety, and are not tested for long-term safety at all.

    Based on the science behind psychoactive drugs, they result in changes to a patient’s brain that are opposite to what the theory behind their use says is needed. In the process, they create tolerance and dependence, which means that they stop “working” but a patient who wants to stop taking them will have to go through withdrawal that is no different from withdrawal associated with “recreational” psychoactive drugs (the way bupropion works is the way cocaine works; cocaine is just stronger). A brain that is dependent on an antidepressant has adjusted itself in ways way that would make more depression a withdrawal symptom. The success of any antidepressant can be attributed to the placebo effect, or to the person simply getting better, but is completely contrary to what the science behind them predicts. This information is all readily available to anyone who does their homework.

    General instructions for administration of antidepressants look more like they are intended to keep the patient on them long enough to created dependence than to help the patient. Product information sheets are carefully worded to make antidepressants sound safe, while protecting the manufacturer from any liability for problems. And problems are bound to occur, because antidepressants are used on people who are depressed, when they are “indicated” for people who are “clinically depressed”, a severe set of symptoms for which no valid diagnostic tool exists. Being addictive and creating dependence are not the same, but doctors, the media and medical dictionaries use “addiction” and “dependence” interchangeably, so some antidepressants are advertised as not being addictive (normally a requirement for approval), knowing that patients hearing “not addictive” will assume they do not create dependence.

    Studies have shown that a “history of depression” is a “risk factor” for cognitive decline, but knowing that most people experiences feelings of depression in their lifetime, leads one to wonder how the history of depression was determined. Is it depression that’s the risk factor, or is it the treatment for depression?

    The first thing that should happen to someone who is depressed without a reason to be depressed is a physical to make sure there’s no physical cause. If there is a physical cause it should be treated by a qualified doctor, otherwise, the person’s diet should probably be cleaned up of junk and processed foods and GMOs, and they should be sent to a psychologist, or a psychiatrist who doesn’t believe in hiding symptoms with drugs. Because everyone reacts differently to psychoactive drugs, while the brain adjusts to counteract their presence, their use to treat anything is stupid.

    I can’t put everything I’ve learned on the subject here, but I can show how the clinical trials are bogus, the statistics used to evaluate the results are not intended for the type of data being analyzed, and the great results some doctors swear by bear no resemblance to the “barely squeaked” by results of the skewed “trials” or the horror stories you can find on line (and the one I have personally witnessed).

  • Dave Sill

    The weak link in the case of the Newtown shooter was his mother. She knew her son was ill but didn’t consider him dangerous to himself or others and failed to prevent him from using her guns without supervision. She paid dearly for that, but so did lots of others.

    For me, the spotlight on mental health following Newtown isn’t about fear or stigmatization, it’s about preventing violence by understanding mental illness and improving mental health care.

    One thing everyone needs to understand right off the bat is that there’s no way to prevent all violence. No matter what we do to improve mental health care or control guns, people will still find a way to kill other people.

  • Louise Ivanov

    Great article Mona.

  • Mike Mathwig

    Americans Anonymous
    Step #1; We admited we were powerless over our place of birth-and that our lives had become unmanageable.
    Step #2; Came to belive that a power greater than a corporation could restore us to sanity.
    And so on and so on untill you CHANGE! ;-o

  • bob

    I agree. The cure in the majority of cases is worse then the disease. These drugs may be the problem. I know. I have taken these drugs and a family member has died because of these drugs