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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.