Mental illness, violence and how local leaders are intervening
By Joan Trossman Bien 04/25/2013
President Obama was publicly furious over the failure of the Senate to pass the modest gun control bill last week. He placed most of the blame on the National Rifle Association and its most zealous followers for twisting the facts about the gun control bill.
“There were no coherent arguments as to why we wouldn’t do this,” Obama said. “It came down to politics.”
Obama was referring to the NRA threats to run opposing politicians out of office. Obama responded, “Obviously, a lot of Republicans had that fear, but Democrats had that fear, too. And so they caved to the pressure and started looking for an excuse, any excuse, to vote no.”
Five Democrats ran for cover by siding with the Republicans. Recent polls have found that nine out of 10 Americans favor stronger gun controls, especially universal background checks.
“The fact is, most of these senators could not offer any good reason why we wouldn’t want to make it harder for criminals and those with severe mental illness to buy a gun,” Obama said.
What really set Obama off was the comment by Sen. Rand Paul, R-Ky., that criticized the lobbying efforts of parents who lost their children at Sandy Hook Elementary. Paul accused Obama of using the parents “as props, and politicizing people’s tragedy.”
Obama responded angrily, “Do we really think thousands of families whose lives have been shattered by gun violence don’t have a right to weigh in on this issue? Do we think their emotions, their loss is not relevant to this debate? So all in all, this was a pretty shameful day for Washington.”
The rest of the world shakes its collective head over the passionate love affair that some Americans openly have with their guns and the way no effort whatsoever is made to protect society. Sen. Richard Blumenthal, D-Comn., warned, “The world is watching the United States Senate, and we will be held accountable.”
The real question that the NRA and its supporters refuse to answer is, what if the gun control laws actually work? We won’t know who wasn’t killed because someone was denied the purchase of a semi-automatic rifle. But we certainly can count the dead and wounded.
Would universal background checks have prevented past mass killings committed with guns? Perhaps, but not for certain. Still, there have been so many school shootings over the years where young people have been targeted, gun control advocates believe that any restriction that is enforced will keep some dangerous people from buying more guns.
When a stranger walked into Sandy Hook Elementary School last December and mowed down 20 children and six adults, it was not the first time that such an unimaginable act had occurred , the scale was just larger than most. But, even after the movie theater massacre last summer in Aurora, Colo., even after the slaughter at Virginia Tech a few years ago, even after the nightmare at Columbine High School in Littleton, Colo., nothing was permanently changed to increase public safety.
A generation ago, a well-armed but mentally deranged young woman, who was known by family, friends and law enforcement to be violent, strolled into a suburban Chicago elementary school and shot up a second-grade class, killing one boy and injuring several others. But exactly 25 years later, even the deadlier slaughter in Connecticut has failed to move Congress to try to stop this madness. The policy decided by Congress is that the craziest and most violent among us get to buy all the killing machines, in the form of guns, that they want. The rest of us are on our own.
So instead of mourning the lost opportunity to do what decency demanded, instead of accepting the political dysfunction in which Congress has chosen to wallow, let’s look at what progress has been made in treating and helping those with serious mental illness, especially those in Ventura County. It is, at least, one step toward solving this intractable problem.
Ventura County has seen an increase in funds for services and treatment of the mentally ill. This, despite the economic downturn that began in 2008.
Ratan Bhavnani, executive director of the National Association of Mental Illness of Ventura County (NAMI), explained.
“The good news is, we haven’t lost too much money,” Bhavnani said. “There was some increased money coming in from Prop. 63, the California Mental Services Act. That money coming in has been relatively stable; we have been fortunate in that regard. Yes, the state has cut back on some of the funds that come from state revenues and it was cut back by the present governor. But the effect was less than minor, so that’s the good part.”
Ventura County Supervisor Linda Parks, District 2, has focused on improving life for those with mental illness. “There is a vast array of new programs that have just been implemented,” she said. “We have had an 18.5 percent increase in the number of consumers we have served.”
Many people who are homeless are also suffering from mental illness.
Parks said there are two areas that have been addressed for the first time, made possible by the new funding. “Usually, we haven’t had the opportunity to intervene early. That, in a way, doesn’t get as much attention because it’s not going to hit the news. It has been shown that if you get in early, you have a higher likelihood of preventing more serious illness.”
The other area that had been lagging was housing for the mentally ill. Approximately 200 residential units have been created since 2008.
Parks explained the significance of housing. “We have a 10-year plan to end homelessness. The new plan is to find, not transitional housing, but trying to get permanent housing. We know that many of the people who are homeless also suffer from mental illness. Housing is such an essential component.”
On the evening of Feb. 15, there was a disturbance call in Camarillo. Deputies responded but kept their distance. As they spoke with a 46-year-old resident, he became uncooperative and then refused to open the door. This was their second call to this house that day, and they had been there several times before. The man’s mother was in the house, too. After several hours of negotiating with the man, the deputies determined that the woman was safe and they departed.
Just before dawn the next day, deputies who had been assigned to keep an eye on the house saw the man drive off. A slow-speed chase ended with the man being peacefully taken into custody. His mother was fine.
This absence of a violent confrontation is the result of new and important training. The police not only kept their distance, they stayed with the situation and it ended without any violence. It didn’t used to be that way. If this had occurred in the decade before 2001, the outcome could well have been very different, and not for the better.
During the 1990s through 2001, local law enforcement had many encounters with mentally ill people that ended only after the person had been shot and killed by police. In 2001 alone, five mentally ill people died in just that manner. It was clear that something had to change quickly. In an unusual display of unity, heads of county agencies as well as law enforcement decided to find a program that would change the outcome of such confrontations from deadly force to peaceful resolution.
That was when the Crisis Intervention Team (CIT) program was put into place. Ventura County Sheriff’s Capt. Curt Rothschiller oversaw intensive training for deputies and dispatchers, teaching them the best way to handle situations where the suspect is mentally ill.
“CIT is a 40-hour training course on most concepts dealing with the mentally ill for officers who volunteer for the program and who have a passion for that type of work,” Rothschiller said. “We approach this with a task-force mentality. Everybody at all of the agencies train at the same place, receives all the same materials.”
Not only have two-thirds of the deputies been through the training; Port Hueneme has trained 100 percent of its force. The idea was to stop the revolving door that was so familiar to the mentally ill. They would do something that frightened their families, who would call 9-1-1. Deputies would take the person to jail and then, observing that the person needed more help, they would dropping off at a hospital. There, the person would get temporary help, usually in the form of medication, and be released. It would repeat itself endlessly.
“The largest population of the mentally ill in one area is the jail, unfortunately,” Rothschiller said, “and the jail probably has more undiagnosed.”
Instead of going in circles, other agencies are now contacted to provide services. Not long ago, there were few services available. That has changed.
County services are not the only sea change in the way people with mental illness are treated in the system. Rothschiller said he is proud of the minds that have been changed.
“I use the word enlightened especially because I haven’t seen a lot of other areas go to our model. It (appropriate treatment) is much more common, and in a good way. It’s not everybody’s dirty little secret. People were embarrassed, and there’s a stigma and all those other things we need to get over so we can help those that we love who actually have an illness. We should treat it that way versus treating them as an outcast. It is hard to change minds but I think we can show in our county that it is very doable.”
Mental illness is just that, an illness. You would not expect a person with two broken legs to run normally, and, likewise, you can’t expect someone with serious mental illness to think normally.
A very large study funded by the National Institute of Mental Health has found genetic links for the five major mental illnesses. They are autism, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, major depression and schizophrenia. This finding will aid in more accurate diagnoses which, in turn, could allow for earlier and more appropriate treatment.
Bhavnani of NAMI said one of the many problems in achieving meaningful treatment is the very nature of the illness.
“When you have a physical illness, your brain is functioning normally and tells you to get help for your problem. When your brain has the illness, it often does not recognize that there is a problem and, in point of fact, everyone else has a problem. That condition is called psychosis; you are not thinking clearly. Your thinking is scrambled. Your brain is not functioning well enough.”
That, Bhavnani said, is just one of the reasons why people with mental illness, especially bipolar disorder, avoid medical treatment. Their emotional reaction to what is going on around them is exaggerated, both for depression and the euphoric state called mania.
“When someone is manic, they are feeling great,” Bhavnani said. “They feel good. They feel better than good. They feel better than happy. Why would they want to seek treatment? That is a dangerous time.”
The medications given to people with bipolar disorder can be difficult to tolerate. “Some people don’t continue the medication because the medication makes them feel not so good,” Bhavnani said. “They feel crummy. They feel like they have a hangover. They feel like they are walking around with the flu all day long. There’s a certain fogginess in the brain sometimes. The side effects of some of the medications are fairly significant. So all of those reasons contribute to not wanting to continue treatment.”
Along with the physical symptoms and personal devils, judgment by those who are unfamiliar with the very nature of mental illness can make a bad situation even worse. For example, NRA CEO Wayne LaPierre publicly made some flat-out incorrect statements about those with mental illness.
In addressing the massacre at Sandy Hook Elementary, LaPierre blamed Hollywood, the courts, video games and the media. He characterized those who commit violence as “monsters,” “lunatics” and “insane.”
“How many more copycats are waiting in the wings for their moment of fame?” he said. “How can we possibly even guess how many, given our nation’s refusal to create an active national database of the mentally ill?”
The idea of being placed in a national database does little good and is just another reason for those with mental illness to refuse treatment. It also sets the stage for an irrelevant and harmful discussion, according to the American Psychiatric Association (APA).
APA CEO James H. Scully Jr., M.D., said those remarks perpetuate the inaccurate idea that those with mental illness are also evil.
Speaking to Good Morning America, Scully said, “This is simply a relic of the past and has no place in our public dialogue. People who are clearly not mentally ill commit violent crimes and perform terrible acts every day. Unfortunately, Mr. LaPierre’s statements serve only to increase the stigma around mental illness and further the misconception that those with mental disorders are likely to be dangerous.”
James H. Scully Jr. M.D., CEO of the American Psychiatric Association.
Many people with mental illness have an additional problem with alcohol or drugs in attempts to self-medicate.
“About 70 percent of people with mental illness also abuse substances,” Bhavnani said. “Treating mental illness is difficult. Treating addiction or substance abuse is also difficult. When you put the two together, it is not twice as difficult, it is perhaps ten times as difficult. So that is the challenge.”
Ventura County still has a long way to go before all of the residents who have loved ones with mental illness are in the right kind of treatment. When someone with debilitating mental illness cannot be left alone, the family shoulders the entire burden.
“That’s one kind of problem that we see all the time,” Bhavnani said. “There are no good answers for that, frankly. The system is such that adult patients have a right to seek treatment or not.”
Bhavnani and Rothschiller both said that when the template for treatment of mental illness shifted in the 1960s from institutional residency to family placement, the funds for families quickly evaporated and no new funds were ever allocated. It is nearly impossible for a mentally ill person who has not committed any crimes to receive long-term treatment in an affordable hospital setting.
“If the hospital understands that you are there because of substance abuse instead of mental illness, those effects wear off fairly quickly, and the hospital is required to let you go because you are no longer a danger to yourself or to others,” Bhavnani said. “The law is such that we cannot take away some of these rights and privileges by involuntarily holding them just in case they might drink too much in the future.”
The history of federal legislation to take care of those with mental illness is predictably pathetic. In 1963, Congress passed the Community Mental Health Center Act, which was supposed to pay for outpatient clinics where families could start their search for treatment. Of the 1500 planned clinics, however, only 550 were built. After the funding ran out, Congress did not allocate more.
A 2011 report by NAMI found that since 2009, states have slashed more than $1.6 billion from mental health services. It was estimated in 2010 that nearly 46 million American adults had mental illness. But only 38 percent received treatment.
California alone among the states provides no financial support such as disability payments or medical insurance for the mentally ill. In 2008, the Mental Health Parity and Addiction Act was passed. It mandated that insurance coverage for mental health be equal to its coverage for physical health. Yet, final rules for implementation have never been written so insurance companies have not met the requirement. President Obama has said the Affordable Care Act will finalize those regulations.
As for the private mental health professionals, payment has become a real problem for patients. You might assume that those who are insured would have access to many professionals. Yet, according to NAMI, there are so many therapists who refuse to take the negotiated lower rates paid by private insurance companies and who refuse to do the required paperwork, that long-term treatment is rarely an option for most people who need it. Few can afford to pay at least $250 for a single 45-minute session.
We can and must do better.