involuntary outpatient treatment Archives

Mental Health Treatment and Mass Shootings

After each mass shooting in the United States, there are calls for increased gun control, better access to mental health services, or both. Fuelled by emotion, we seek solutions; I have been right in there, too, simultaneously grieving those lost and asking for system changes to prevent reoccurrences.

A bit ago, I came across an article which hypothesized that improved mental health treatment won’t impact mass shootings or school killings. The author, Dr. John M. Grohol, founder of website PsychCentral.com, focuses on school shootings in this piece, and posits that what will help most is restricted access to household guns, and more involved parenting.

When I re-read this piece today, I pondered whether I agreed or not (and then I veered off to something about the Paul Simon and Edie Brickell arrests for disorderly conduct, and then I saw a Jennifer Aniston story that I just had to read—love her—and then I came back to this mental health piece. And so it goes. Sometimes it helps to break the tough topics into bite-size pieces.).

Like I said, I’ve let my emotions lead me into the debate before. After Sandy Hook, I was annoyed that some people focused on gun control, when for me, the shooter so clearly needed mental health services. “That’s what it’s about,” I said, “because a person with a mental illness can always find a weapon.” Then I read a comment on Dr. Grohol’s piece, which reminded me how complicated each and every case is. The commenter wrote:

I love how everyone thinks they have the answer to this problem. Intellectual humility seems to be in limited supply. “It’s the drugs,” “it’s mental illness,” “it’s the provision of inadequate services.” There are so many imponderables involved in human behavior, our point of departure for any enquiry into its determinants… …should be both skepticism and an acknowledgment of the limitations of human understanding.

As humans, we’re very good at pointing a finger and assigning blame. It deflects our own icky feelings. However, those getting pointed at and blamed feel shame, and shaming someone gets us nowhere.

So, can we do any better than we are now to prevent them? Yes, I still believe we can.

For starters, I agree with Dr. Grohol – locking down guns in a household is common sense. As for parenting, well, I can’t speak from personal experience, but I’ve seen troubled parents turn out well-adjusted kids, and vice versa, but I agree with his assertion in principle.

But kids grow up and move out. Then what?

I don’t want to oversimplify, but for treatment of both kids and adults with severe mental health issues, doesn’t a lot of it come down to communication and collaboration? Parents and doctors and lawmakers and community health nurses and hospital psychiatry teams and teachers and the child/adult in question all working together? Long-term relationships, not revolving-door appointments. Courage. People who aren’t afraid to talk, to question, and to course correct. To have some intellectual humility, rally all of our resources and push the limits of our human understanding. Or, rather, our understanding of one human.

What are your thoughts and practical considerations?

P.s. Here’s a story about parents of a son who had bi-polar depression, and who was killed by Seattle police. They’re lobbying for a bill that allows family members to request a judicial review if emergency in-patient psychiatric treatment has been denied to their loved one with a mental illness. I support this, because it’s another avenue for conversation and collaboration between parties, as opposed to decisions made in a vacuum, often due to cost or expediency.

You and Mental Health: Empower the Consumer

By Laura Zera 9 Comments

‘Empowerment’ is one of those words whose meaning can lose impact over time and with overuse. Or when you use it like this: “Let me reach out to my team and see if we can ignite our value proposition in a way that will empower them and help us achieve our organizational goal of scalability.” Do you gloss over when you read or hear stuff like that, or, like me, hear the voice of Charlie Brown’s teacher in your head?

Recently, two readers left brilliant comments on my blog post regarding involuntary outpatient treatment that reminded me why empowerment should never become cliché, no matter how often it is used in corporate speak or marketing materials or annual reports. It’s not cliché, nor is it easy, which is perhaps why we gloss over it and take shortcuts that will produce quicker results, even when we know we could get better results if we waited longer, and, yes, invested more.

In their insightful responses, both Marcy and Jill brought the discussion back to be one of meaningful care instead of forced treatment. This isn’t to say that involuntary outpatient treatment doesn’t have a place in the conversation, but rather, if we focus on building resources around something like that, it’s like saying, “Well, the car dealer sold us a lemon with an oil leak, but that’s okay, we can just keep adding a quart of oil to the engine after every 100 miles and it’ll keep going.”

What about the car dealer? And is it just that car dealer, or is there a culture—of expediency, of profit, of apathy or whatever—that has sprung up in the automobile industry and trickled out into all the car dealer tributaries? (Note: I mean no offense to car dealers and my own experience with them has generally been very positive!)

Thinking about what path leads to more meaningful treatment for people with mental illness, it seems to me that we need to go back and look at where the cracks and gaps in the mental health system start, and to make sure that forced outpatient treatment isn’t our version of accepting a car with an oil leak.

We don’t want to keep driving that car, just barely maintaining it until we’ve run it into the ground. We need a system that empowers mental health consumers—in a real way, not a corporate-speak way—so that they are able to advocate for their needs and fully participate in their own care, as Marcy and Jill suggested. And the vision would be that if mental health care were delivered in a more meaningful way, mental health consumers wouldn’t reach the crisis states that lead to forced treatment in the first place.

Why is empowerment so vital? It’s human nature that we invest more of ourselves in something when we’re given a role to play in the process and decisions. Just think of anything that you’ve ever worked on at a job, and what aspects of your work made you put skin in the game for one thing and not another.

I do hope that some of you guys will post references and links to organizations who participate in models for treatment delivery that engages the consumer.

In the meantime, here are a few resources from which I’ve taken inspiration.

Agnes’s Jacket, a book by Gail Hornstein
Hearing Voices Network
Freedom Center

You and Mental Health: Views on Involuntary Outpatient Treatment

By Laura Zera 23 Comments

I was thinking about a woman I never knew today. Her name was Gloria Leonidas, and she was one of five people killed just over a year ago in what has become known as the Seattle café shooting spree. Gloria was a wife, mother of two daughters and well-known community volunteer. The day she was shot started out just like any other day for her. And then she was gone.

The man responsible for her death, Ian Stawicki, had shown a variety of mental illness symptoms over the years, becoming increasingly violent in the last handful. He’d never been a patient at a psychiatric hospital, but was charged twice with misdemeanor assaults (charges that were later dropped). He owned guns. His family knew something was wrong with Ian, but didn’t know how to get help for him, and Ian wouldn’t seek help on his own.

This isn’t a unique case. Margaret Ryan was killed in Seattle last year, too, by her mentally-ill son, Brodie Lamb. He was also known to have violent outbursts, but unlike Stawicki, he’d previously been both convicted and treated with medication for his illness. He refused to comply with court orders for continued treatment of his mental illness, however. And then he killed his mother.

There are good arguments against involuntary treatment for mental illness, and I agree that no one should be forced to take medication except when they’re a threat to themselves or others. But why aren’t more states willing to put adequate money into funding follow-up outpatient care for a person with a serious mental illness?

According to a recent study on involuntary outpatient treatment, a state’s investment in such programs, where caseworkers visit patients to ensure they stay with their therapy and medication, can lead to lower overall health care costs. Researchers at Duke University found that patients in the program require fewer revolving-door hospital visits and become more productive in society. Here are the stats.

Forty-five of the 50 U.S. states have some form of involuntary outpatient treatment, however the level of states’ investment is so varied that for all intents and purposes, in some places, the program doesn’t exist. Other states, such as New York, have invested heavily. The program took shape there after 32-year-old Kendra Webdale was pushed to her death on the tracks of a New York subway by a man suffering from schizophrenia. But even with New York’s significant investment, it happened there again just last year, when Ki Suk Han was killed.

So where do we go from here? Do we keep trying to build involuntary outpatient programs (and plug the holes in the existing outpatient programs)? And can we do that without stomping all over basic civil rights? Or does the safety of the whole outweigh the rights of the individual in these cases?

What are your views on this issue? All opinions are appreciated.

Note: this post was updated on 08/31/13 to correct references to “involuntary outpatient commitment” where it should have read “involuntary outpatient treatment,” including in the title of the post. D’oh!