Monday, December 17, 2012

Not Just Guns - It's Mental Health Too


Gun enthusiasts have been quick to come down hard on the nation’s failure to provide adequate mental health care to those who need it most.  They are absolutely right.  We are lousy at it, and not just for those who need it most.  Mental illness needs to be addressed on a much broader scale than that. 

Years ago we closed down most of our state run mental hospitals, our insane asylums, because they were inhuman.  Many were.  We said that the mentally ill could be treated at the community level more effectively, at less cost and with more dignity.  That was true, but we never did it.  Moreover, mental illness has retained it’s patina of something sufficiently embarrassing to the rest of us that it must be kept in the closet, under the rug, locked in the basement, anywhere but admitted in decent society.

The past few decades have provided us with some extraordinary medicines that do amazing things to relieve the symptoms of mental illness, but prescribing them has fallen mostly to primary care givers who are not well trained in their use.  What choice do they have?  In our community we have only one psychiatrist in private practice.  The Yellow Pages list a slug of therapists of varying qualification.  At least, for the most part, they do no harm, and maybe some good.  So it’s the primary care physician who doles out the pills, and for goodness sake don’t ever suggest that mom or dad’s little helper has anything to do with mental illness.

As for those with serious mental illness, I have to give credit to the ones who have learned to cope with their psychoses most of the time.  Street drugs and alcohol help dull the pain, even if they make the psychosis worse.  It’s a deadly trap.  Homelessness is not that bad if you’ve got it figured out.  Holding a job is impossible, but one can learn to ignore the “pick yourself up and get a job you lazy bum” jibes from more decent people.  

We have two ways of helping them.  If they are crazy enough when they come into the ER, our Crisis Response Team can usually, but not always, find a bed for them in a city over a hundred miles away.  It’ll be a short stay, just long enough to detox and work on a new regimen of meds.  Acting out more often becomes a crime, and it’s off to jail, our number one mental health warehouse in the county. 

I don’t know what’s going on in your community.  In ours we are finally beginning to address our needs.  Both hospitals and several other agencies have a task force working on identifying our most pressing mental health issues.  The United Way has it’s own task force, and will dedicate as much as a third of it’s funding next year to a targeted mental health project.  The county will soon be receiving a small percentage of certain sales tax revenue dedicated to mental health.  All are working together to coordinate for significant impact on projects yet to be identified, but with intent to begin funding them by the spring of 2013.

In the meantime, one of our hospitals is about to offer the third in a continuing series of symposia aimed at helping physicians, nurses, hospital staff, pastors and other care givers improve the skills needed to attend to the emotional well being of others and themselves.  Another group has conducted two community wide workshops on the impact of Adverse Childhood Experiences (ACES) on emotional health and behavior.  The long standing work of other organizations that have for years helped dysfunctional families and abused spouses are getting more widely recognized.  It’s a start.  Not a very big one, but a start just the same. 

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