Treatment before tragedy. Photo by Daniel Battiston, freeimages.com |
Why are some mental health advocacy groups opposed to critical healthcare
reform for serious mental illness?
Early Saturday morning, I woke up to the news of another
mass shooting, this time in a pleasant Santa Barbara neighborhood.
Details were still sketchy at that point—the shooter was young, white. and
male. I turned off my computer, packed my kids and our camping gear in the car,
and headed for the hills, out of cell phone range.
Like so many other mothers of children who have mental
illness, I knew how the story would go. His parents would have sought
treatment. He would have had encounters with law enforcement. Probably he was
bullied as a child. He played violent video games. And now, he—and six other young people, all of them with
promising futures—were dead.
When we returned this afternoon, sunburned and covered in
sand from playing all morning on the dunes, a few new details of the story surprised
me: the connection to Hollywood, the misogynistic YouTube rant (see Laurie
Penny’s analysis here),
the Fox News allegations that Elliott Rodger was gay (???). But Fox News aside,
the media seemed to be paying far less attention to the tragedy than they were
to NASCAR.
It seems as if after Newtown, we just gave up. We decided
that this is the kind of society we are going to live in—a society that has too
many guns,
and a society that chooses to ignore people with mental illness and their families,
at great cost (see Liz Szabo’s timely piece in USA Today).
Part of the problem is that just as gun control opponents
and gun control advocates can’t agree on even common-sense things like
background checks, the mental health community can’t come to a consensus about
how best to fund—and treat—mental illness. As I’ve shared before, my son has a
serious mental illness. For him, and for my family, medical treatment has
restored a sense of normalcy to our lives. But not everyone thinks the medical
model is best for treating mental illness.
Right now, there are two competing bills in Congress. HR
3717, the “Helping Families in Mental Health Crisis Act” proposed by Rep. Tim
Murphy, promises hope to families and children like mine. The other, the “Strengthening
Mental Health in Our Communities Act” proposed by Tucson shooting survivor Rep.
Ron Barber, maintains the status quo, a broken and fragmented system that
requires patients to be well enough to seek their own care and promotes a focus
on behavior and prevention, two concepts that don’t apply to people who have
organic brain diseases, people who are too often “treated” in prison or ignored
on the streets.
What I want—and what Elliot Rodger’s parents no doubt wanted—is
“treatment before tragedy.”
Last week I attended a webinar sponsored by SAMHSA-funded
mental health advocacy groups who are opposed to HR 3717. As the mother of a
child who has a serious mental illness, I’m a supporter of Rep. Murphy’s bill.
But since I also volunteer for and donate to organizations that get grants from
SAMHSA, I wanted to understand the other side.
The phrase “Nothing about us without us” was used 30 times
in the course of the hour-long webinar. This dictum establishes the common
sense model of including people with mental illness in crafting legislation
that would affect their lives. It’s a good idea, and that’s exactly what
Representative Murphy did over the course of his year-long post-Newtown
investigation into the myriad problems that continue to plague our mental
healthcare delivery model. You can read the final report here.
But at the end of the webinar, I was left wondering who
these probably well-meaning and sincere advocates meant by “us.” Because I
don’t think they are talking about me or my son, or hundreds of other families
I know.
“When young men rage and scare their families, where are
they supposed to go?” a friend who was also on the webinar and whose adult daughter
suffers from bipolar asked me. “I feel like I have to beg my government
not to imprison my child or leave her on the street to get prostituted out or
taken advantage of by druggies. All while they spend money in the name of the
illness she suffers from.”
The problem is that many of the sickest among us do not know
that they need help. And even if they—or their families—realize they do need
help, as Creigh and Gus Deeds did, too often there are no resources available. That’s
why anything less than HR3717, the comprehensive transformation of our broken
mental health care system proposed by Rep. Tim Murphy and backed by 86
bipartisan legislators, is so critical.
My son has never gone to an acute care psychiatric hospital
willingly; in fact, it usually takes 2-3 police officers and a tranquilizer to
get him into care. I can’t do it on my own. But at least he’s still a minor, so
I can make sure he gets the help he needs—if we are lucky and beds are
available.
And at least when he’s not in a manic rage, he’s aware of
his illness and wants to take his medications.
What happens when he turns 19? What happens if he decides
not to take lithium anymore?
The alternate bill proposed by Rep. Barber fails to address
this all-important question, and many others that will haunt the investigation
of this most recent mass shooting.
According to Susan Mosychuk, Rep. Murphy’s chief of staff,
the bill introduced by Rep. Barber
denies inpatient and outpatient treatment options to those who are experiencing an acute mental health crisis. It denies families the opportunity to be part of the care team and help their loved ones with serious mental illness. And it denies the reality that the lead federal agency, the Substance Abuse and Mental Health Services Administration, has failed in its mission. It’s almost as if the Barber bill wants to deny that people with severe and persistent mental illness exist. Denial doesn't work for substance abuse, and denial won't work for the families whose loved ones are in a mental health crisis.
Allen Frances, the author of Saving Normal, articulated the
problem beautifully: “This is the cruel paradox haunting our mental health
non-system: we deliver way too much care to basically normal people who don't
need it, while providing way too little care to the really sick people who
desperately do.”
So why are some mental health advocacy groups opposed to
Rep. Murphy’s bipartisan-backed legislation?
In the webinar I attended, they gave three reasons: that the
medical model of mental illness would prevent people from seeking mental
healthcare services, that requiring accountability and restructuring SAMHSA
would eliminate or curtail innovation in mental healthcare, and that HR 3717
discriminates against people with serious mental illness by forcing treatment
through its Assisted Outpatient Treatment provisions. While civil rights are undeniably
a concern for those with mental illness, forced treatment and loss of civil
rights already occurs when we choose to treat them in prisons rather than in
hospitals.
Though this conclusion disturbs me, I think the real
opposition to HR 3717 comes down to money. Organizations are afraid of change,
and they are afraid of losing their funding. But as the most recent tragedy so
clearly demonstrated, we can’t keep doing things the same way and expect our
outcomes to be better. Those of us who have serious mental illness deserve a
chance at hope and health. We deserve, as my son does, to have a life worth
living—and to live that life. Please don’t support proposed legislation that is
written without us, the parents who love our children and want treatment before the next tragedy.