JANUARY 2017

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The Shame of Mental Health Care In The US

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By Fazal M. Kamal *

A combination of lethal weapons and psychological aberrations, obviously, makes an incredibly volatile concoction. Thanks to the powerful and resource-rich gun lobby in the United States access to arms is all too easy---even for people with serious mental issues, as is evident, from daily reports in the media. But of course those on the payroll of gun manufacturers and their patrons the murder and mayhem the guns generate across the nation is of no consequence.

It's an all too familiar story of someone with wild thoughts on his/her mind going around, one day, and shooting and killing till they are brought down in the midst of blood and gore. It's happening in schools and universities, it's happening in shopping malls, it's happening in movie theaters. And it goes on and on. There are usually much loud demands for gun control immediately after each such gruesome incident; but at the moment the other side is on a winning streak.

That's one side of the story, i.e. the ready access to weapons. The other element in the story is the inadequacy of the mental health system to actually do enough to help those in need---often in dire need---of attention and assistance. The fissures in the system are enormous and consequently too many needing help just fall through the cracks and often are left unattended while a few with violent propensities embark on brutal rampages.

Here are some illuminating numbers: 1) 40 percent of the estimated number of adults with serious mental illness in the US doesn't receive mental health services. 2) $100 billion is the annual economic cost of untreated mental illness. 3) 63 million is the number of visits to physician offices, outpatient facilities and emergency rooms associated with mental health disorders each year. 4) 1.25 million is the estimated number of prison inmates across the US who have reported mental health problems. What's worse is that numerous people with psychological problems are incarcerated instead of being provided medical assistance.

Clearly it's a horrendous situation crying out for attention. Hence the report that gave the foregoing figures also stated: “One reason for the apparent low funding priority and neglect given to mental health is the high level of stigma associated with mental health problems. Countering this stigma and discrimination remains one of the most critical challenges for improving mental health at a time of economic crisis, because this stigma may impact on the willingness of public policy makers to invest in mental health. Public surveys in some countries have indicated that mental health can be seen as a low priority in terms of safeguarding services in the face of budget cuts.”

A recent report by Amanda Holpuch in the Guardian on mental illness and homelessness in the US states a few of the dreadful facts, “Hospitals are often overwhelmed by the number of people seeking psychiatric care, in part because the amount of psychiatric beds available decreased by 14% from 2005 to 2010, according to the Treatment Advocacy Center .” She adds, “Incarceration is a fairly common fate for people with severe mental illness . Jails house 10 times as many mentally ill people as state hospitals, according to an April 2014 Treatment Advocacy Center report ….[In] New York's Rikers Island jail, … a homeless veteran on anti-psychotic medication was ‘baked to death' in March .”

In a case this writer is familiar with, a young person diagnosed with schizophrenia, initially taken to the emergency room of a hospital, was then let out on his own after a couple of weeks of treatment without installing any procedure that would guarantee he would take his medications or attend therapy sessions. The result was what was fearfully expected: Soon he disappeared from home for a week and after a frantic search by the family was located in the same hospital from where he was released a mere few weeks earlier. The question whether this time the system will succeed in assisting him to function as a productive member of society is still up in the air.

Talking of hope and the future another report in the Guardian says, “While the Affordable Care Act made some small steps towards removing the roadblocks to psychiatric care – and the Obama administration has, more recently, issued new regulations that have also had an impact – it did not fix a chaotic financing system that discourages therapists from accepting insurance and makes it hard for many people to get treatment they need.”

“The inefficiency of the American health care system,” it quotes Dr David Spiegel, a professor and associate chair of psychiatry and behavior sciences at Stanford University's school of medicine, as commenting, “puts a special burden on mentally ill people, because they are less able to cope with the complexity and find the care they need.” Additionally, even the essential first step of looking for a therapist is not as simple as picking and choosing from dozens of insurance company - trusted doctors, and finding an in-network therapist can involve a process of rejection and confusion that may last for days or even weeks.

The Guardian investigative report found three salient facts: 1. After sharing his own struggles with the US mental health system online, comedian Chris Gethard has become a de facto remote caregiver for others facing a similar situation . Many don't know where else to turn. 2. Those who seek professional care face basic hurdles that can be discouraging. Finding an in-network therapist can involve a process of rejection and confusion that may last for weeks – and nearly half of all psychiatrists don't accept insurance at all . 3. The Affordable Care Act promises to give more people than ever access to mental health treatment, but there won't be enough therapists to treat them.

Clearly, it doesn't require a whole lot more elaboration to comprehend that the mental health care system in the United States is in urgent need of rectification and resources. Without the appropriate corrections and reorientations mentally ill people will continue to suffer---ironically---in the richest nation on earth. That, evidently, is a matter of humongous shame, to say nothing of the indignities and pain the inadequacies are inflicting on patients in need of help and treatment.

Finally, nothing can be more telling than the words of Tim Murphy, a Republican member of the House of Representatives and a practicing psychologist: “ In the nearly year and a half since I have been investigating America's broken mental health system – even with my 30-year background in clinical psychology – I have been shocked to learn just how much our country has failed those with severe mental illness. Take Elliot Rodger, a 22-year-old whose instability was known, but went overlooked before he killed six college students and himself in California…All had untreated or undertreated serious mental illness. All spiraled out of control within a system that lacked the basic mechanisms to help.”

He reemphasizes: “The time has come that we approach serious mental illness as a medical emergency demanding an approach best described as ‘crisis psychiatry'. That's the basis for a bill I first introduced six months ago, the Helping Families in Mental Health Crisis Act. My legislation fixes the shortage of psychiatric hospital beds, clarifies … privacy laws so families are part of frontline care delivery team, and helps patients get treatment well before their illness spirals into crisis.” And that ought to include, I certainly hope, cases that I personally know of before it's way too late.

* Fazal M. Kamal has been a media professional, in print and online newspapers as editor and commentator, and in public affairs, for over forty years.

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