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January 20, 2011

It’s Not about Guns…

Patricia A. Kelly

...or civil discourse. It’s about mental illness, discrimination, stigma and the lack of a safety net. In our society, we desperately need an attitude adjustment about this important subject.


Of course, the recent tragic shooting of Congresswoman Gabrielle Giffords of Arizona, and so many others, brings the subject to mind, along, in Frederick, with the story of a local family. This week, a young man shot his mother and sister, terrorized his father into jumping out a second story window, and killed himself following a low-speed police chase.


Eerily, as in the Arizona shooting, the Virginia Tech shooting, the family’s next door neighbor reported being afraid of the young shooter. That fear was an unrecognized warning sign that something could soon go very wrong.


The mentally ill may be more stigmatized than any other group in our society. This is the primary reason that they and their families do not seek treatment.


One reason for this is that they do not appear physically ill, and their actions appear volitional, or the result of their own free choice. Therefore, we think they are lazy, on alcohol or drugs, dirty, immoral and shiftless. In reality, they are often too ill to control their own behavior, and they are suffering from an illness as real as measles, and likely about as dangerous as a heart attack.


They are at high risk of being injured by others, and very low risk to do harm to others, although that is what makes the news, and it‘s often gruesome. They are, by definition, very hampered in their ability to work, carry out the normal activities of daily living, or to develop satisfying personal relationships. They are often victimized by others, or injured by accidents or unhealthy living habits. They are sick.


Insurance companies usually limit both the dollar amount of care they can receive, even with very good policies which allow maximal freedom to choose one’s own health care provider. This is clear discrimination, and definitely leads to inadequate care.


Mental illness is so common that you have a 50-50 chance of developing symptoms in your lifetime. In any one year, one in four adults develops symptoms of mental illness. Depression, anxiety, bipolar disorder, or psychosis may be lurking around the corner, awaiting many of us. With treatment, we can be fine.


We need to get that this is a disease, that we could get it, that it causes huge disability, and that the victims need acceptance and treatment as much as anyone with a physical illness. Cure, especially in the case of treatment delays, is not always possible, but good control can almost always be achieved.


If someone in your family or neighborhood were physically ill, you would not shun them. If you heard that someone was having chest pain, you would insist that he go to the hospital right away. If you stayed in touch with your mentally ill family members and neighbors, and accepted them, you could get them help when things are getting out of control. Just as with your contacts who are physically ill, you would know them well enough to notice when things were not right.


They would have a happier life, as everyone needs acceptance and connection, and they would probably do better. You would have more control over the safety of your surroundings.


It’s understandably difficult to remain friends with someone who is mentally ill. Behaviors such as substance abuse, poor hygiene, excessive talking, ignoring of normal personal boundaries can make us very uncomfortable. Having a relationship of mutual trust can make all the difference, though.


We also have to be realistic about privacy and personal choice and consent.


If we find someone unconscious on the street, we don’t say, “Well, he hasn’t consented to going to the hospital, so we should leave him here until he does.” For all the ability a deeply psychotic person has to make decisions, he might as well be unconscious, too. A person who is convinced she just gave birth to Jesus (and I’ve met several in the course of my nursing career), is in all likelihood incompetent and unable to decide for herself. She should be taken to the hospital. The police can do it if you can’t, based on the concept that she is a danger to herself, as she is unable to care for herself.


If someone like the Arizona shooter had been sent to the hospital for evaluation after being kicked out of school and told he needed a certificate of mental health to return, the shooting might not have happened.


Our concern about the safety of society and the wellbeing of the mentally ill person should be the deciding factor. We can’t let ill people run around without needed treatment if we suspect they’re incompetent.


In Maryland, when people are sent to the hospital for evaluation, they could be held for as much as 72 hours. In my experience, people are sometimes committed inappropriately by disgruntled spouses, but these people are often released directly from the Emergency Room because the physician can tell that they are okay.


There is a system in place for commitment, and it works pretty well. The primary problems relate to inadequate treatment after initial evaluation.


If a person is determined to be mentally ill, he should not be allowed to purchase any kind of deadly weapon without a hearing. We have a number of lists in our country, such as background checks, “no fly” lists, etc. My first idea of how to effectively protect the mentally ill and society might be some kind of addition to the Medical Alert system. In small communities, the police can be made aware, too.


Here in Frederick, a mentally ill neighbor of mine dropped eggs on my car as I drove under his apartment window. The police officer responding to my complaint said, “Oh, I know him. I’ll go talk to him and take care of it.” How great was that?


We, as citizens, could act upon the messages flashing across our highways when it comes to our mentally ill neighbors. “Report Suspicious Activity.” We could demand better medical care, a possible return to institutionalization in the worst cases, and de-stigmatization in our local communities. Don’t be afraid to talk with people about mental illness, just as you might ask a friend how their diabetes is doing. Acceptance is key.


For individuals and those in charge of organizational training, contact your local Mental Health Association for information and to arrange to take the Mental Health First Aid course.


How many murders and how much personal suffering has to happen before we get this? They’re sick. They’re just like us, only with worse luck. They need acceptance, validation and help. Now.


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