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Reforming the Mental Healthcare System

Mental health has been in the news a lot recently, mostly for the wrong reasons. What is most disturbing is how some commentators are using the recent mass shootings as evidence to further stigmatize mental illness. While they talk about reforming a broken mental health care system, what they are actually promoting is institutionalization for individuals with severe and persistent mental illness. This is unacceptable and distracts policy-makers from the fundamental issue; our current mental health care system is broken, underfunded and often criminalizes mental illness.

Why do we allow society to blame those who suffer from these devastating illnesses when they are the victims? It is no secret that even the best evidence-based treatments are still not good enough. Yet, they represent the latest research and should be widely available to patients. Sadly this is not the case. Community mental health centers are underfunded and lack the resources to offer such treatments. Training is expensive and access is limited. Insurance companies frequently balk at paying for treatment that they argue is questionable from an efficacy standpoint. The complexity of the mental health system, divergent opinions about treatment, and limited access to care often leaves family and patients confused, frustrated and marginalized. It is not exaggerating when people say the mental health system is broken and in crisis.

So what can be done? To start, our leaders need to stop using these isolated incidents of violence as evidence to support changes in the mental health system. However well meaning, it sends the wrong message and ultimately does more harm that good. Secondly, the government needs to get out of the way and let those who understand mental health care take the lead. There is far too much bureaucracy and inefficiency in the system (the current government shutdown an outstanding example). We need congress to appropriate funding at a level that meets the current needs of the system, without any stipulations or interference from special interest groups. Appoint a director to oversee a complete reformation of the system who is given the authority to implement the necessary changes (versus the usual congressional route of asking for a report that never goes anywhere). The director should bring together the National Institute of Mental Health, the Veterans Administration, the Substance Abuse and Mental Health Services Administration, the National Alliance on Mental Illness, the Center for Medicare and Medicaid Services, as well as various research and provider stakeholders to develop a comprehensive plan that aligns research, training, advocacy and treatment objectives on a national level. Simplify the process for accessing care and reduce the administrative burdens associated with providing mental health care. Stop kowtowing to special interest groups and make mental health parity a reality. Create a national standard for reducing the criminalization of mental illness through the use of mental health courts and mandated treatment for those most at risk for violence. Ensure that there is adequate access to various levels of care nation-wide. Prioritize the implementation of electronic medical records that allow for seamless communication between providers. Provide funding for training providers that includes national standards for graduate programs and licensing. Revamp psychiatric training programs to ensure that psychiatrists are thoroughly trained in psychotherapy as well as psychopharmacology. Mandate that insurance companies reimburse for psychiatrists who provide psychotherapy. Provide incentives for the development of novel treatments, including medications.

This is a daunting list and incomplete. Critics may call such a proposal idealistic, too expensive and unworkable. However, what other options do we have? The patchwork approach has not proven effective and there is little evidence that leaving the process in the hands of a partisan congress will produce acceptable results. Overhauling the mental health care system can only be effective if there is a comprehensive, long-term vision that aligns research, treatment, training and advocacy objectives. It will be difficult and expensive, but those who suffer from severe and persistent mental illness deserve our best effort.

Suicide Prevention Month

September is suicide prevention month. Every year, more than 37,000 people die by suicide. NPR’s Science Friday did a wonderful piece on suicide titled “Diagnosing Destruction” which looked at the science and research behind suicide and suicide prevention. There are many excellent books to help us understand suicide and why people kill themselves; two that I have found particularly helpful are The Suicidal Mind by Edwin S. Shneidman, and Why People Die by Suicide by Thomas Joiner.

Statistically, we know that certain demographic groups are more at risk to die by suicide. These include being male, between the ages of 15-24 and over 65 and being diagnosed with a mental disorder. Despite these statistics, it is still impossible to predict if a person will make a suicide attempt. However, here are some warning signs that a person may be considering suicide.

  • Being depressed
  • Actively talking about death or desire to kill themselves
  • Researching ways to kill themselves
  • Purchasing a firearm
  • Expressing feelings of hopelessness or unbearable emotional/physical pain
  • Increased drug or alcohol use
  • Increased agitation or anxiety
  • Increased risk-taking behaviors
  • Extreme changes in mood
  • Rage or desire to seek revenge

Always take someone seriously if they say they are feeling suicidal. Even if someone has made suicidal statements in the past and never followed through, there is always the possibility that this time they will try to kill themselves.

If you or someone you know is thinking about suicide, here are some recommendations. Any person who is thinking about suicide should be evaluated by a qualified mental health or suicide prevention professional.

  • Contact your local or national crisis line or accompany the individual to your local emergency room.
  • Never leave someone alone who says they are seriously thinking about killing themselves.
  • Remove all firearms and ammunition from the home (locking them up is not considered sufficient).
  • Secure or remove any potential lethal medications or chemicals from the home.
  • Call 911 if the person is actively making an attempt to kill him or herself or is refusing to seek help.

Visit the Suicide Prevention Lifeline for more tips on how to help someone who is feeling suicidal. Military veterans also have the option of calling the Veteran’s Crisis Line.

The National Alliance on Mental Illness (NAMI) has developed a fantastic suicide prevention program called The Connect Project that aims to train community partners in how to prevent suicide and intervene when someone has died by suicide. In New Hampshire there are several grief support groups for family and friends who have lost a loved one to suicide. NAMI New Hampshire also provides resources for those who have survived a suicide attempt. Finally, NAMI New Hampshire hosts an excellent Suicide Prevention Conference each year.

Suicide is preventable. There is hope. Please make a difference by learning more about suicide prevention and educating others.

Mental Health in New Hampshire

As I get Ascent Counseling ready to go live, I thought I would start by publishing the blog. My goal for the blog is for it to focus on current news and information about mental health treatment. With that in mind, I got an email today from NAMI NH about the schedule for state budget meetings. You can access the dates here. If you can’t attend the meeting, make sure to voice your support for mental health funding in New Hampshire. It is critical that NH begin reinvesting in mental health care; it has been neglected for far too long, and they are not fulfilling their promises as outlined in the ten year plan.