Sunday, December 23, 2012

Mental Health or Gun Control?

[accidentally deleted this post, so I'm reposting]

Public discourse, political, media, whatever, likes to frame things in dichotomies, false or otherwise.  No wonder that in the wake of yet another tragedy we seem to hear we have a choice with two options.  Limit access to military style weaponry or provide more mental health services.

I don't like forced choice questions.  Usually makes me feel like I'm being railroaded.  Usually is the case too.

Just a few thoughts on the mental health side of the equation.  People on both, or all, sides of the political spectrum are generally supportive of increased mental health services when something like this happens, but few people are aware of what that means or the issues involved.

Here is just an outline of a few things people should be aware of.
  • Not every mental health problem can be resolved by talk therapy (an understatement)
  • Not every mental health problem can be resolved by medication (another understatement)
  • Except under very legally circumscribed circumstances, we, as a society, cannot make people visit and talk to a therapist.
  • Even where we can legally compel someone to see a therapist, we can't compel individuals to care or to want to change or to benefit from therapy they don't want.
  • Likewise, we cannot compel most people to take medications even if we think they are very not sane.
  • When we can compel someone to take medications, it may not actually help much, and may have severe repercussions for the individual (side effects up to and including death, psychological and physical trauma from restraints and forced injections).
  • Civil commitment laws (or interpretation of them) have drifted toward the individual liberty side of the equation.  This is in no small degree a result of historical abuses in the mental health system.  It likely also reflects shifts in the overall sociopolitical zeitgeist.
  • We generally cannot civilly commit, and thus compel treatment and seclusion, unless someone has already engaged violently or they have made credible threats.  There are times when individuals with mental health problems plan violent actions and choose not to broadcast their intentions to mental health professionals.  In these cases it is very hard to predict and even where we have concerns there is often very little we can do.
This continues to be the state of the field when it comes to extreme mental states and available interventions
It saddens me deeply every time I talk to some parent who has come to me believing I will be able to intervene with their adult son or daughter with a psychiatric disability and I see the relentless disappointment on their faces as I explain to them the limitations of what we can do to intervene with an adult who does not want help.

Just so everyone knows.  Increasing availability of mental health support may be a good thing and it may help, but it will never be a complete solution to protect us and our children from rampages and violence.

addendum -- Oregon is now looking at increasing civil commitment from six months to two years after a Eugene police officer was gunned down by a woman in a psychotic and paranoid mental state.  I happen to think this is the wrong approach.  Lengthening commitment would have made no difference to the death of the officer.  The real rub is what it takes to place a hold and then commit someone.  If the legislators want to make a difference, they will need to look at that issue instead.

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