Moderated by Tom Sabulis
By Frank E. Shelp
Horrible killings across the country dominate the news and the agendas of President Barack Obama, Congress and many state legislatures.
The discussion involves guns, mental illness and violence in video games and movies. But if guns and a culture of violence fed by games and movies were the issues they appear to be, then a city such as Chicago should be the impetus for concern rather than small cities and towns. Chicago had 10 times the death and mayhem last year than Tucson, Ariz., Aurora, Colo., and Newtown, Conn. combined.
The debate over gun accountability and our society’s gluttony for violence in games and movies will continue. Mental health is the area most likely to be explored superficially, couched in cries for money and involuntary confinement of people with mental illness. Yet it is likely none of the recent shooters would have been hospitalized even if they had been evaluated the day before their terrible acts. Snapshot evaluations and acute hospitalizations are not solutions for the progressive effects of untreated mental illness. Maintaining engagement in active treatment is the single most effective and direct element in avoiding tragedies like these.
Our mental health system is described as fragmented, inadequate and dysfunctional. Our safety net of community mental health centers and service boards is largely a training platform for inexperienced, newly licensed or not-yet-licensed counselors and clinicians. Accountability for productivity is highly variable and, for effectiveness, largely nonexistent.
Family, school officials and others knew the shooters in recent tragedies to be troubled at a minimum. Severe mental illness is alienating. It begins with alienation from school and employment, then friends and family. Those with severe mental illness need to be engaged and maintained in their own treatment and recovery, not further alienated by quick-fix policies.
President John F. Kennedy signed the Community Mental Health Act in 1963. It was intended to provide consistent, continuous active treatment in the community while still providing hospitalization when needed. Many states saw this as an opportunity to divest of costly institutions while redirecting money intended for community mental health care to other priorities. De-institutionalization without appropriate community care led to homelessness, poverty and violence toward the mentally ill, far more than by them.
Medication is helpful, but if it were only a matter of taking medicine, the solution would be easy. As in all medicine, diet, exercise, better choices and active engagement of the individual in their recovery is needed.
There are no simple fixes. Laws on the books do not translate into effectiveness in the field. What is needed is an examination of our community mental health safety net.
The most relevant questions we can ask are: Is the skill and expertise in place? Is there measurable value for what is spent? Is our safety net focused on the most needy? Does it serve and support those most severely ill? Are mental health counselors and therapists experienced, motivated and supported in maintaining engagement with those most in need?
Dr. Frank E. Shelp M.D. is former commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities.