December 19, 2018
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No “quick fix” for mental health after Tucson


The tragedy this past Saturday in Tucson, Arizona involving Congressperson Gabrielle Giffords, in which she was critically wounded and others were wounded or killed by a gunman, should give us all a reason to pause.

Representative Giffords’ record as a state legislator and on Capital Hill is as a strong advocate for accessible mental health services and fighting the discrimination that burdens people who have mental illnesses.

According to information reported in the papers and on TV, the suspect, Jared Loughner, may have a mental illness. Our first thought should be for the victims of this violence; those hurt or dead and all their families and those who witnessed this crime. My prayers are with them.

In addition to my concern for the victims, I have concerns for what we will do as a society in reaction to this horrific event. Much talk will continue to look at why a person with a mental illness was not “caught” and placed in treatment prior to this event.

The largest barrier to persons affected by mental illness in receiving treatment is stigma. It is a mistake to treat persons with mental health conditions as “presumed dangerous”. That would be a huge overreaction. Persons with mental illness are at much higher risk for being a victim of violence than actually performing a violent act. Studies show that having a mental illness, in and of itself, does not increase one’s inclination to commit serious violence; other factors come into play, including co-abuse of substances, trauma, and hopelessness.

In the past, political responses to such rare events translate into efforts for quick-fixes, typically, efforts to pass laws making it easier to commit people to psychiatric hospitals or to court-order outpatient treatment, which forces treatment on to people in distress.

Research on forced treatment is mixed. Arizona has had such laws in place for many years. Generally, compliance to the often difficult treatment protocols, including the unwanted side effects of some medications, is low IF the patient feels the outcome only enhances their awareness of their own deprivation.

Long term forced treatment which relies on coercion, is approximating “re-education incarceration” utilized by some communist countries in the past to change behavior of dissidents. For most, it doesn’t work well. Without the participation of the patient, outcomes are very, very poor.

In my experience, coercive treatment is only valuable when it is limited to the initial exposure to treatment. The goal of all treatment must be to provide a benefit to the person served to the point that they voluntarily participate in their continued care relationships.

I hope that the country and specifically Maine, avoids the political quick fixes that may do more harm then good by making those in need less likely to seek out help. Public health policy can and should focus health care access, engagement, and recovery outcomes.

Access to immediate mental health assessment upon first signs and symptoms of emotional/mental distress in a non-stigmatizing manner should be a first priority reflected in our health policies.

Assistance in securing appropriate housing would be a crucial component. Housing First models have extremely high success rates in helping those with mental health conditions benefit from treatment and obtain a meaningful recovery.

Education on mental health conditions, signs and symptoms, preventive care, and guidance on how to help those you see in distress should be provided to all, starting in our schools.

For treatment to be effective, the person served must see a value to the treatment offered. “Value” as defined by the individual may be that he or she is able to get a job, have a clean and decent residence, or improved relationships.

Rather than stigmatizing people who have mental illness with false stereotypes of dangerousness, law makers should make a meaningful effort to address the core issues in health policy.

David S. Proffitt is the president and CEO of The Acadia Hospital in Bangor.  This commentary is posted on the Acadia Touch Points blog.

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