My friend, Dr. Tracey Skale, the chief medical director at the Greater Cincinnati Behavioral Health Services, was interviewed by a local television channel in Cincinnati about violence and mental health services. I’ve been traveling for several days and only now was able to watch the half-hour interview on NEWSMAKERS . Dr. Skale made several key points:
1. While the majority of persons with mental illnesses are not dangerous, those with severe mental disorders who are untreated, are more likely to commit violent acts than the general population.
2. Mental illnesses are exactly that and there should be no shame or stigma in having one.
3. While dangerous behavior is nearly impossible to predict, there often are warning signs such as a person being isolated or unconnected with others. The chances of identifying someone who might be violent are greater when psychiatrists spend adequate “face time” with their patients. Unfortunately, psychiatrists are being pushed for cost reasons to focus only on issuing medications rather than actually getting to know their patients.
5. While risk assessments are done when patients first are interviewed, there often are no updates or follow-up reviews.
The Wall Street Journal recently published an editorial by Dr. Lloyd Sederer, the medical director of the New York State Office of Mental Health and an adjunct professor at Columbia University’s Mailman School of Public Health, that pinpointed other problems in our mental health care system. Dr. Sederer criticized HIPAA (Health Insurance Portability and Accountability Act) for limiting the exchange of information between family members and doctors. He also complained about overly restrictive laws that limit the treatment of persons against their will.
I’ve been disappointed in the sort of legislation that is being proposed because of the Sandy Hook shootings. The legislative bills that I’ve seen in various state legislatures call for drawing up lists of persons with mental disorders to make certain persons with mental health backgrounds can’t buy or own guns. Such laws will further stigmatize persons with illnesses.
We don’t need lists. We need improved and better-funded community mental health services. We need a national dialogue about our existing mental health laws with an eye toward protecting civil rights but also getting people help before they become an imminent danger.
I am grateful that persons who actually work in the trenches, such as Dr. Skale, are speaking out. It would be nice if the White House listened. It would be nice if our lawmakers actually paused long enough to hear from persons who have been diagnosed with mental disorders and are in recovery. Sadly, parents, doctors and the persons who actually have been through the system are the last to be heard.