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Falling Through the Holes: Mental illness, A Broken System, and a Parent’s Anguish

By Dr. Sarah Williams
. 2 Comment(s)

Like most of the country, I have spent the past week deeply pained and horrified by last Friday’s killings in CT, and  have asked myself how such a horrible event (and all the previous mass killings of innocent people) could have happened?

As a psychiatrist, the only reasonable answer that comes to me, is the presence of mental illness, or—to put it another way--of the deep and dark psychological and emotional troubles that plague many of our fellow citizens.  So often this suffering goes unidentified and uncared for, which is why we need to fix our broken mental health system now and for everyone.

Note: I don’t at all mean to imply here that all –or even most—mentally ill people are dangerous; this is in itself a dangerous and discriminatory idea we need to guard against.  In fact, most of the harm done by emotional illness is inflicted on the sufferers themselves (consider, for example, suicide, which is now the 3rd greatest killer of young people in our nation). 

On Monday, a colleague forwarded me the article by Ms. Liza Long entitled “I am Adam Lanza’s Mother.”  While this piece (which has since gone viral) has generated a huge amount of controversy, the powerful issues and questions it generates remain deeply relevant.  

In her article Ms. Long describes her brilliant, angelic and apparently mentally ill son, who she reports is subject to sudden fits of violent rage that put both herself and her other children in serious danger.  After describing some of her son’s “episodes,” Ms. Long goes on to share her struggles to find the help her son desperately needs, and describes the insurmountable obstacles she faces in doing so. She recounts being told by her son’s social worker during their last visit to the hospital that “the only thing I could do was to get (my son) charged with a crime.  ‘If he’s back in the system,’ the social worker reportedly continued, ‘they’ll create a paper trail; that’s the only way you’re ever going to get anything done.  No one will ever pay attention to you unless you’ve got charges.’”  Ms. Long correctly notes that a huge portion of our mentally ill citizens are currently in prison, which now houses the largest mental health facility in the nation!

Unfortunately, this situation is disturbingly similar to that of parents of developmentally ill children who are told that their best option is to give up custody of their children to the state in order to “get them into the system” where they can get the help they need.

As a psychiatrist in New York, I feel fortunate to be practicing in a state that provides some of the best care to the poor and uninsured in the country.  However, even in this relatively “good” state,  I have had to deal casualties of our inadequate system:  a young man  who was rushed  to his local hospital after attempting to slash his throat with a kitchen knife, only to be released the next day because the hospital was not “in network;” or the public hospital patients who are admitted and readmitted to the hospital (at a cost of $1500/day), because the community services they used to rely on have been decimated by budget cuts; or the sweet and smart college student I admitted emergently to prevent her from jumping in front of a subway train, who emerged from this lifesaving hospitalization with a $50,000 hospital bill because her insurance company insisted (erroneously) that the hospitalization had not been “pre-authorized!

As healthcare providers, we know we have to work to change the ignorant, phobic and dangerous attitudes toward mental illness in our communities; however, as socially aware providers and citizens, we also know that this is not enough.  We know we also need to work to fix our very broken healthcare system (which is even more broken when it comes to mental health), so that our emotionally troubled family, friends and neighbors can be identified and get the support and care they need.  How many people need to suffer or die because funds for school counselors, public hospitals, and community health centers have been cut?  Or because they’re not eligible for Medicaid? Or their insurance doesn’t adequately cover behavior health? 

As providers, our care does not end with our individual patients; we also need to care for our societies and communities.   The Affordable Care Act (also known as “Obamacare”) contains valuable provisions to improve care for the mentally ill; I believe we need to work to increase understanding and implementation of this ground-breaking law among our colleagues and in our communities.  However I—like many others—also believe this law does not go nearly far enough and therefore we also need to work to extend full  and adequate care to all citizens, including those who suffer the ravages of mental illness.

Yes, we desperately need gun control and health care providers need to stand up for it now.  We also need to strengthen-- not cut-- Medicare and Medicaid.  We need to restore funds for hospitals, community mental health centers, and counselors in our schools-- not further cut the few bare-bones programs that still exist.  We need to ensure insurance companies (as is done to some extent in the Affordable Care Act) cover all illness for all people-- including mental illness and psychological suffering.  Last but not least, we need to show love and respect to our troubled citizens and give them the care they need. 




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  1. Julia Frank

    As a fellow psychiatrist, I agree 1000%. Ignorance, stigma, fear and exploitation all compromise our society's effort to provide care for the mentally ill. Adequate care would not break the bank--not providing care has contributed to excessive costs for both the medical and criminal justice sectors.
  2. Julia Frank

    I am also a psychiatrist, and every word of this rings true. The choices offered by a complex insurance market, which executives now defend as a core value, are hardly choices at all. As a patient, you can "choose" your policy, but in so doing, you may lose the ability to see the doctor most able to treat you or access to the hospital where you can most readily find care. If you are mentally ill, and your capacities for rational choices is impaired, even intermittently, the barriers to getting what you need are even higher. And if you are a doctor or other provider, you can't chose to offer your services to those you may be best qualified to treat.

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