Deranged killers and us: Part 2

Photo above: the candle light vigil held at Virginia Tech University on April 17, 2007, the day after 32 of its students were murdered and another 17 were wounded by a lone gunmen with serious mental health issues. (Wikipedia)

Part 2

In 1909, Mental Health American was founded as a way to begin changing the standards of care for the mentally ill. By 1950, President Truman had passed the Mental Health Act, which resulted in the National Institute of Mental Health.

This guided government funding towards research to discover the etiology and treatment options for our mentally ill population. However, it still took a decade after the establishment of NIMH before Congress passed the Mental Retardation Facilities and Community Health Centers Construction Act, and the National Alliance for the Mentally Ill (NAMI) came into being even later, in 1979.

Progress continues, but controversy continues over the nature of mental illness, the immediacy of problems, disputes regarding which treatments are most effective, and how best to fund those treatments.

Partly due to cultural expectations of independence and self-reliance, and partly due to nature of our specialized, formerly privatized healthcare system, treating mental illness is not only an arduous task, but a controversial one. Recently, the publication of the DSM-V (the Diagnostic Statistical Manual) has put many psychiatrists and patients alike in a state of added uncertainty regarding the definition — and thus the treatment — of various mental disorders.

Some disorders, such as Asperger’s Syndrome, were eliminated entirely. If mental disorders appear to be so arbitrary, they are less likely to be taken seriously and treated as serious impairments in functioning. In the context of an already individualistic and independent culture, it is quite possible that stigmas, labeling and criticism directed toward mental illness may increase with criticism of the DSM.

Secondly, the nature of treatment has changed since Congress passed the ACA, which allowed for a huge expansion of treatment, including screening and preventive care.

While this may lead to new battles over what constitutes as an impairment or disability, the increased coverage will be a step toward lessening stigma toward the mentally ill, and perhaps furthering research to determine which treatments are valid.

After all, with a larger number of people receiving treatment, it would not make sense to throw money at ineffective methods.

Thirdly, pharmaceutical companies have taken on an undeniably prominent role in psychiatry. The U.S. remains one of the primary countries to consistently increase their direct-to-consumer advertising for pharmaceutical drugs. In 2002, nine of the top U.S. pharmaceutical companies spent over $45 billion on marketing and distribution while spending merely $19.1 billion on research, according to the 2007 publication Drugs and Drug Policy, by Clay Mosher.

In fact, the medical world has been quickly and powerfully affected by its continued immersion (some would say entanglement) in the waters of pharmaceutical representatives from the big companies. “Big Pharma,” as the phenomenon is often called, has become a deciding factor in who is treated by what means and how that is financed. Knowing this, it’s easy to see why people distrust psychiatric practices and their claims to actual scientific backing.

Lastly, the very idea of mental healthcare — particularly for adolescents — often seems a tricky issue to many researchers in the Human Development and Sociological fields of study, some of whom argue that naturally occurring changes in the life cycle account for many cognitive and behavioral abnormalities in teenage years.

Given the very nature of neurological and social development, some argue, it would make sense the brain’s adjustment to all the necessary changes during adolescence might produce a variety of undesirable side effects resembling psychotic symptoms. I mean, who wasn’t crazy in their youth?

What we need right now is some gospel, some “good news” grounded in valid, scientifically tested truths. And we might have the ability to deliver, if we’re willing to induce the labor pains. We have found various ways to promote mental well being and treat mental illness, specifically focusing on adolescence (when it commonly surfaces), with methods such as Cognitive Behavioral Therapy (CBT) and Multi Systemic Therapy (MST).

Both of these have been proven to effectively treat adolescents — particularly MST. However, MST is a complex and arguably secretive treatment requiring a well-functioning and supportive family unit, not to mention economic stability. Thus, it is less likely to be accessible, affordable and available for an adolescent without a stable or economically advantaged family.

Here again, one sees a systematic struggle. Shockingly, NREPP — the National Registry of Evidence-based Programs and Practices — reported its availability to be limited to 38 states, as of 2012. And, while MST could be helpful to all demographics, an article from Stambaugh L.F., published on the MST Services website in the same year, reported an unequal population being served, with the majority (90 percent) being white, with 75 percent of those participants being Medicaid eligible.

It appears that while a therapy may be proven effective, actually using it remains a separate battle.

If, as the evidence suggests, these problems start in adolescence, let us begin by voicing the need to improve the treatments we have, make them accessible to those who need them, and prevent this cycle from taking hold.

The United States has a host of peer countries from which to draw upon in terms of strategy and reform, and a strong rap sheet for taking on such responsibility. We even have the practitioners needed for the job, with about 14 in 100,000 citizens opting to be psychiatrists, if you check the 2013 report from The Organization for Economic Co-operation and Development (OECD).

Still, that’s less than the 15.6 average for OECD countries, and we remain the only country with data citing a decrease in the number of psychiatrists per capita, by 0.4 percent between 2000 to 2011. It’s urgent that we find, create and fund viable solutions to a problem that is, literally, killing us.

 (You can read Part One Here)