The Abysmal State of Mental Health in the United States
The recent tragedy at Virginia Tech illuminates the colossal failure of government and public policy to all our citizens who have mental disabilities and are ignored, denied. blurred, blamed and are invisible. The Federal Government should lead in establishing an environment of reality and acceptance of treatment without the ignorant stigma of shame. Mental problems are just as legitimate as a cut needing stitches or a heart attack. Yet people who seek help for a psychological problem are still looked upon as flawed and blamed for not being able to handle their own problems.
We need public education to encourage individuals to go for help when they recognize feeling out–of-control or in a situation where they need counseling, support and advice. Some problems are chemical imbalances and often medications can reduce symptoms or stabilize the individual, if the person takes the medication. They don’t always take them because the medications have such uncomfortable side effects that the patient believes that the disease is easier to cope with than the drugs.
Other problems are situational and don’t need to be medicated but brought to the surface, worked out and resolved. The best way to do this is through “talk therapy.” There are many modalities that effectively work to educate and empower people to stop repeated patterns of destructive and self-deprecating behaviors. Being molested as a child is one example. There is no drug to resolve the damage done and continuing negative effects on adult relationships like trust issues, guilt, shame and sexual confusion and dysfunction. These issues need to be resolved by other means.
Medicating such a wound just exacerbates the dilemma and doesn’t resolve or heal the wound. Neither does behavior modification.
Grief is similar issue. Typically it isn’t pathological, yet it hurts like hell for a long time. Medication isn’t recommended. Talking about the pain and expressing the hurt is a healthier way to deal with grief. Knowing what to expect, the hot spots and the time frame is empowering. Just knowing that the immediate pain will heal itself is part of the healing process.
Historically, we as a nation have attached a stigma of shame on the individual suffering from a mental problem and on the family. I know because in 1956 my father was diagnosed with bipolar disorder and rather than go to a hospital and inflict shame on his family and himself he killed himself at 45 years old.
In the 1960′s we began systematically to empty out all our mental hospital. Often they were less than ideal, but rather than reform them we dumped the patients onto the street. Most homeless people have serious mental health problems and so do most inmates in jail. Today when a person is identified with serious mental problems there is no place to put him or her, few long-term beds and certainly not an adequate amount are available for the mentally ill. Half way houses substitute as a safe place to be housed, but they are rarely safe. And inmates in jail don’t get adequate mental health help to prevent recidivism, returning to jail after they are released.
Then in the 1990′s the Health Maintaince Organizations (HMO’s) appeared on the reimbursement stage and embraced short-term therapy with an emphasis on behavioral modification and limited psychotherapy to six or on occasion twelve sessions. Any additional sessions need to be approved by the HMO before they would be paid. This was the death knoll to effective therapy for the severely mentally ill.
Behavior modification is basically a band-aid type of therapy believing if you change your thoughts you heal any pain or problems from old wounds. Just sweep it under the carpet and it will fade away. This works for some minor problems and patients who can adjust in a very structured modality but is not realistic for more severely wounded people, some need months and even years of therapy. The most seriously disturbed patients may take months just to establish trust in their therapist before they even reveal what happened to them.
States don’t have enough money to adequately fund Community Mental Health Programs. Many people fall between the cracks even when identified and mandated to get out patient therapy. Mental health practioners are overloaded, overwhelmed and underpaid. It is a job with high burn out and high turn over. A patient may begin with one therapist, who moves on and the patient is transferred and has to start all over with someone else.
Private insurance limits the number of visits they will pay for through reimbursement and co-payments. They closely monitor the number of visits, that are regulated by HMO staff. A mental health professional literally has to beg for additional visits when deemed necessary. Additionally the HMO tells the practitioner what they will pay and it is rarely his or her regular fees, always less.
Mental health must become a higher priority in this country to prevent innocent people from becoming victims. All of society is responsible for this tragedy. We must demand more education, better treatment and prevention strategies to avoid similar incidents in the future.
This is a broken system and needs to be fixed. Now!
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