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Sarah Steverman, director of state policy for Mental Health America, addresses the major issues of mental health policy today, and explores options for improvement.
→ More: Yesterday's Segment on Mental Health | Crowdsourcing Mental Health Policy
Most of the above comments are right on target.If you or a loved one need help, NAMI can give you guidance. But the governments, state, local, federal are very backward in trying to offer real help. Your/our insurance companies will quickly drop you if you begin filing claims for mental illness/treatment.And several years ago the brainiacs running the government felt that meds were the best and almost only answer to treatment...so what did they do? Shut down mental hospitals, close clinics, cut or discontinue budgets for treatment. We have to get real about the needs for the mentally ill. The mentally ill need our help and support because they surely cannot get it for themselves.
I am the Clinical Social Worker and psychotherapist from the community mental health organization who was the last caller to the show. Thank you for echoing and reinforcing the point I was attempting to make. We enter this profession with the intention of assisting those in need. We take on student debt for years of advanced training (with Masters’ degrees or better, along with professional licensure), then have little choice but very low wage positions in high pressure environments. The clients at these settings face extreme challenges, which we as clinicians take on as higher risk to ourselves. Most of my colleagues, even those in full-time salaried positions (including me) are struggling to get by or are going further into debt just to survive. Those doing fee-for-service have it even harder. (Some of us could do better working at McDonalds. No exaggeration.)
We do our best to manage our own stressors, but it makes it difficult when we have little financial ability to take care of ourselves. Any “reform” of the community mental health system must take into account not just increased access to services or issues of training, but the needs of those providing the services themselves.
Mental health policy needs to address payments to clinics and providers. The current outpatient system in NYC, for many organizations, makes it impossible for professionals with Master's Degrees in Social Work to earn wages enabling them to live in NYC. Many social workers are working as "fee-for service consultants" without medical benefits, sick days, and/or reliable income. When clients do not show up for appointments, even if work is completed (treatment plans, notes, following up with other services/family members)a clinician will not be paid unless they can bill for a kept appointment. How can professionals sustain themselves in this work?
I am the child psychologist who called in during today's show. I wanted to thank you, Elle, for your kind words! I believe it was an essential discussion, and appreciated the creative ideas of each of the callers. I was also pleased to hear that in Sarah Steverman's work with Mental Health America, prevention is a cornerstone of their policies. In the wake of a tragedy of this magnitude, there are several multidimensional components underlying such violence. Crowdsourcing is generative in its approach. The more we professionals, parents and citizens contribute to debates with productive dialog, the more we model healthy coping with agency for our children.
Yes Kelli - pharmaceuticals one can't change the dosage of, or get off of, without dangerous reactions seems like the industry running a mill.See: Coast-to-Coast AM (on WOR AM radio 1-5 AM), Sat. 12/15, for a discussion with an anti-pharmaceuticals psychiatrist who's never had a suicide among his patients.
So some nutcase with an assault machine and more bullets than brains attacks some innocent kids and their teachers AND the guy at the top takes time off [from goofing around with those arcade-game drones, taking out whole schools and villages], to proclaim "we've gotta stop doing this stuff" AND nobody laughs?
C'mon, America! Where's your sense of humor??
After this whole discussion, this story hits the news:"South Carolina Bill Would Criminalize Obamacare"
Should have read- "Most inner city kids access mental health care through the courts"
The most effective therapy I've ever gotten is DBT. It's group therapy and it's run like a class with instruction, homework, and discussion, except it's all about emotional self-regulation. If schools would teach it to all kids regardless of "mental health status," it would improve the general mental health of the nation, and nobody would be stigmatized.
A critical issue regarding mental health in this country is the conspicuous absence of the discussion regarding the epidemic of pharmaceuticals that are being prescribed especially to developing children that have grave side effects including suicidal tendencies. The lawsuits paid by corporations like Glaxo Smith Klien regarding Paxil, Welbutrin etc attest to this fact. When medication is warranted, it is invaluable but it must be closely monitored by parents AND a mental health provider. Yes proactive measures are critical as are cultural measures, within schools and workplaces, which support and encourage drug free mental health wellness. This would not only help the individual but gives all of us tools to recognize and address early warning signs. Add a medications background check to any potential gun owning HOUSEHOLD (in addition to stringent gun laws) and now we are talking. We need to be careful that mental health is not reduced to and equated with prescribing medication.
Most inner city kids access health care through the courts- i.e. by getting arrested & hauled into court. Cops actually pitch this to parents so they consent to the arrest. Our criminal justice system effectively has become the mental health system for minorities. Of course, the price they pay is having a rap sheet.
In this 2 tier system, suburban kids don't get subjected to this indignity, because their families have insurance. And they don't get a rap sheet either.
I'm with John on this and I say again: so you screen people-- so what? Are we prepared to take dangerous people (including children)and put them where they can do no harm or are we medicating more people (and to john's point, where's the evidence that that works?)
Everyone wants to find some magic bullet: more funding for healthcare, more meds. Maybe we need to make some hard decisions about people that need to be removed from society of they're dangerous. How many times do we hear families of these people saying they were afraid? What are we really going to do about this?
The normalization and de-stigmatization of mental healthcare will go a long way. Particularly in the hood.
This is not just an individual problem of troubled individuals who commit mass murder.As Brian indicated earlier, gun violence is predominately the act of hand gun users who kill 30,000 people.
Thus it is a cultural phenomenon related to how we perceive resolving conflict.
Successful, well established, but rarely known, and unfunded programs exist in some schools to teach Resolving Conflict Creatively. This is actually the name of the flagship program of the NYC based Morningside Center For Teaching Social Responsibility, which focuses on teaching peaceful conflict resolution attitudes and skills, including peer mediation and anti-bullying approaches.
If such programs were valued as essential to a school curricula equal to the value of teaching arithmetic, millions of young people would grow up seeing themselves related to others, and understand that they have other tools to deal with their anguish from negotiating interpersonal relations, aside from resorting to violence.
Yearly psychological exams are a very frightening prospect. Sounds like a good way to dramatically increase the diagnosis of otherwise harmless (or even non-existent) mental "diseases" and more importantly, prescribe otherwise unnecessary drugs.
Pardon me for posting again but .. We see the following posts:
Nancy from ManhattanA school nurse and a psychologist in every school with regular screening of each child over the school year. Early intervention with troubled children, and psychiatric treatment of both child and parents or adult guardians, ...
Elle from BrooklynWhere is the prevention?...
Sarah from Brooklyn I believe early intervention and access to support and services is critical to prevent mental health crisis...
My mother studied this at Barnard in the 1930s. There is nothing new here, and still NO EVIDENCE THAT ANY OF THIS WORKS.
Although I appreciate the conversation on the show, Adam Lanza grew up in an upper middle class family with means. The mother was college educated and had presumably had the financial resources to afford the best care for her child. This conversation is focused on families without resources. Let's talk about what made Nancy Lanza think she had the ability to take care of her son. Clearly she was in over her head.
Why isn't the link between mental health professionals prescribing drugs that are known progenitors of homicidal/suicidal ideation brought into questions?
Why is not the prescribed drug link and the mass shootings brought more attention?
I am a retired psychiatric nurse who has worked on locked inpatient units. I found this type of confinement for mostly docile patients often to be a fall-back position of a health system and society that does not have more humane options.
I was part of a People to People delegation of nurses who toured and observed mental health facilities in Cuba. We concluded that the Cuban mental health care system, which as presented to us did not maintain locked units, was more humane than the system in the United States.
The most agitated patients were engaged in work and in arts groups. We were entertained by an orchestra and chorus, members of which showed symptoms associated with the side effects an antipsychotic medications which are in short supply in Cuba. The mentally ill appear to be more included in Cuban society.
I think that much of the inclusion and more humane treatment that we observed is a phenomenon of Cuban culture and the influence of the extended family and community there. Unfortunately, we concluded that this was a foundation of humane treatment that could not be imported into the United States without major societal changes. Maybe viewers could suggest potential policy that might encourage maintenance of the extended family in our country.
My question is what we're doing with all the screening other listeners are suggesting. So you find someone is "psychotic and dangerous" then what? You can't lock them up, you can force them to stay on or even take meds. What are we do to with these walking powder kegs? Guns or no, they're a danger to society.
One of the primary things that impacts mental health is poverty. That is true for kids as well as adults.
Regarding the child psychologist who just spoke and her proposal for annual screening - I adore her! I could hardly agree more. Most health insurance covers health care inadequately or not at all - unless you actually have to be committed. Then they'll cover it. Where is the prevention?
#1 on my list: Social workers in schools - starting in pre-school. I believe early intervention and access to support and services is critical to prevent mental health crisis.
As a former social worker in a community college - I was able to catch a few students that were actively psychotic and dangerous. These are youth that had signs early on of mental instability and fell through the cracks for years. Despite the great need of students for mental health services, the mantra I keep hearing in schools is "we are educators, not a mental health clinic." We are in a position as a society where we need to do both.
Also, I keep hearing people call for "child physiologists". Please don't underestimate the value of social workers; we do more than just put people on welfare - we are trained to provide therapy and early intervention.
Comprehensive nutritional, hormonal and allergy testing. Including saliva tests which is the best way to determine neurotransmitter/hormone health/ dysfunction.
My concerns are the medications given to patients. Often it is not just one but a cocktail of drugs. Some of these drugs have very serious side effects such as feelings of suicide and homicide.
There is something very disturbing here. If we understood and could treat various "mental health" problems, great.
But decade after decade, we are told that this can be done, with no SCIENTIFIC evidence that any proposed treatment is actually effective.
We start with the desire to help people. Then we accept the superstition that psychology knows how to do it. Then we say we need MORE MONEY!
A school nurse and a psychologist in every school with regular screening of each child over the school year. Early intervention with troubled children, and psychiatric treatment of both child and parents or adult guardians, plus parenting training. Also, parenting training as part of health curriculum in high schools. We must break the cycle of child abuse and dysfunctional parenting, where that is the issue.
Also, make bullets expensive; make assault weapon bullets very, very expensive; prohibit the sale or possession of more than a reasonably-small number of bullets.
If there is a “mental health” dimension to mass homicides, it is less the state of mind of the perpetrator than that of a populace driven to acquire weapons intended to maximize death and injury. The mother of the Newtown killer was a gun “enthusiast” who owned multiple firearms, but we do not know why she felt the need for a semi-automatic, military-style weapon her son used to commit his heinous crimes. The demand for such weapons may well be driven by deep-seated anxieties, inadequacies and delusions. Until we are ready to look at our motivations, tragedies like Newtown and daily gun violence will continue to be a normal part of American life.
Little is said this week about the abuse of prescription and illegal drugs, or the extreme side-effects of drugs that might make one violent. Will we ever hear what drugs Adam Lanza was taking last Friday?
Can there be help for those paranoids who think our government is going to grab them in the night?
I would like the interviewee to address the issue of mandatory treatment - both medication and institutionalization - for people with mental health illnesses that may pose a risk to others. Every time there is a mass killing or someone gets pushed in front of an oncoming subway, we learn about the perpetrator's history of mental illness.
Under the ACA, insurers can't provide fewer benefits for mental health services than for other health services. Yet my insurer -- CIGNA -- is trying to end-run the ACA by establishing mental health service "guidelines" that effectively limit psychotherapy to those individuals with serious mental illnesses, and then only for short periods of time, with regular audits of therapy providers.
CIGNA and other providers claim to be following APA standards in opposing such purported guidelines, but the therapists to whom I've spoken about this issues say that there are no such standards, and that insurers are inventing their own rules to limit therapy to those individuals who literally can't get up out of bed.
Here we are, talking about a mental health problem in our nation, yet limiting psychotherapy to the severely mentally ill. Don't withdrawn, isolated young men such as Adam Lanza need such therapy? Are we instead going to give such people a bag of pills -- that they probably won't take -- and send them home?
Maybe the NYS insurance department and other state and federal agencies should look into this latest insurance company attempt to limit mental health benefits.
It seems that the only budget cut that both Democrats and Republicans have consistently agreed upon is for mental health services. Both Jerry Brown and Andrew Cuomo have led the way for cutting funding for these services in their states. Mayor Bloomberg has kept in business the Independent Party that was founded by members of an anti-psychiatry cult. The only time mental health services get much attention is when tragedies like Sandy Hill occur and then, as in the Virginia Tech and Aurora shootings, it is largely to blame mental health professionals for not stopping them.
My question to your guest is why she would expect any thing to change in the future with politicians saying once again we need better mental health services while at the same time reducing funding for them.
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