One result of the tragedy at Newtown has been the growing use of a tragically mistaken and dangerous metaphor: the mentally ill as boogeyman.
It has achieved a lot of currency and in some circles has been promoted to the status of simply obvious truth. The mentally ill are violent so the argument goes. (Proof is not a condition of making this argument. Anecdote is assumed to be sufficient and one anecdote is assumed to have more validity than all the proof in the world.) The mental health system does not sufficiently manage them and because of this we are all at danger. The solution is to manage them better through the increased use of coercive options that have either been decreased by funding cuts (psychiatric hospital beds) or to institute more things like assisted outpatient training (AOT). Part of the underlying message is that we have the services or options to manage behavior effectively if we would either fund it, make it legal or force the “mentally ill” to use them. Furthermore we are doing this ‘for their own good” since they are incapable of making informed decisions and often dont even know they need help. The problem with this argument is that it is wrong on virtually every step.
Since Newtown I have published many articles on this site that deal with the issue in one way or another. One of the best is the previous one that talks about how many deaths have argued by guns in the United States since Newtown. 1250 people have been killed. Reading it one of the things that struck me was how little role if any mental illness seemed to play. If you havent read the article you should. There is no evidence that I know of that correlates mental illness with violence. In fact the mentally ill are much more normally victims. The major correlation that I know of is young, male, and drinker. There is not enough beds anywhere to put them all away if we decided to put all the people away that meet this criteria. If you havent had a chance go back and read some of the articles. Many of them are very illuminating. The authors come from a wide variety of backgrounds but their message is common. Violence, particularly gun violence, is not a mental health issue. It is a people issue. And it is a huge issue.
Lost in the furor over mass murder is the idea that if we deal with the “crazy mass murderers” we have dealt with the problem of murder. It is simply not true. Again look at the research cited in some of this articles. “Normal” people show an amazing tendency to murder other “normal” people. It almost makes you think the problem is not with “mentally ill people” but simply people. Too many people believe that a gun offers the solution to many issues.
The problem with the mental health system is not its lack of muscle. It is its lack of heart. Too many people believe getting a mental health diagnosis, accepting that diagnosis, and trying to get help is an aversive process not worth the effort. Their experience is that the mental health system is just as big a problem as the mental health issues they deal with. Being mentally ill in this culture means accepting a definition of yourself as broken and deficient. It is not simply what mental health professionals say, but the culture as a whole. And if the mental health treatment ever becomes widely accepted as the only thing that protects us from mass murderers the stigma of mental illness will becoming past measure and people will flee from any involvement in it.
Efforts to “muscle up” the mental health system are simply wrong. There is little evidence that psychiatric hospitals are very successful. It trains people more to be a chronic patient than anything else and it eats up funds with an insatiable appetite that might better be used to fund community based programs for people who really do want help. One study I saw from New York said 20% of people are back in a month and 40% within one year. If they dont work any better than that for “normally mentally ill people” what makes you think it might work for the “violent mentally ill?”
AOT is an even bigger boondoggle. It matters what you commit people to. The argument that making people do something that didnt work when they chose to do is going to make anything different is simply bizarre. What is the old phrase, “Insanity is continuing to do the same thing and expecting it to have a different result.”
In Tennessee the state pays $690 a year to the behavioral safety net for services for people without insurance. They get skeletal services that for many are very helpful. They have a pilot AO”T program that is going to serve 10 people a year at $12,500 a year. The behavioral health safety net serves about 25,000 people. AOT has yet to serve its first. It makes me wonder if some of that $12,5000 could not be better used to make the safety net less skeletal.
Helping people with mental health issues is not about what we do to people but what we do with them. The best way to help people in distress is to treat them as people. I remember telling one lady she was an ordinary person dealing with exceptional circumstances. She simply cried. She had never had anyone tell her that before.
For all the people hollering that we need to be realistic and meet a problem that threatens all of us I can only agree. It is time to be realistic. Boogeymen dont really exist. And trying to act like they do dont make them any more real.
It is time to treat people as people. If we dont start there we dont start.