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A Mental Health Crisis

illness

Once again extensive and lengthy mental health issues are revealed after a heinous crime. Once again we are left wondering how can this happen? How can anyone living in today’s over-exposed world manage to evade authorities and/or medical attention? How can a person with repeated exhibitions of mental illness have access to weapons? These discoveries of warning signs and bells usually crop up during the first 24 hours of investigation. This speed suggests that the perpetrator’s mental health status was pretty well known. How does this happen?

How do police listen to a man talk about hearing voices and microwave vibrations and not have him hospitalized? How does someone retain his military security clearance after violent and erratic behavior? How does someone with a well-known history of mental imbalance own and keep a gun? It’s actually quite simple. We don’t want to get involved. We see examples of this aversion every single day. When you use a restroom and discover there is no toilet paper, it’s because at least one person before you did not tell management. We don’t want to get involved in even the most benign situations let alone one that might be complicated. And nothing is quite as complicated as mental illness. We are equally consumed with fears of offending someone behaving questionably as we are for our own safety.

We are woefully under equipped both personally and on a larger infrastructure level to deal with mental illness. If you work with someone who exhibits troubling behavior you might screw up your courage and go to personnel. Then what? A competent personnel officer may talk with the employee in question about services and counseling. Then what? Does the veil then lift from the employee’s eyes? Do they trot off to up until that moment an unknown resource known as counseling and become cured? Only in a Lifetime movie. What if it’s your next-door neighbor, the guy in the diner, or the woman on your bus? How do you alert anyone? Who do you tell?

When a person’s behavior becomes impossible to ignore, the police are often called. The police may or may not be well versed in the signs of mental illness. The police usually have some leeway as to whom they can have transported to an emergency room. Then what? If a person in distress makes it to the emergency room they are held for less than two days. If they are not a danger to themselves or others (which is determined by the patient saying the words; I am a danger to myself and others) they are released.

Over the years we’ve become more comfortable with the concept of mental illness. We bandy around terms like post-partum depression, P.T.S.D., eating disorders, O.C.D., etcetera. Many people are comfortable taking psychotropic medication and/or sedatives. But mental illness is far more vast and varied. There’s a whole lotta real estate in between social anxiety and paranoid schizophrenia and most of us are a bit vague about it all. Compounding the confusion is the fact that mental disease can be scary for spectators. Of course in our most rational moments we know that it is far scarier to ignore erratic behavior. But we can hardly be blamed for listening to our own little voice inside saying; “run the other way!”

In a world in which people often assume that someone else will take care of something, mental illness is mysterious and scary and our mental health infrastructure is flimsy at best it is no wonder that we have what we do on our hands. We’ve heard people (including politicians) say that guns don’t belong in the hands of the mentally ill. We’ve never heard what that means. Surely not all mental illnesses are considered in this classification. What has been spelled out is that “people with mental illnesses” will be identified as those who have sought help. This is a ludicrous and meaningless classification as it’s a deterrent to people to seek help, and we don’t really have many options for those seeking help. And that is the issue.

We’ve shrouded mental health issues for which there isn’t a kicky acronym or a medication to be peddled, in a thick cloud of secrecy and shame. We’ve manifested that sentiment in the abysmal mental health system with which we’ve settled. It’s great that you can get a flu shot and blood pressure check while picking up some cat litter. But what of prevention and detection of diseases that could affect public safety? How much devastation does it take before we face this issue? How many lives must be destroyed until we can say; we have a mental health crisis in this country?

 
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Posted by on September 18, 2013 in Cultural Critique, Well-Being

 

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An Illness In The Family

 

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Periodically, most often prompted by crisis, mental health pops up in our cultural conversation. Pundits point out the obvious flaws in our care system, medical professionals speak of conflicting and vague diagnostics, and some families share heart wrenching personal tales. This flurry of post-crisis activity is actually a microcosm of the complex issues of mental health care: People state the obvious, others admit to the complexity and the people in need are suffering.

Family members (and by ‘family’ we mean everyone who shares love) are often in the direct line of fire of mental illness. Their lives can be upended by the illness of a loved one and their every moment consumed with pursuing effective care. It is those closest to someone ill who will witness and be subjected to troubling behaviors. And unless the ill person is a minor or the behaviors so blatantly outrageous, it is difficult to judge when it’s appropriate to intervene and to what extent. We are a culture that holds personal freedom and autonomy in the highest regard. And while we like to tell people what to do with their lives in the abstract, we shrink from doing so in reality. We don’t want to unnecessarily offend and even if we did, it’s difficult to know what to say or do. It might be helpful to think of behaviors and approaches categorically.

Danger to self or others – There’s no wiggle room here. Our society has agreed that impending physical harm trumps personal freedom. While the “danger to self or others” definition is meant to be applied in crisis, the philosophy applies more universally. When asking ourselves; “Is it time to seriously intervene?” we can use this statement as a guide. It is time to move on from nagging and/or cajoling a family member to eat when you see/feel that their weight loss is dangerous. If someone is driving when drinking, passing out and/or injuring themselves when drinking, they are a danger. If someone cannot get out of bed and has vulnerable people in his/her care he/she is a danger. The question to ask when making this judgment is; “Is someone going to get hurt?”

In crisis is probably the most common presenting challenge. There is no immediate danger but instead a person who is simply not well. For the most challenging mental illnesses (i.e., schizophrenia, bi-polar, personality disorders) a state of crisis is a common occurrence. For people faced with depression or anxiety, crises can be one-offs or few and far between. Depression is a real and debilitating illness, it should not be confused with sadness. Being sad is prompted by incident: a death, a world event, a hormonal event all can trigger sadness. Of course these events can also trigger depression. The key is how long is the darkness lasting and has it changed the very nature of the individual? The same is true for anxiety. When a response to real and present danger morphs into sustained hyper-vigilance it is not serving the individual well.

Intervention – Erase any image you might have of corralled family members confronting someone while shakily holding index cards. It’s a powerful scene for television and movies but is flat out surreal in real life. If there are other caring people who can assist in getting the person in need appropriate care, so be it. But folding chairs and prepared statements are not necessary. If the person is in crisis (danger to self or others) they need immediate professional assistance. If someone has demonstrated a desire to hurt themselves or others they can and should be hospitalized and treated until they are stable. If the person in crisis is compliant you can take them to an emergency room yourself. If they are violent the police will help them to the hospital. *Note: It is best to assume that each and every threat of harm is valid. There is nothing to gain from assuming someone is crying wolf. If nothing else the emergency room staff will become more familiar with the person in crisis and be able to provide more specific care with each return trip.

For people not in crisis, intervention can be a hairy and anxiety provoking business. Every situation, relationship and individual is different. There are no universal guidelines on what to do, but there are some pretty clear guidelines on what not to do. Do not make it easy for someone to not get help. Do not take on the role of amateur therapist. Do some research and find a therapist in the right price-range (any doctor’s office, school, women’s health clinic, or divorce attorney will have referrals.) When the individual seeks to emote or purge have a contact number on hand and take full responsibility; “I want to help in a meaningful way, I’m your friend/family but not a therapist.” If an individual refuses professional help do not abandon them but do not engage in the fiction (i.e., “it’s just a phase, the season, pesticides, politics, etc.) Keep in mind that they are not entirely themselves and may not be the most reliable narrator. Bring them into the world (perhaps kicking and screaming.) Do not sit by their side and watch television. Go for a walk; remind them of the world they’re missing out on. Do not lose sight of the goal of professional help. Do not give up until you’ve exhausted every argument and yourself.

Someday we will treat mental health as we do dental or physical health. Blame and shame will dissipate and systemic effective care will be available to all. Family (in all its definitions) will always be at the front, but in time they will have proper support. There simply is no sane alternative.

 
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Posted by on January 7, 2013 in Cultural Critique, Well-Being

 

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