Wednesday December 26, 2012

The horrific Newtown massacre has put the issue of long-standing and difficult access to mental health services in the spotlight. Hopefully, something good will come of it. Social problems in this country are rarely dealt with on a proactive basis, so we must seize the opportunity and work on change in the usual reactive mode while the issue is still hot.

Consider these facts recently reported by Sarah Kliff in a Dec. 17 Washington Post blog: "The United States spends $113 billion on mental health treatment. That works out to about 5.6 percent of the national health-care spending, according to a 2011 paper in the journal Health Affairs. Mental health dollars mostly go toward prescription drugs and outpatient treatment."

Kliff adds more facts to the discussion citing that, "Access to mental health care is worse than other types of medical services. The Bureau of Labor Statistics estimated in 2010 that the country had 156,300 mental health counselors. Access to mental health professionals is worse than for other types of doctors: 89.3 million Americans live in federally designated Mental Health Professional Shortage Areas, compared to 55.3 million Americans living in similarly designated primary- care shortage areas and 44.6 million in dental health shortage areas."

She goes on to note that, "Mental health care is pricey, with 45 percent of the untreated citing cost as a barrier. A quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, according to one survey that looked at those services from 2005 to 2009. The majority of those who did seek outpatient treatment had out-of-pocket costs between $100 and $5,000."

It is no secret that when it comes to the brain most health insurance does not consider mental health as important as the health of the heart or lungs. Then there is the stigma of mental illness. We are still living in the dark ages when it comes to society's attitude toward people with mental illness.

The way the world has reacted to the Newtown massacre is a good example. Politicians and pundits are trying to say that if this country had better access to mental health services tragedies such as this might be prevented.

The truth is that there will always be people who exhibit extreme behavior no matter how much help is available. It is the nature of the human race. It is also true that violence is a rare behavior among people with mental illness. Associating violence with mental illness is one of the most ingrained stereotypes without basis in fact.

According to a study published in May, 1998 in the Archives of General Psychiatry - patients discharged from psychiatric facilities who did not abuse alcohol and illegal drugs had a rate of violence no different than that of their neighbors in the community."

If you look at statistics I suspect you might be able to find an association between violence and people with coronary artery disease or people with chronic lung disease. Imagine a newspaper headline that read, "Man with heart disease kills 20 children."

Yet that is how absurd it is to associate violence with mental illness. Until we educate our population and learn to understand the nature of mental illness, we will never make much progress in stopping the stigmatization of one in 17 Americans who live with serious mental illness.

It will be a good thing to improve access to mental health services in this country, but it will do nothing to change the amount of violence. Stopping violence is not about better mental health treatment, it is about changing a culture that worships violence in all forms of media, especially entertainment.

Stopping violence is about cutting down on the number of people with guns. Politicians are hiding behind the less contentious issue of automatic weapons saying their only purpose is to kill people. That may be true, but almost all guns have the potential to make killing an expeditious act. Until we face that fact and learn to look at society's problems without political and moral lenses, we will never deal with the root causes of violence in our society.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.