Gun violence and children: Remove barriers to mental health treatment
As I listen to the national gun control debate following the tragic shootings in Newtown, I know in my heart this is not the right strategy. The real discussion should center on how our nation will embrace decades-old strategies to end the stigma surrounding mental illness and give the required resources to prevent and treat mental illness. This strategy is not only the most cost effective; it's also the most humane. Our nation must provide leadership in protecting children.
The U.S averages 2,200 child homicides by gun per year. A thousand more youngsters die annually by suicide using a gun. Yet as a country we have become strangely inured to these personal tragedies. Perhaps it takes a dramatic and very public event such as Newtown to make us realize our society has become complacent in protecting children.
Where our children are at risk, re-shuffling our spending priorities is the fundamental issue to address. It is far less expensive to promote mental health, implement preventive strategies, and treat existing illness than it is to allow stigma to drive us to other solutions that do not target the primary problem. Mental illnesses are real health conditions that are defined by alterations in thinking, mood or behavior -- all of which are mediated by the brain. Psychiatric treatment involves a complex blend of psychology, biology and compassion. It means never giving up on someone struggling for relief from unbearable pain. It is deciphering when an individual cannot care for him or herself and how to intuit danger and protect others while caring for our children, our communities and ourselves.
In 2006 the Institute of Medicine reported that mental health and physical health efforts are often fragmented and of uneven quality for children and again recommended a "public health network linking services to respond to the growing recognition that mental health is dependent on good physical health." In 2009, the Institute of Medicine took things a step further stating, "We recommend attention to areas that have heretofore been neglected, such as effectiveness in real-world situations, cost-effectiveness, integration of genetics and neuroscience with intervention research, and the careful monitoring of rates of disorder and present risk factors to assess whether population-based improvements can be achieved. Without adequate surveillance, what the burden of disorder is for the society or where best to direct national resources will not be fully known."
Yet in any given year less than one in five children in the U.S. who need mental health care will receive it. This statistic has been consistent since the first Surgeon General's report on mental illness in 1999 that stated: "We are now facing a public health crisis in mental health care for children and adolescents in which the systems of care created to take care of the needs of these children are failing them instead."
The nation has been admonished now for several decades by high level governmental and private organization reports that for children the promotion of mental health and the prevention of disorders must be tied to strategies that integrate mental health and physical health with a public health design that links families, health care providers and schools in an inclusive and de-stigmatizing approach.
Why is stigma so strong despite better public understanding of mental illness? The answer appears to be fear of violence, as people with mental illness, especially those with psychosis, are perceived to be more violent than the general population. Yet research suggests that the overall likelihood of violence from people suffering from mental illness is low. In fact, evidence from many sources including the Journal of Public Health (2002) underscores that social risk factors such as substance abuse, being a victim of violence during childhood, or living in high crime neighborhoods is more predictive of violence than having a mental illness.
In fact, the overall contribution of mental disorders to the total level of violence in society remains exceptionally small. But when it does occur it is highly visible due to stigma and fear. Yet the general public remains poorly informed about the nature of mental illness, further isolating those with mental illness.
A 2011 study by Leong and Kalibatseva demonstrated that more than half of all adults in the country will experience a mental illness during their lives: "But for members of ethnic and racial minority groups, the road to treatment is often blocked by cultural views of mental illness and therapy, lack of insurance and access to appropriate care, and a critical deficiency of studies pertaining to nonwhite populations."
Our efforts should be focused on removing the stigmatization of mental illness and deliver on the promise of decades of research and evidence that promoting mental health and treating mental illness is a very effective strategy to reduce violence. We must embrace common sense solutions such as providing mental health insurance coverage on par with medical care, supporting full implementation of the Affordable Care Act's coverage requirements that ensure all American access to the full range of mental health and addictive services while guaranteeing adequate funding of treatment services.
We cannot bring back the lives of the children lost in Newtown. But this strategy holds more promise than any other being debated in the political arena today to begin to dramatically decrease the number of deaths by guns of children. We should embrace the decades of scientific work that underscores that no matter the number of children killed by guns in a given year or in a given event, providing mental health prevention services at all levels of society will help us move away from violence as a solution to conflict and unmet emotional needs and replace it with critically needed professional and personal support.
Dr. Robert E. Simpson, Jr., is the president and chief executive officer of the Brattleboro Retreat. He has worked in the field of mental health as a clinician and an administrator for more than 40 years.
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