All in the Family

Mental Illness and Caregiving Across the Generations

If I had $50 million

The mental health crisis needs an attention-grabbing effort

Michael Bloomberg, former mayor of New York, plans to spend $50 million this year building a nationwide grass-roots network that will outmuscle the National Rifle Association. He believes gun control advocates can learn from the N.R.A. by punishing politicians who fail to support gun control.

This May, as we celebrate the 65th Mental Health Month, Bloomberg’s announcement made me think about what I would do to address the challenges facing people with mental illness, their families, and society if I had $50 million to spend.

With such money, I would not build a grass-roots network. We already have that. The National Alliance on Mental Illness (NAMI) advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope for those in need. And NAMI does a great job.

Although I’m a researcher, I would not put this $50 million into research. For over a decade, the NIMH budget has been close to $1.5 billion a year. While more support for research would always be helpful, it’s not likely that an influx of $50 million would make a difference for people with mental illness, their families, or society.

No, the mental health crisis our nation faces is too urgent to rely solely on such deliberate and steady efforts. What’s needed is instant impact. Something that will grab people’s attention. Each time a tragedy involving mental illness occurs, there’s a lot of handwringing but very little action by our elected officials. What’s necessary for change is to make it more costly for our government to continue doing nothing than to take decisive action.

That’s why, if I had $50 million to address the mental health crisis, I’d hire a smart, aggressive attorney, find the perfect victim, and sue the Federal Government for failing to protect its citizenry from known, foreseeable harm. For the victimized plaintiff, I might choose someone like:

  • The 6-year old girl who was the lone survivor of her Sandy Hook Elementary first grade class or any of the families of the schoolchildren who died at the hands of Adam Lanza. While it’s nearly impossible to know when someone with mental illness will crack, in Lanza’s case, there was abundant evidence for concern. Yet existing laws tied the hands of the police.
  • The parents of Christina-Taylor Green, the 9-year old bystander killed by Jared Loughner in the Tucson shopping center melee. Loughner’s parents and the local police knew he was troubled.  Jared’s parents disabled his car each night to try to prevent him from harming others. They confiscated his shotgun after Pima County College police warned that their son might be a danger to himself or others.  Despite their pleas for help, Jared Loughner was neither taken into custody nor evaluated.
  • The families of any of the 12 people killed by James Holmes in the 2012 Aurora, Colorado movie theater. Holmes was known to mental health professionals at the University of Colorado to be very troubled prior to the massacre, yet existing laws rendered them powerless to intervene.

Surprisingly, laws governing the rights of individuals and society when mental illness is suspected are not consistent with laws pertaining to other health conditions.  We have laws prohibiting people with typhoid fever from working in restaurants because they pose a threat to public health. For the same reason, we do not allow people with active tuberculosis to use public transportation and we insist that people with epilepsy take medication if they are going to drive cars. Mental illness should not be any different than other organically based illnesses because mental illness, when allowed to go untreated, poses a danger to others.

Current law prohibited my husband and me from helping our daughter – diagnosed with ADHD, bipolar disorder, and borderline personality disorder. Although her health care providers agreed she was incompetent to make health care decisions, as her parents, we were powerless to help her.  Adam Lanza’s parents, Jared Loughner’s parents, and James Holmes’ parents also knew their children were sick, but the law prevented them from helping their children.

To be sure, our laws are a backlash to the atrocities associated with enforced institutionalization of the nineteenth and early twentieth centuries that robbed persons with mental illness of their autonomy.  Those laws were inhumane, but the pendulum has swung too far.

It remains the responsibility of government to protect the rights and personal safety of citizens. When we enforce laws impeding people with mental illness from getting the help they need and allow untreated mental illness to persist, the government neglects this responsibility and puts its citizens at risk. People with mental illness rarely are violent; they are more likely to be the victim than the perpetrator of crime. But, we have seen too often what happens when serious mental illness goes untreated. It’s time we insist that our government protects our citizenry from the foreseeable harm associated with untreated mental illness.

It’s very difficult to change laws. It takes time. It takes a long pattern of abuse recognized by the public and lawmakers. It takes public groundswell. Or, it takes a high profile lawsuit like Brown v. the Board of Education or Roe v. Wade.

Certainly, suing the government is extreme. But the lack of progress made toward improving life for people with mental illness over the past 65 years is shameful. People with mental illness shackled in prisons or roaming homeless and caring family members cast as enemies are nothing to be proud of.  We owe those who suffer severe mental illness a better chance for a productive quality of life.

We owe ourselves and our children a better world.

How many more Sandy Hook tragedies must happen before we say, “Never Again?”

Rachel Pruchno, Ph.D. is Endowed Chair and Professor of Medicine at Rowan University School of Osteopathic Medicine. Her memoir Surrounded by Madnessis available at online bookstores.

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