All in the Family

Mental Illness and Caregiving Across the Generations

Societal Shrapnel, the Mentally Ill, Could Be Better Served

What we should take away from the recent hospital shooting

Yet another tragedy involving mental illness unfolded recently and still we wring our hands about guns.

On July 24, Richard Plotts, a patient with a history of psychiatric problems and a violent criminal record, smuggled a gun and 39 rounds of ammunition into a wellness center on the campus of Mercy Fitzgerald Hospital. He shot and killed caseworker Theresa Hunt.

As psychiatrist Lee Silverman ducked behind his desk for cover, a bullet from Plotts' gun grazed the doctor's head. Silverman grabbed a handgun from his desk and fired back. Silverman emptied his gun, hitting Plotts twice in the chest and once in the arm, ending an unfathomable gunfight in a gun-free hospital.

Many laud Silverman as a hero, arguing that his actions probably prevented a murder from becoming a massacre. Undoubtedly he saved the lives of many patients and staff. Now pro-gun forces, led by the National Rifle Association, will clamor for more gun-toting psychiatrists, teachers, and social workers. Gun-control advocates will counter that gun violence is tied to the sheer number and availability of firearms, combined with lax laws allowing anyone to carry a gun.

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But the big issue is why Silverman, a seasoned psychiatrist with no previous sanctions or board actions, deemed it necessary to obtain a concealed-carry permit and bring a gun to work, knowing it was against hospital rules.

The answer is clear to those who understand that our mental-health system is terribly broken.

Doctors like Silverman know their patients are ill, yet they're not empowered to treat them. Patients, even those suffering from anosognosia (a condition common to severe mental illnesses such as schizophrenia and bipolar disorder in which people are unaware of their illness) decide whether they'll adhere to prescribed medications and therapies. Families are cast to the sidelines, forced to watch as mental illness destroys their loved ones while neighbors, knowing something is wrong, become fearful.

To fix our mental health system, we need to address the issue of untreated mental illness. This means changing our laws.

Pennsylvania law says people must be "clear and present dangers" before they can be committed involuntarily. That means that neither health professionals nor the police can do anything until a tragedy unfolds first.

But there is hope. H.R. 3717, titled "Helping Families in Mental Health Crisis Act of 2013," would make life better for people with mental illness, their families, and society. It is sponsored by Pennsylvania's Tim Murphy, the only member of Congress who is a clinical psychologist.

Under this bill, more and better outpatient treatment programs would exist, primary care physicians would be trained to care for people with mental illness, and behavioral health services would improve. Parents of adult children with mental illness would be able to talk with their child's physicians, empowering them to help with treatment decisions when their child is in crisis.

A bill like this would have kept my daughter–who was diagnosed with bipolar disorder and borderline personality disorder and deemed incompetent to make decisions about her own health care by every professional consulted–from living on the streets, becoming addicted to methamphetamine, and being jailed.

Murphy's bill would provide training to law enforcement officers and other first responders, enabling them to recognize individuals with mental illness and know how to effectively intervene. Assisted outpatient treatment programs would offer a less costly and more effective alternative, keeping sick people out of our jails and off of our streets. A continuum of treatment plans would be available, giving patients the opportunity to live in the least restrictive environment.

This bill has the support of professional organizations representing mental health providers, law enforcement agencies, and families. It has its opponents, mostly organizations focused on patient rights. They contend that the bill threatens the rights of people with mental illness. Nothing could be further from the truth.

This bill proposes that a continuum of first-rate care should be available to persons with mental illness. Rather than requiring that a person be dangerous before he may be helped, this legislation focuses on the need for treatment. Making treatment available does not rob people of their rights. It empowers them to assert their "inalienable rights to life, liberty, and the pursuit of happiness."

Opponents suggest that the bill would exchange low-cost services that have good outcomes for higher cost ineffective interventions.

If existing services are so effective, why are our jails, prisons, and streets filled with people with mental illness? This bill demands that states be held accountable for developing interventions that will reduce suicides and homicides while getting people into treatment and back to work.

Opponents also claim that the bill promotes stigma and discrimination by linking mental illness and violence.

In fact, the bill proposes a national awareness campaign involving public health organizations, advocacy groups, and social media. The proposed campaign targets high school and college students, with the goal of reducing the stigma of mental illness, recognizing its signs, helping people who appear to have mental illnesses, and developing an understanding of the importance of seeking treatment from a qualified provider. If this bill were about discrimination, it wouldn't encourage students to help their friends get treatment.

We need to stop debating gun control each time a tragedy involving mental illness unfolds. Instead, we must focus on the real issue. To ensure the welfare and safety of all, we need to change our laws so doctors can provide appropriate care to people with mental illness.

 

This blog post was originally published as an op-ed piece on Philadelphia Inquirer on August 3, 2014.

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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