mental health care
Mental health is a phrase that gets tossed about a lot -- this is true especially during the few decades prior to this one -- but its full meaning often gets shorted. Casual mental health discussions usually focus on significant disorders: schizophrenic condition, bipolar condition, sociopathic tendencies, even Alzheimer's disease. But what gets left out in these sorts of discussions is how mental health affects each of our lives, without exception.
Mental health emphasis is typically on disorder. A person with some sort of a condition is mentally unhealthy, while a person free of condition possesses mental health. This sort of thinking is problematic in a couple of ways. Firstly, many people with legitimate mental health conditions go undiagnosed. The world is filled with the mentally and emotionally undiagnosed.
The second problem is that mental health is not simply an absence of a diagnosed condition, or presenting symptoms. In other words, mental health isn't simply about lacking; mental health is equally about having.
Being mentally healthy means a number of things: coping successfully with the setbacks life invariably presents; healthy relationships with loved ones; functional relations regular acquaintances -- coworkers, for example; and integrating successfully into general society. These traits can certainly be absent in people who don't show symptoms or indications of mental illness.
In the event that one does lack these coping and social interaction capabilities, would they be considered mentally ill? Very unlikely under current definitions. But perhaps current definitions should be changed. An argument could be made that the lack of coping or interaction skills does, in fact, indicate mental illness, particularly when acting out, or the use of drugs or alcohol, is a response to poor coping. Habitually angry or addicted people don't typically fall under the label of mentally ill. Were this to change, large numbers of people might be encouraged to get some form of mental health care.
The argument against broadening the definition of mental illness, and encouraging more people to seek psychological treatment, is that seeking psychological treatment for common dysfunction is overkill, is intrusive, and is akin to sedating large sections of the population. But mental health treatment needn't be oppressive, or sedating, at all. This is not a suggestion to pass out pharmaceuticals in bunches -- even more than they're being passed out already.
Mental health treatment, at its core, should emphasize the teaching of coping techniques. This is different than changing a person's reality. Let the reality remain the same: just change the dysfunctional strategies and methods people use to cope. This approach needn't involve using pharmaceutical treatment at all. Mental health treatment has a long history, and during much of that history pharmaceuticals weren't even available. People don't need to use pharmaceuticals to treat basic emotional and psychological functioning. Let's get that truth out in the open, where it belongs.
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The recent tragedy at Virginia Tech illuminates the colossal failure of government and public policy to all our citizens who have mental disabilities and are ignored, denied. blurred, blamed and are invisible. The Federal Government should lead in establishing an environment of reality and acceptance of treatment without the ignorant stigma of shame. Mental problems are just as legitimate as a cut needing stitches or a heart attack. Yet people who seek help for a psychological problem are still looked upon as flawed and blamed for not being able to handle their own problems.
We need public education to encourage individuals to go for help when they recognize feeling out–of-control or in a situation where they need counseling, support and advice. Some problems are chemical imbalances and often medications can reduce symptoms or stabilize the individual, if the person takes the medication. They don't always take them because the medications have such uncomfortable side effects that the patient believes that the disease is easier to cope with than the drugs.
Other problems are situational and don't need to be medicated but brought to the surface, worked out and resolved. The best way to do this is through "talk therapy." There are many modalities that effectively work to educate and empower people to stop repeated patterns of destructive and self-deprecating behaviors. Childhood trauma caused from molestation is one example. There is no drug to resolve the damage done and continuing negative effects on adult relationships like trust issues, guilt, shame and sexual confusion and dysfunction. These issues need to be resolved by other means.
Medicating such a wound just exacerbates the dilemma and doesn't resolve or heal the wound. Neither does behavior modification.
Grief is similar issue. Typically it isn't pathological, yet it hurts like hell for a long time. Medication isn't recommended. Talking about the pain and expressing the hurt is a healthier way to deal with grief. Knowing what to expect, the hot spots and the time frame is empowering. Just knowing that the immediate pain will heal itself is part of the healing process.
Historically, we as a nation have attached a stigma of shame on the individual suffering from a mental problem and on the family. I know because in 1956 my father was diagnosed with bipolar disorder and rather than go to a hospital and inflict shame on his family and himself he killed himself at 45 years old.
In the 1960's we began systematically to empty out all our mental hospital. Often they were less than ideal, but rather than reform them we dumped the patients onto the street. Many homeless people have serious mental problems as do most inmates crowding our jails. Today when a person is identified with serious mental problems there is no place to put him or her, few long-term beds and certainly not an adequate amount are available for the mentally ill. Half way houses substitute as a safe place to be housed, but they are rarely safe. And inmates in jail don't get adequate mental health help to prevent recidivism, returning to jail after they are released.
Then in the 1990's the Health Maintaince Organizations (HMO's) appeared on the reimbursement stage and embraced short-term therapy with an emphasis on behavioral modification and limited psychotherapy to six or on occasion twelve sessions. Sessions necessary to complete effective therapy must be approved by the HMO responsible for service delivery. This was the death knoll to effective therapy for the severely mentally ill.
Behavior modification is basically a band-aid type of therapy believing if you change your thoughts you heal any pain or problems from old wounds. Just sweep it under the carpet and it will fade away. short term therapy works for minor problems but ignores and fails the needs of the severely mentally ill who need long term therapy. The most seriously disturbed patients may take months just to establish trust in their therapist before they even reveal what happened to them.
States don't have enough money to adequately fund Community Mental Health Programs. Many people fall between the cracks even when identified and mandated to get out patient therapy. Mental health practioners are overloaded, overwhelmed and underpaid. It is a job with high burn out and high turn over. In community mental health agencies patients may be shuffeled from one therapist to another and must start all over with someone new adding to their problems.
Private insurance limits the number of visits they will pay for through reimbursement and co-payments. They closely monitor the number of visits, that are regulated by HMO staff. A mental health professional literally has to beg for additional visits when deemed necessary. Additionally the HMO tells the practitioner what they will pay and it is rarely his or her regular fees, always less.
Mental health must become a higher priority in this country to prevent innocent people from becoming victims. All of society is responsible for this tragedy. We must demand more education, better treatment and prevention strategies to avoid similar incidents in the future.
This is a broken system and needs to be fixed. Now!
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