Ann Marie Buerkle, Mental Health Services, and the Role of Governments

Ann Marie Buerkle said something that caught my attention regarding Jared Loughner and the federal government's role in providing mental health services. 

The following is from an article by Brian Tumulty, Gannett Washington Bureau, the text of which appeared on the WGZR Buffalo website yesterday:

               

               Buerkle, a registered nurse and attorney, said the Arizona shootings highlight  gaps in mental health treatment that might be an issue for Congress to examine.

               [The article went on to say...]  "The issue was that a very mentally ill person somehow got control of a weapon," Buerkle said.                                                                   

I want to assist in educating Buerkle and her supporters about this area as governments pertain to it, so that she can be of real service during her time in the House of Representatives.

I believe she does not understand the role of the Federal government in mental health services. Furthermore, she seems to be suggesting that it might want to increase its role. But at the same time she was just elected on a platform of smaller Federal government. I hope she will come to understand that this is cognitive dissonance.

I do wholeheartedly support anything Ann Marie wants to do to strengthen gun control in our country.

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So, how have we come to develop our mental health services and how do they work?  How do our communities deal with the issues surrounding provision of mental health services issues? 

Unless you have yourself lived through a mental illness, or have or had a relation or friend with a mental illness, you may not know a great deal about how mental health laws and mental health services work.

Quickly in the aftermath of the awful events in Tuscon last Saturday, came statements about the alleged shooter Jared Loughner. Universally the comments demonstrated that most people, observers, newspeople and pundits, have little understanding of mental illnesses and mental hygiene laws. This is understandable. We usually don't become informed about personal misfortune until we are forced to do so. Similarly, who wants to say the "c" word, much less talk about it, until you've come out the other side?

We saw descripters such as"troubled", "deranged", "sick in the head", "monster", "evil". Descriptive yes, but they leave out an important aspect of understanding what appears to me to have happened: serious and persistent mental illness. I am not talking about "situational depression" or temporary anxiety over a life event. I am talking about illnesses as serious as diabetes, heart disease or cancer, or injuries as serious as a broken back or head trauma. In fact, mental illness is in many ways a head trauma: the brain is damaged.

We heard that Jared Loughner had been asked to leave a community college, and we were able to view his disturbing appearance and speech on his UTube and twitter posts.

Someone said Loughner is a lunatic and therefore justice should quickly be rendered. 

Someone else said, "I hate this situation. Insane or not he deserves to be removed from humanity. He ended a life and inflicted an amount of damage I can't even wrap my brain around. The 9 year old who died speaks volumes to my soul. Death sentence." 

This rhetoric is meaningless and cruel. Do we want a country where an accused person with obvious serious mental illness is quickly put out of his misery and ours? Do we draw a line and not afford every person our dearly won protections? If so, then we are no better than every repressive regime.

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Having worked in the field, I want to draw for you an outline, the barest minimum of information, so that you can more wisely interpret the events past and coming in regard to the alledged shooter.

First of all, there will be very little reliable information available about him coming from any service providers past or present because there are strict standards of confidentiality. This is a good thing. In general, who wants providers talking about you, even to other treatment providers, without your explicit permission? Mental illnesses are stigmatizing. Your career or job, your friendships, your impending marriage, can be destroyed by merely revealing that you received the mildest form of counseling, never mind taking even mild psychotropic drugs or a hospitalization in the past.

Federal laws in this area have mostly to do with Constitutional protections and approving psychiatric drugs for the market. We are all familiar with HIPPA, which guarantees confidentiality. Federal laws also regulate certain aspects of gun control. The Federal government does not control exactly how states regulate and deliver mental health services.

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The states have the responsibility to draw up laws and regulations regarding mental health hospitalizations and treatment. They provide some services directly, and they contract out to agencies in communities for many others.

Most states, including NY, can hold and hospitalize someone for 72 hours for evaluation if he or she is deemed by a court to be a danger to one's self or others. This is a good thing and yet it makes families extremely frustrated. I cannot tell you how many times professionals see someone who desperately needs help, and yet there is no legal way to give it. People with mental illnesses cannot be forcibly sent into treatment unless they are a danger to themselves or others.

On the flip side is personal freedom and liberty, rights we cherish in our country. Mental hygiene laws are purposely made and interpreted strictly, to err on the side of freedom, because we have seen what happens in countries where a government can argue that someone it doesn't like can be labeled "insane" and imprisoned indefinitely.

These competing interests, our Constitutional guarantees of liberty and freedom, and protecting individuals and communities from the ravages of serious mental illness, are often difficult to reconcile and take a great deal of consideration. This is a good thing.

If you don't believe me, look around our own community. There are people walking the streets whom we understand intuitively have a mental illness. They mean no harm to themselves or others, and they are free to come and go. It also means they are free to be homeless, or to refuse medical care.

The 72 hour rule is meant to help people who are suicidal or in some other way are found to be dangerous, and help keep the community safe from them and them from themselves.

Beyond that 72 hours, someone may be hospitalized involuntarily (this is an operative word) because professionals and the court, in consultation with family and friends if possible, are persuaded that the person continues to need serious help.

And sometimes one may actually choose to continue hospitalization or accept out-patient treatment and medications. The side effects of these powerful drugs is another story, and an important one, whch I will not go into here.

Within the 72 hours framework, patients are protected and observed. They may also sober up and/or come down from drugs, and otherwise begin to give trained staff time to evaluate their mental state. Sometimes time is all that is needed. The person may begin to regain rationality with the help of psychiatric drugs, lowered stress, and the lifeblood of human contact. Little is completely resolved within 72 hours. Sometimes a person must be released at that point because he or she has stopped demonstrating a danger to self or others.

With the severe budget cuts every state is experiencing, these very services, crisis interventions, are curtailed and eroded, as is longer term care. Because of stigma, these very services are not valued, and they are more easily cut by legislatures. 

Find me a legislator who resists cutting mental health services and I will show you someone who has somewhere, somehow, experienced mental illness first hand and understands services' vital role in our communities.

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It is also important to note before concluding that once someone is arrested and incarcerated, the rules change. Once the person is in jail, other considerations having to do with safety and keeping order apply.

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I'll stop here. I am certain there will be more chances to help Ann Marie understand the other side of things as she explores her role vis a vis competing interests and, especially, the size of government.