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Monday 31 December 2012

The Problem's Guns—Not the Mentally Ill


The Problem's Guns—Not the Mentally Ill

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In the aftermath of the massacre of first-graders at Sandy Hook elementary school, right-wing defenders of unregulated guns have gravitated to a common alibi: The problem isn’t guns; it’s mental illness. If only society kept better track of crazy people and kept weapons out of their hands, we could prevent more episodes of armed mayhem.
Senator elect Marco Rubio has spoken of the need to “keep guns out of the hands of the mentally ill” and dozens of Tea Party Republicans have echoed the same talking point. The always predictable Charles Krauthammer wrote: “While law deters the rational, it has far less effect on the psychotic. The best we can do is to try to detain them, disarm them…. there's no free lunch. Increasing public safety almost always means restricting liberties.” And the NRA's Wayne LaPierre, in additional to calling for an armed guard in every school, urged an "active national database of the mentally ill."
Oh my, where to begin? Mental illness is just now starting to become less stigmatized. If we create an even more Orwellian society in which anyone who has ever sought treatment for emotional problems ended up in some national database, you can just imagine what that would do to people’s willingness to seek help. Surely it is better to end the easy purchase of combat weapons than it is to keep a record of everyone in America who might hypothetically go on a rampage. 
Surveillance as a substitute for gun control is no idle threat. In the age of anti-terrorism, courts have already permitted the National Security Agency to troll among otherwise confidential records—everything from cell phone and computer-information trails to bank and insurance company records. The Fourth Amendment, which usually requires a warrant for invasion of privacy, has been simply waived. If the justification is preventing “terrorism”—and surely shooting up a classroom is a kind of terrorism—the NSA could create a database in which half of Americans are classified as potential mass killers. 
Isn’t it better to just get rid of the guns?
For now, privacy protections such as The Health Insurance Portability and Accountability Act of 1996 (HIPPA) make it illegal to disclose medical records, and mental-health treatment has an even higher standard of privacy protection. But it would be child’s play for the NSA to ignore these privacy protections, as it has others.
A second irony: The very right-wingers shedding crocodile tears over the need to focus on mental illness rather than gun control are the same people who have shredded public budgets that support treatment of the mentally ill. No area of public spending has been cut more deeply.
In Portland, Maine, a pioneering psychiatrist named William McFarlane has devised a strategy and outreach protocol for dramatically reducing the incidence of psychosis. The research of Dr. McFarlane and his colleagues demonstrated that it wasn’t the condition of schizophrenia per se so much as it was the devastating experience of a mental breakdown that disabled young adults and put them into the permanent status of the emotionally impaired. 
Dr. McFarlane and his team devised an early outreach and prevention system called the Portland Identification and Early Referral program (PIER) that made use of community education. Teachers, counselors, clergy, youth workers and young people themselves were encouraged to be alert to patterns that might indicate future risks of psychosis. Dr. McFarlane’s main intervention was family education and early counseling, supplemented where necessary by medication.
Many teenagers who were loners or were haunted by delusional thoughts, seeing the educational materials “self-referred.” They would come into the PIER office saying, “that sounds like me.” In Portland, the predicted incidence of hospital admissions for psychotic breaks was reduced by between a third and a half.
McFarlane’s breakthrough was hailed as the most important insight about how to reduce the devastating effects of severe mental illness in decades. With support from the Robert Wood Johnson Foundation, the approach was expanded to several other cities and states. But in Portland, it has been shut down for lack of funding, thanks to that state’s right-wing governor. Reopening PIER in Portland would cost under $100,000 a year and would save many millions on hospital admissions and ruined lives spared.
What’s the connection to gun violence? “These kids who go on gun rampages,” says McFarlane, “tend to be pre-psychotic. Most people with mental illnesses are not dangerous, but these are. They still have enough functioning to methodically plot out their attacks. They have lost capacity for judgment but not for planning.” 
“At our very first family meetings,” McFarlane adds, “one of the things we emphasize is safety. Families get it. If they own guns, they either get rid of them, or lock them up.”
It may be a coincidence, but there have been no gun massacres in the communities that have programs modeled on PIER. However, referrals to Dr. McFarlane’s program and others like them are voluntary. Nobody is put into a database.
At the very least, the right-wingers who hope to shift the focus from gun control to mental illness might have the decency to support more funding to treat the latter. According to Michael Fitzpatrick, executive director of the National Alliance on Mental Illness (NAMI), some 60 percent of people with some form of mental illness receive no treatment whatsoever. More than half the counties in America, he adds, have no practicing psychologist, psychiatrist, or clinical social worker. 
When press coverage of Adam Lanza first surfaced, there was conjecture that the 20-year-old shooter may have had Asberger’s Syndrome, a loose diagnostic category that is being dropped from the newest edition of the official Diagnostic and Statistical Manual of mental disorders (DSM-V) in favor of the broader category of Autism.
All over America, parents of quirky kids are agonizing over whether their children might be “on the spectrum” or whether they simply hear “a different drummer,” as Thoreau so beautifully put it. Federal and state law gives parents the right to seek a full evaluation, and if a child is identified as having some version of even mild autism, the family can qualify for additional services. But there is the dreaded trade- off of services for stigma.
What if the risk of getting your child listed on some database as potential doers of violence were added to that equation? What parent would ever seek help? In fact, Asberger’s and Autism are seldom associated with violence.
The problem, folks, is the guns
Absent the guns, the loners who have shot up schools and shopping malls might have gotten out of control, but they would not have been able to go on shooting sprees. 
To the extent that the issue is mental illness, the problem is the gross underfunding of known treatments that work. Adding stigma and surveillance while not adding funds would only make an injustice that much worse. Can’t we at least keep that straight?

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