This article first appeared in the St. Louis Beacon, Dec. 18, 2012 - Since last Friday, people have been trying to make sense of the incomprehensible: Why would a young man kill 20 children and six adults inside Sandy Hook Elementary School, shortly after killing his mother at home?
That Adam Lanza, 20, was an awkward loner seems to be the general consensus among those who knew him. But he had no criminal record, and what was going through his mind at the time he started shooting 6- and 7-year-olds will never be known.
President Barack Obama and others are calling for action to prevent future tragedies. To many people, that means gun control. To others, it means greater access to mental-health care.
Statistics show that the overall contribution to violence by mentally ill people in the United States is “exceptionally small,” according to Jackie Lukitsch, director of advocacy at the National Alliance on Mental Illness in St. Louis. But the persistent belief that mental illness equals violence feeds a harmful stigma and may actually prevent people from getting help.
“Stigma is the No. 1 reason people don’t seek mental-health care when they need it,” Lukitsch said. “Getting it, I think, would reduce the possibility of these incidences.”
Treatment often delayed
It’s common knowledge that early intervention can prevent physical health problems from becoming incapacitating or deadly ones, especially for those who have health insurance.
“It’s so easy to pick up the phone and call a doctor if you have a number of different medical problems like diabetes, flu, heart disease,” Lukitsch said. “Ideally, there would be no stigma to seeking care as soon as you have mental-health issues.”
But the reality is that most people wait eight to 10 years before seeking mental health treatment, Lukitsch said. In the case of an adolescent, that can be half a lifetime.
One reason people delay treatment is society’s distorted image of a person who needs intervention, according to Saint Louis University sociology and criminal justice professor Norman White.
“What’s ‘crazy’ in our minds is the characters in the D.C. comics -- the Joker and the Riddler,” White said. “We need to honor that if you feel a little bit depressed, then maybe you need to talk to somebody.”
Ironically, some of the the very violence-prevention measures being discussed may further stigmatize mental-health treatment. UMSL professor of criminology Richard Rosenfeld recommends that people with a history of mental-health issues be restricted in purchasing firearms.
Rosenfeld said there are no public records with regard to diagnoses, but there is information available about institutionalization.
“There is a database right now available to law enforcement and others that indicates whether a person has spent time in a mental-health facility,” Rosenfeld said.
Shrinking resources
Many agree that after health-care reform kicks into gear in 2014, mental-health care will be available and more affordable for more people.
Right now, mental-health resources for people without health insurance is shrinking rapidly in Missouri. Since 2007, the state’s mental-health budget has been cut by one-third. Now, according to Amy Blouin, executive director of the nonprofit Missouri Budget Project, the state can serve only one out of every five people who need mental-health care.
It’s a shortsighted budget solution with long-term consequences, Blouin said.
“All the research says that if you can get people into treatment early, you can really avoid some of the more costly experiences,” Blouin said.
Those without insurance can turn to public clinics or hospital emergency rooms, both of which can diagnose and prescribe medications including antidepressants. But most public clinics now have waiting lists for mental-health patients and emergency care is often the last resort and ultimately the most expensive option for the state. Neither is likely to result in followup care.
But continued treatment -- and even effective care -- aren’t guaranteed even with health insurance, according to Moisy Shopper, a local psychotherapist who treated children for 45 years. For one thing, teachers who refer students seldom follow up, in ways that Shopper recommends.
“Did the person go? OK, they went once. Did they go two or three times? Are they following the instructions of the mental-health professional?” Shopper asked.
Shopper also bemoans what he sees in his profession as a shift away from talk therapy and an increasing reliance on pharmaceuticals. He believes going back to psychotherapy will produce better results, which, in turn, will eventually lead more people to treatment.
“Our mental-health system has to be improved,” Shopper said. “And with improvement, there will be less stigma.”
