Wednesday, June 3, 2009

Tiller/Roeder: Mental Health Care Systems Fail, Anti-Murder Advocates Are Blamed. Does this add up?

It is very upsetting to discover, yet again, that we do and do not have the ability to treat mental illness.
We do, in terms of diagnosis and treatment.
We don't, in terms of being able to get people in need into treatment to the point of benefit.
The first aspect, the "do," has to do with where we spend the lion's share of our time and effort: diagnosis and treatment.
The second, the "don't," is where we should be focusing, but are not: organization and delivery of health care. Including care for mental illness.
Late-term abortion provider Dr. Tiller was recently shot and killed by Scott Roeder. This killing seems motivated by Roeder's political views regarding legal abortion, including late-term abortion.
The views are not unusual. Most in the U.S. do not favor legal late-term abortion. Roughly half favor very restricted legal abortion, or no abortion at all. This is all a matter of established fact. Roeder's view, that there should be no abortion, is not at all unusual. Roeder's view ,that abortion should not be legal, is fairly normal. We can't pin an abnormal act on this normal view, although many are trying.
It is now emerging that Roeder has a history of mental illness, possibly a psychotic disorder. At least a history of involvement in mental health treatment. It is clear that he was not being consistently, optimally treated.
Roeder is an example of the failure of the mental health care system.
Falling through the cracks, and insufficient care, is not at all unusual in the world of mental health treatment. This is actually par-for-the-course. Public and private sources of mental health care are, across the nation, woefully inadequate.
We have not yet figured out how to organize mental health care to adequately treat recognized problems.
We do know how to treat, when the patient is right in front of us. But we don't: we don't know how to keep people in treamtent, or how to provide what they need to achieve decent outcomes.
For progress, we have to focus on the "we don't."
we have to accept that our problem is NOT that we need yet another me-too drug : another SSRI, another SNRI, another "atypical antipsychotic." Sure, new drugs with efficacy plus ever-decreasing side effect profiles are great.
But how much benefit do we get from each new drug? Each new drug is yet another treatment that will fail to reach those in need.
Because the "we don't" issue - we don't know how to treat mental health problems - is more pressing.
Scott Roeder had been in the mental health treatment system. But somehow it failed. And, as can occasionally happen to some with a mental illness, his off-track thoughts lead to terrible behaviors. This is not the norm: a recent study has yet again reinforced the reality that people with schizophrenia are not more dangerous than the average person without schizophrenia. But in rare cases, poorly managed mental illness, including from psychoticism as well as other mental illness symptomatology, can result in tragedy.
Just like Andrea Yates. The problem was not a belief in the devil, but poorly managed mental illness. She had extensive interaction across years with mental health care, but it was inadequate. The failure was ours - our mental health care system. Just like Seung-Hui Choi and the Virginia Tech Massacre - he had extensive mental health care involvement. The failure was ours - the failure to have any sort of coordinated system by which a person would not fall through the cracks, where overworked staff do not have the means to keep things going in the right direction.
With the Virginia Tech Massacre, the true issue was discovered. Lots of response has occurred in that geographic area, amongst the various mental health care systems. Why? The signal-to-noise ratio was strong enough. The extensive mental health care involvement, plus its fragmented nature, was revealed in the course of the story, even as others tried to define the story as a matter of [fill in the blank: gun control, bullying, racism, video games, etc].
As this Tiller/Roeder case evolves, it appears that the signal is not strong enough to rise above the noise.
Pro-choice advocates are attempting to define this mental health care system failure as a different issue: that beneath the civility, and Constitutionally favored, all-American, red-white-and-blue patriotic behavior, of all right-to-life activists is the supposedly true nature: a supposed desire to willfully kill in the style of a person with years of mental illness who was known to the mental health system but inadequately treated.
This off-track behavior is egregious: while history and official statements clearly demonstrate the scorn that the leading organized right-to-life community has for this murder, the leading pro-choice groups have nearly in totality come out declaring that this incident reveals the supposed true heart of all pro-lifers: a group ready to murder the abortion-providing physicians supposedly if only they could get a supposed clear shot and not face earlthy consequences.
It is crystal clear that this is not the case. Even bordering-on-the-edge radical Terry Randall has not come out in favor of this, or any other, ends-justifies-the-means murder of an abortion performer.
As long as the dialogue fosuses on whether the half of Americans, the half who are opposed to abortion, are actually killers waiting and wishing for an opportunity, we will miss the true problem: a fragmented, insufficient, underfunded, disrespected mental health care sytem that contributes to individual tragedy daily, and occasionally results in a national, headline-stealing tragedy.
Folks, let's admit it: We do not know how to treat mental illness. We do not know how to fund and organize care for the burden of need that is out there. We do not know how to develop care systems that are attractive and valued enough to keep the mental health consumers in active care. We do not know how to actually have a client get involved in the recommended service whenever we make our weak "referrals." We fail at this handoff more often than we succeed. We have failed to recognize the burning desire for the warranted assistance of case management, and we have failed to respond to the burning desire for empirically proven psychotherapeutic interventions, while we continue to push the unpleasant, and often marginally effective, medication-based "treatments," which are incrasingly being recognized as not only marginally effective, but also damaging, with increased risk of a range of bad outcomes in the short-term and long-term - which we are largely clueless about because we have no will to monitor and honestly acknowledge long-term bad side effects.
When we fail, most of those in need suffer, and their families suffer. As we know, at rare times, people with mental illnesses, including because of the interference of psychotic thought processes, can perform regretable actions: being led by psychoticism to murder their parents, to kill innocent bystanders, etc. It is rare, but it happens. Sometimes, when thinking is off-track, people with disturbed thought processes, or disturbed reality testing, or whatever we are going to call it, the person will get caught up in some big issue, with some fertile, active, energetic group. Sometimes it is a religious theme (Andrea Yates wary of the devil), and sometimes it is political theme (Charles Manson pro-counter-culture and wary of a racist government, etc.). This time, it was political: separatists who threw pro-life issues in with the rest of their anti-government views. Roeder's ex-wife has revealed that Roeder himself was not initially interested in the pro-life aspect, but the soveriegnty/no-tax anti-government dimension.
It just does not fit - at all- anywhere in this whole story - that Roeder is anywhere close to the pro-life. activists.
At this point, I am not going to quote and link to the range of the recognized, leading pro-choice organizations to prove that they are dishonestly painting this issue in the wrong colors. Ask yourself who these groups are, then Google their name, plus "Tiller" or "Roeder." YOU go find their official positions and statements for yourself.
And then you go ask yourself, honestly, when no one else is around to ensure your political correctness or to ensure that you are following the marching orders from the self-proclaimed virtue police, ask yourself: does their official definition of this tragedy match reality?
Doe their spin fit - at all - anything close to reality?
Half of the United States adults (what, maybe 100 million people?) disapprove of abortion, and there are literally thousands of people active in the pro-life efforts, yet the supposed views of these pro-choice groups has translated into only eight murders in the Roe era?
And each and every leading pro-life group has quickly come out with a statement, thoroughly consistent with well-stated organizational principles, of thorough denouncement of any supposed-justification of any murder of any abortion provider.
Who is adding noise, causing us to miss the signal: an inadequate mental health care system?
Either the pro-life advocates are, collectively, a terrible shot, or they simply are not bent on killing people. You decide.
Here is another way to judge who might be trustworthy and honest, and who might be seeking to make political gain: follow the money.
Folks, I hate to break the news to ya, but there is not much money or financially fruitful political career, to be made in pro-life activism. There is much money and financially fruitful political power in the pro-choice realm.
Hopefully, with decent reporting, my blog comment here, and other discussion, we can increasingly come to recognize that we are failing to recognize one problem, and we are looking in the wrong direction.
It would not be so bad to be failing to treat mental health problems, if we were at least looking at the problem in the right way. but if we keep failing to recognize the problem, and keep blaming the wrong problem, we are really delaying and detouring ourselves from getting on-track.
Our narrow view of the world, our rose-colored glasses, prevent us from seeing what is the true tragedy, and we go after an entirely wrong culprit.

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