2013년 11월 28일 목요일

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"Mental               health               has               been               hidden               behind               a               curtain               of               stigma               and               discrimination               for               too               long.

It               is               time               to               bring               it               out               into               the               open.

The               magnitude,               suffering               and               burden               in               terms               of               disability               and               costs               for               individuals,               families               and               societies               are               staggering."               -               Lee               Jong-wook               with               the               Department               of               Mental               Health               and               Substance               Dependence,               Noncommunicable               Diseases               and               Mental               Health,               World               Health               Organization,               Geneva.

As               the               events               unfold               surrounding               the               attack               of               an               apparently               mentally               ill               young               man               on               a               small               gathering               in               a               shopping               center               in               Tucson               Arizona,               killing               six               and               wounding               13               others,               including               Congresswoman               Gabrielle               Giffords,               questions               have               been               raised               about               what               appears               to               be               the               absence               of               adequate               care               with               our               mentally               ill.
               There               has               always               been               stress               on               the               health               system               to               accommodate               those               individuals               of               moderate               and               low               means               who               can't               afford               timely               and               prolonged               treatment               for               their               mental               diseases,               like               schizophrenia.

But               the               stress               becomes               amplified               in               economic               hard               times               much               like               what               we               are               experiencing               today.

State               budgets               are               struggling               to               pay               their               bills               and               keep               from               sinking               deeper               into               debt.

As               has               always               been               our               tendency               in               this               country,               social               services               are               usually               the               first               to               feel               the               knife               when               it               comes               to               finding               ways               to               balance               budgets.
               Funding               for               behavioral               health               treatment               in               Arizona               was               cut               by               as               much               as               50%               last               year               according               to               the               National               Alliance               on               Mental               Illness,               denying               mental               health               service               to               nearly               28,000               Arizona               residents.

What               are               the               repercussions               of               this               and               how               might               it               have               effected               the               outcome               of               Jared               Loughner's               deadly               actions.
               According               to               Dr.

H.

Clark               Romans               with               the               National               Alliance               on               Mental               Illness               (NAMI),               the               recent               budget               cuts               in               Arizona               beginning               in               January               2010               have               expelled               some               2800               former               mental               health               patients               from               the               system               because               their               mental               health               status               was               not               diagnosed               as               serious.

Beginning               in               July               2010               those               who               did               have               a               serious               diagnosis               lost               "virtually               every               service               they               were               getting               except               generic               medications"               because               they               weren't               deemed               not               poor               enough               by               state               officials               to               qualify               for               the               state's               run               Medicaid               program               called               ACCESS.

This               meant               these               people               could               no               longer               have               access               "to               their               doctor,               case               manager,               support               groups,               out               patient               services,               transportations               subsidies               and               eventually               housing               subsidies"               according               to               Dr.

Romans.
               The               PhD               representative               with               NAMI               pointed               out               in               an               interview               Monday               that               Arizona               has               laws               in               place               that               will               allow               some               involuntary               commitment               for               those               who               clearly               need               help.

When               the               Pima               County               Community               College               administrators               recognized               Loughner's               erratic               and               strange               behavior               they               could               have               used               these               options               to               have               him               committed,               as               could               the               Sheriff's               Department               that               had               been               aware               also               of               Loughner's               spells               of               abnormal               behavior.

Romans               says               "it               is               not               an               arbitrary               process,               it's               a               thoughtful               process,               it's               a               tool               that               can               be               used"               to               help               those               like               Loughner,               who               supposedly               did               not               indicate               an               apparent               danger               to               himself               or               others               by               these               two               institutions               prior               to               his               rampage               on               January               8th.
               Will               not               only               Arizona's               budget               cuts               but               similar               budget               cuts               in               other               states               create               a               condition               that               may               allow               another               unstable               person               to               wreak               havoc               on               society               if               not               detected               beforehand?

It's               possible               according               to               Dr.

Romans.

"The               fact               that               people               who               are               making               more,               at               least               for               the               moment,               more               than               100%               of               the               poverty               level,               are               now               in               a               category               that               they               have               virtually               no               access               to               services,               the               public               mental               health               services,               so               I               think               we               have               raised               the               barrier               considerably               higher               than               it               used               to               be,               so               people               who,               you               know,               could               be               unstable               are               at               risk."
               Dr.

Romans               further               points               out               that               "the               fact               is               that               most               people               who               do               have               serious               mental               illnesses               go               through               their               life,               undiagnosed               and               untreated.

So               any               of               those               people               could               at               any               time               be               in               a               situation               where               the               stress               precipitates               their               symptoms,               and               the               services               are               moving               further               away               from               that".
               In               studying               this               issue               we               should               consider               some               of               the               other               cases               where               people               who               were               mentally               unstable               and               wound               up               killing               others               as               a               result               of               their               disease               that               went               undetected?
               Seung-Hui               Cho,               the               Virginia               Tech               shooter               was               diagnosed               as               early               as               the               8th               grade               for               selective               mutism               ,               "a               psychological               mental               disorder               ...

which               a               person,               most               often               a               child,               who               is               normally               capable               of               speech               is               unable               to               speak               in               given               situations,               or               to               specific               people."               It               can               co-exist               with               severe               forms               of               social               anxiety.

Cho               was               supposed               to               be               treating               his               symptoms               with               medications               and               therapy               and               had               been               placed               in               special               education               classes               under               an               "emotional               disturbance"               classification.

After               his               junior               year               in               high               school               he               rejected               any               further               treatment.
               Eric               Harris               and               Dylan               Klebold,               the               Columbine               High               School               killers,               were               not,               as               first               portrayed               as               part               of               some               "trench               coat               mafia               outcasts".

They               both               suffered               from               mental               instabilities.

Diebold,               the               hothead,               was               depressive               and               suicidal.

Harris,               the               kid               everyone               thought               was               "sweet-faced               and               well-spoken"               was               later               diagnosed               as               a               psychopath.
               Dr.

Robert               Hare,               who               authored               Without               Conscience,               considered               the               authoritative               work               on               psychopathic               behavior               and               was               one               of               the               psychologists               consulted               by               the               FBI               about               Columbine,               says               "Unlike               psychotic               individuals,               psychopaths               are               rational               and               aware               of               what               they               are               doing               and               why.

Their               behavior               is               the               result               of               choice,               freely               exercised."
               It               appears               their               illnesses               had               not               manifested               themselves               to               a               level               that               those               close               to               them               saw               it               as               a               potential               threat.No               one,               not               even               their               parents               seem               to               pick               up               on               these               symptoms               because               as               David               Cullen               points               out               in               his               Slate               magazine               article               on               these               findings               five               years               after               the               1999               incident,"Both               killers               feigned               regret"               to               a               previous               robbery               and               avoided               prosecution               for               the               robbery               by               engaging               what               Cullen               says               "was               a               'diversion               program'               that               involved               counseling               and               community               service."               Perpetual               deceitfulness               is               a               classic               symptom               of               the               psychopath.
               Timothy               McVeigh,               the               Oklahoma               City               bomber,               seems               to               fit               Dr.

Robert               Hare's               description               of               a               psychopath.

He               was               a               product               of               parents               that               underwent               a               painful               divorce               when               he               was               10.

There               are               no               records               of               his               mental               condition               leading               up               to               the               bombing               of               the               Murrah               Building               bombing               but               clearly               he               developed               a               neurosis               that               is               typical               of               someone               who               was               raised               by               a               unaffectionate               father,               was               bullied               in               school,               read               anti-government               literature               (McVeigh               read               William               Pierce's               neo-nazi               tract,               The               Turner               Diaries),               couldn't               hold               a               steady               job               and               was               never               able               to               develop               a               stable               relationship               with               women               he               dated.
               He               served               in               military               combat               but               no               record               exists               that               shows               he               suffered               PTSD.

After               showing               a               keen               interest               in               the               United               States               Army               Special               Forces               he               later               became               discouraged               after               entering               the               program               and               soon               left,               with               a               military               psychological               profile               that               catergorized               him               as               very               unsuitable               for               SF.

A               1995               Washington               Post               article               cited               that               "McVeigh               complained               that               the               Army               had               implanted               him               with               a               microchip               into               his               buttocks               so               that               the               government               could               keep               track               of               him."               McVeigh,               unlike               the               others               who               killed               innocent               victims               from               some               mental               imbalance,               was               never               around               others               long               enough               to               diagnose               his               building               schizophrenia.
               Does               society               pay               a               higher               price               in               monetary               terms               and               human               suffering               when               they               fail               to               address               mental               health               issues               early?
               As               I               indicated               above,               the               costs               to               assist               those               in               our               communities               who               suffer               debilitating               mental               illnesses               are               high.

Most               people               who               need               the               services               are               those               least               likely               to               afford               them               or               encouraged               to               seek               out               what               is               made               available               through               state               and               federal               funding.

What               are               the               social               costs               when               treatment               is               delayed?
               According               to               National               Institute               of               Mental               Health               "Suicide               is               a               major,               preventable               public               health               problem.

In               2007,               it               was               the               tenth               leading               cause               of               death               in               the               U.S.,               accounting               for               34,598               deaths.

The               overall               rate               was               11.3               suicide               deaths               per               100,000               people.

An               estimated               11               attempted               suicides               occur               per               every               suicide               death."               Globally               we               rank               40th               out               of               106               nations               studied               that               have               suicide               rates               per               100,000               people               per               year.
               One               in               four               families               has               at               least               one               member               with               a               mental               disorder,               with               other               family               members               often               serving               as               the               primary               caregivers,               according               to               the               World               Health               Organization               (WHO).

Out               of               pocket               expenses               are               often               not               revealed               in               statistics               on               mental               health               care               coverage.

Also               not               revealed               is               the               human               toll               that               victims               of               mental               illness               suffer               ,               including               family               members,               in               the               form               of               "               human               rights               violations,               stigma               and               discrimination,               both               inside               and               outside               psychiatric               institutions."(WHO)
               In               their               study               on               the               issue,               WHO               has               estimated               that               "The               cost               of               mental               health               problems               in               developed               countries               is               estimated               to               be               between               3%               and               4%               of               GNP.

However,               mental               disorders               cost               national               economies               several               billion               dollars,               both               in               terms               of               expenditures               incurred               and               loss               of               productivity.

The               average               annual               costs,               including               medical,               pharmaceutical               and               disability               costs,               for               employees               with               depression               may               be               4.2               times               higher               than               those               incurred               by               a               typical               beneficiary.

However,               the               cost               of               treatment               is               often               completely               offset               by               a               reduction               in               the               number               of               days               of               absenteeism               and               productivity               lost               while               at               work.
               Clearly               their               is               a               need               to               address               our               growing               dilemma               with               dysfunctional               members               of               society.

When               they               fail               to               get               the               help               they               need               with               their               disorders,               they               become               a               deadly               threat               to               themselves               and               others               in               their               community.

The               Affordable               Care               Act,               that               was               repealed               by               House               Republicans               in               Congress               yesterday,               attempts               to               mollify               this               crisis               by               preventing               insurers               to               regard               substance               abuse               or               mental               illness               as               a               condition               to               deny               coverage               as               a               "pre-existing               condition"               ;               nor               will               they               be               able               to               use               those               conditions               to               raise               premiums.

Furthermore,               "               mental               health               and               substance               use               disorder               services               will               be               part               of               the               essential               benefits               package               ,               a               set               of               health               care               service               categories               that               must               be               covered               by               certain               plans,               including               all               insurance               policies               that               will               be               offered               through               the               Exchanges               ,               and               Medicaid."               (               The               Affordable               Care               Act               &               Mental               Health:               An               Update)               -               http://www.healthcare.gov/news/blog/mentalhealthupdate.html
               The               tragedy               in               Tucson               should               not               become               a               missed               opportunity               to               get               all               of               us               involved               at               a               level               that               could               hopefully               prevent               any               similar               reoccurrence.

Next               time               it               may               be               our               own               communities               that               experiences               the               public               apathy               that               in               part               allows               this               to               happen.
               Related               Articles:
               Jared               Loughner               And               The               Sorry               State               Of               Mental               Health               Care
               How               the               mental               health               system               failed               Jared               Loughner
               This               article               was               originally               posted               from               my               blog               at               woodgatesview






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