US shooting revives debate over mental health careDecember 20, 2012 by Jean-Louis Santini in Medicine & Health / Psychology & Psychiatry
The deadly US shooting rampage last week has revived debate about access to mental health care—a tough issue as state funds dry up and laws make it difficult to treat people against their will.
So far, authorities have not yet confirmed that the Newtown shooter, 20-year-old Adam Lanza, suffered from any particular psychiatric disorder.
Lanza—who shot his mother in their home before killing 20 children and six adults, and then himself, in a primary school—reportedly had Asperger's syndrome, a form of autism not usually linked with violent behavior.
Despite the US epidemic of gun violence, with more than 60 mass shootings since 1982, the availability of psychiatric care is dwindling, with hospitals closing and community health services slashed due to budget cuts, doctors say.
"We might have wonderful new treatments but you cannot deliver them to the people who need it," Jeffrey Swanson, a professor of psychiatry and behavioral science at Duke University in North Carolina, told AFP.
When asked about the reasons, Swanson said: "They don't have insurance, or maybe they are homeless and addicted, or they don't think they are mentally ill."
The situation is made even worse by the reduction in the number of facilities providing mental health care services, he added.
Since 2009, the funding allocated by state governments for psychiatric care has fallen by a staggering $4.35 billion, according to the National Association of State Mental Health Program Directors.
In the past three years, 10 percent of the available beds in psychiatric hospitals have been lost nationwide, and the trend—which had been halted a decade ago—is only getting worse.
"Mental health resources are shrinking—actual psychiatric hospital beds and public funding," said Lisa Gold, a professor of clinical psychiatry at Georgetown University in Washington who also maintains a private practice.
"For people without insurance, it's even worse," she said. About 30 million Americans do not have health insurance.
Gold also criticized changes in laws, noting: "At one time, it was much too easy to lock someone up. Now it's almost impossible to put someone into a psychiatric hospital for treatment against their will."
And even when a patient is admitted to a psychiatric facility, the average length of stay is "three to seven days," Gold said—not enough time to make a real difference, as most medications only take effect after two to six weeks.
She also noted that hospitalizations usually only occur when a patient is in crisis, and presents an imminent danger to himself or others.
But even under those circumstances, it is often impossible to commit a person against his or her will. In most cases, a person must commit a crime to be hospitalized by force.
One possible motive of Lanza now gaining traction in the US media is that his mother Nancy was trying to have him committed, and that his anger over her efforts may have caused him to snap.
Gold said that given the difficulties of having someone committed, parents are sometimes forced to press charges against their children after a physical fight so they are sent to juvenile detention and considered for treatment.
"It's horrible," she said.
The Georgetown professor said the viral blog "I Am Adam Lanza's Mother," which was written by a woman who has a 13-year-old mentally ill son, poignantly describes the desperate situation faced by overwhelmed parents needing help.
According to a 2010 study by the National Institutes of Health, about 20 percent of youths aged 13 to 18 suffer from a mental disorder at some point in their lives.
A further analysis of the study done last year showed that only 36 percent of those teens received psychiatric treatment. Of the most seriously disturbed, only half were treated.
"There are a lot of depressed teenagers who need more help that we give them," said Katherine Newman, a professor of sociology at Johns Hopkins University, calling for more funding for mental health.
(c) 2012 AFP
"US shooting revives debate over mental health care" December 20, 2012 http://medicalxpress.com/news/2012-12-revives-debate-mental-health.html