Newtown shooting aftermath reopens discussion about how to aid mentally ill

There was a time when Marla, a local mother of a 10-year-old boy with mental illness, kept handmade laminated cards with her whenever she took the child out of the house. “My son is bipolar,” they read, “please just walk away.”

Once, when her son was about 5, a man came up to him in a store, reached over and mussed his hair and said what a “cutie” he was. To the stranger’s shock and disgust, the round-faced little boy spewed a sudden barrage of profanity and threats that his arm would be bitten off.

“My son is bipolar, please just walk away.”

Eventually, the child’s behavior made people so angry they would slash Marla’s tires or physically try to hurt her. So, she just stopped leaving home.

“People don’t understand. They just think you haven’t taught him or that you don’t discipline him,” Marla said. “He has a misfire in his brain. Something isn’t connecting, something isn’t moving around correctly or communicating correctly in his brain and it’s causing this to happen to him. He doesn’t want to be this way.”

For mental illness sufferers and their families, misconceptions about the disease can seem almost as debilitating as the illness itself. Many people still just see the behavior and not the malady, or simply fear what they don’t understand.

According to the American Psychiatric Association, about one-third of Americans believe mental illness is a sign of emotional or personal weakness. And nearly half admit to knowing either nothing or very little about mental disorders.

The stigma some feel because of their mental illness can be so strong that they would rather suffer in silence than seek help. And some families simply isolate themselves rather than try to explain what’s going on with their loved one.

Even when mental health does receive attention at the state or national level, it is often reactionary — in other words, when something goes wrong.

This has been the case after the mass shooting in a Newtown, Conn., elementary school in December. The nation is discussing mental health more than it has in quite a while. The Obama administration, for example, has called for better treatment programs geared toward mentally ill teens, better health care coverage and educational outreach.

Mental health advocates are watching closely, hoping lawmakers bring positive changes to a long-broken system.

“It’s an opportunity for us to have a conversation. The opportunity to dispel many of the myths and the stigma, as well as to advocate for the application and funding for the things that we know work, where there’s going to be payoff as opposed to continuing to do things the way we have historically done them,” said Wayne Lindstrom, president and CEO of the nonprofit advocacy organization Mental Health America.

One in four adult Americans, or about 58 million people, suffer from a mental disorder in a given year, the National Alliance on Mental Illness reports. And half of all lifetime cases of mental disorders begin by age 14.

Mental illness covers a spectrum of disorders including anxiety issues, depression, schizophrenia, eating disorders, post-traumatic stress disorder and autism spectrum disorders. For some people, mental illness lasts a lifetime; other people may be only occasionally affected.

Someone, for example, may suffer depression after a trauma such as the loss of a loved one, Lindstrom said. Post-traumatic stress disorder, or PTSD, can affect soldiers returning from war, and studies are even pointing to the development of PTSD in some patients who have suffered the trauma of a heart attack, he said.

“There is a tendency to think of mental illness as a dichotomous variable — either you are or you aren’t,” he said. “And the reality is that it’s a continuum, that any one of us can transverse up or down over the course of our lifetime.”

Science is still researching mental illness’s causes. But there is a strong link to heredity, combined with environmental triggers such as stressful or traumatic life experiences, Lindstrom said. The brain’s biochemical makeup is also connected to mental illness. And science is still learning about the neurobiology of mental disorders.

In the United States, the availability of mental health services is deemed woefully inadequate. In 2009, the National Alliance on Mental Illness gave the country an overall “D” grade for delivery of mental health care. Since then, states have cut their mental health budgets further because of the recession.

Nevada cut 28 percent of its general fund mental health budget from 2009 to 2012, placing it among the handful of states that have made the most “devastating” cutbacks, an alliance report shows.

State Sen. Justin Jones, chairman of the Senate Health and Human Services Committee, noted that the reductions have meant, for example, a 19 percent drop in mental health staffing and a loss of 100 beds at the Rawson-Neal Psychiatric Hospital in Las Vegas. All of this during tough economic times, when the need for services usually rises, he said.

Despite the cuts, there have been rumblings about proposed changes in Nevada’s mental health services. One proposal is for a 24-hour urgent care center in Las Vegas for the mentally ill, many of whom now have to seek help during a crisis at hospital emergency rooms. There’s also discussion of an outpatient commitment law that would help keep the mentally ill from continually revolving in and out of community jails by requiring them to receive treatment.

Besides staunching the wound, however, Jones hopes to steer the dialogue toward a broader understanding of mental illness and long-term, quality care. He said he has watched relatives struggle with bipolar disorder, and they have encouraged him to talk about it so that others don’t have to suffer from the stigma or a lack of services.

“My hope is that we take the opportunity that we’ve been presented, unfortunately as a result of (the recent shootings) ... not just to focus on a very narrow subset of those with mental illness who may find themselves dangerous, but on the much larger issue of funding for mental health services and making sure that those who do have episodic depression or paranoid schizophrenia or any other type of mental health issue, that they can feel safe talking about the issue with their family, with their health professionals, with their psychologists and psychiatrists so that they can get the help they need,” he said.

Jacqueline Harris, chairwoman of the Clark County Children’s Mental Health Consortium, agrees that the long-term approach is where Nevada, like many states, falls short. Programs that focus on early intervention and treatment, for example, are often the first to get cut, so that funding is used to simply pick up the pieces.

Nevada, she said, spends millions of dollars every year placing youths already wrapped up in the juvenile justice system into out-of-state residential treatment centers because of a shortage of local facilities.

A recent consortium report shows Clark County Juvenile Justice Services placed 188 youths with serious emotional disturbances in out-of-state centers during 2011. It costs the state’s Medicaid program more than $9.5 million a year for every 87 placements.

“I worked in early childhood mental health for 15 years and what we know is the sooner that there’s intervention, the better the outcomes … but we wait until it’s too late,” said Harris, who is also executive director of Bridge Counseling Associates in Las Vegas.

The consortium has recommended a series of “community-based, family-driven” improvements that include mobile crisis teams that would help families in their homes and lessen the burden on local hospitals. Between 2005 and 2009 there was a 40 percent increase in the number of youths in crisis entering local emergency rooms, the consortium report showed.

The report also calls for stronger partnerships with schools, including more screening programs to identify teenagers who may be suicidal; parent education programs; and family-to-family support services.

Another pressing issue, families and mental health advocates say, is the lack of providers in both urban and rural Nevada. The Elko Daily Free Press recently published an article that noted there are no psychiatrists in Elko County, which has a population of about 50,000, and said that some residents wait as long as a month for outpatient mental health services.

The ability to pay for services can also be a huge roadblock. Marla, whose son’s volatile behavior includes threats to harm family members, said her private insurance covers only one monthly therapy session and two weeks a year at a psychiatric hospital.

She said she finally took a charge of negligence in the family court system so her son would be placed in the custody of the Department of Social Services and receive services through Medicaid. He is now living in a therapeutic foster home on weekdays and comes home on weekends.

When he eventually comes back home full time, she won’t be able to afford most of his services, she said.

Charlene Frost, statewide family network coordinator for Nevada PEP, which offers support for parents of children with disabilities that include mental illness, understands the struggle to find help.

She is the parent of a child who has suffered from major depression and another with autism. Her family’s private insurance had a significant cap on how much could be spent on her children’s therapy and there was no access to services such as psychosocial rehabilitation unless they were on Medicaid.

“So just finding those therapists who will, first of all, take your insurance or will take your child is a challenge,” she said. “And finding somebody for medication management is a whole other ball of wax.”

Mental health care is a complex issue. But besides knowing where the gaps are, experts agree we have a pretty good idea of what can work — not just until the next crisis, but in a way that will endure.

Melissa Piasecki, a University of Nevada School of Medicine psychiatry professor, says addressing mental illness will take an integrated approach involving both mental health professionals and society to create services that work and to bring mental illness out of the shadows.

“There’s great momentum right now and I hope we can maintain it,” she said. “I think that the state legislatures throughout the country, if Nevada is any example, are acutely aware and have a lot of energy to pursue this topic and I’m hoping that the stars stay lined up like that.”