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Our broken mental health system

Wednesday, Dec 19, 2012

* An Illinois Auditor General’s report from April of this year had some disturbing news about the state’s Firearm Owners Identification Card laws. Almost all circuit court clerks weren’t forwarding any info about mentally ill people to the State Police

The audit reviewed the state’s 44-year-old FOID program between 2008 and 2010 and found circuit court clerks in 99 of Illinois’ 102 counties weren’t forwarding names of potentially ineligible card holders to the Illinois State Police, which oversees the FOID program.

The failure to forward the information was the result of a state law that says a judge “shall direct” a circuit clerk to forward information about a mental illness ruling to the state police.

Without a specific order from a judge, the clerks were not passing along the decision.

In response, state police spokeswoman Monique Bond said the agency has opened the lines of communication with circuit clerks and the state court system in hopes of better coordinating the flow of information.

In August, Quinn signed legislation requiring clerks to ensure state police are receiving up-to-date information about mental health findings.

But that just covers those who are found mentally incompetent or judged not guilty by reason of insanity. That’s basic stuff. It’s enraging that the circuit clerks weren’t providing this information, and that nobody appeared to know about it, but at least that part is taken care of.

* More needs to be done, however. Much more. We need lots more public education in this country to help destigmatize mental illness issues. People need to be encouraged to seek help before it’s too late, and their families need to know about trouble signs and be warned that ignoring problems won’t make them go away. And maybe we need to talk about whether it should be so difficult to institutionalize some folks.

Whatever the case, the mental health infrastructure this country has in place right now is clearly not working.

* And there’s a very real danger that the mind-boggling Connecticut slaughter will make things worse on this front instead of better. The national media is all about ginning up the most fear it possibly can. This has to end. We need a grown-up discussion about mental health, about guns and about our society in general. And we can’t do that unless the media abandons its infantilism and grows the heck up, myself included.

- Posted by Rich Miller        


62 Comments
  1. - ZC - Wednesday, Dec 19, 12 @ 10:11 am:

    It is worth mentioning here that there is a major initiative underway to expand mental health services to the poor and uninsured, through an expansion of Medicaid and also a requirement that insurance providers cannot treat mental health services on a different basis than other kinds of health care. It’s called Obamacare.


  2. - cassandra - Wednesday, Dec 19, 12 @ 10:11 am:

    Does the basic package for insurance under the Affordable Care Act include mental health treatment? I think it does, and that should make treatment available to millions who can’t now afford it. Is the mental health community able to provide competent care to all of these new patients? I’m not sure.

    I would again point out, however, that Asperger’s, from which the Newtown shooter allegedly suffered, is not a mental illness but a developmental disorder. And he presumably had access to care through his father’s insurance, father being a corporate vp who presumably could insure his young adult children under current laws. This well-off family clearly had access to top-notch care if they chose to use it. Not sure what lesson we can draw from that, or how to fight tendency to stigmatize those who have a mental illness.


  3. - Anonymous - Wednesday, Dec 19, 12 @ 10:11 am:

    It takes a big man to admit he’s wrong. I appreciate your candor.

    I would suggest in addition to destigmatizing mental health issues, something needs to be done about parents who refuse to accept the fact that somethings wrong with their kids.

    There’s no doubt the mother of the shooter in Connecticut loved her kid but what was she thinking by traininh him to use a weapon of war?

    My point is, if you change the gun laws and destigmatize mental health problems that still won’t stop bad parenting. I beleive something needs to be done on both frontd. We need gun control and more acceptance and awareness of mental health issues. Maybe if something had been in place when she pulled him out of school, perhaps mandatory counseling sessions with a state appointed mental health provider, this wouldn’t have happened.

    I caught one of this kids high school administrators on NBC. It was clear the man was distressed that the mother pulled him out of school and away from those professionals who could help him. Should we be looking at parental rights too? That’s a tough one,


  4. - wordslinger - Wednesday, Dec 19, 12 @ 10:14 am:

    There are reports today that Lanza’s mother was seeking to institutionalize him, causing him to snap (why she left guns laying around the house is another question).

    Still, up to now, all that has been said about Lanza is that he had Asperger’s Syndrome. That is not a mental illness, and I hope folks slow down from characterizing it as such. And not everyone who is mentally ill is a homicidal maniac.

    As for institutionalizing the truly dangerous mentally ill, I’d imagine Sheriff Dart would tell you he has his hands full down at 26th and Cal trying to do a job that his office is not designed or equipped to handle.


  5. - Wensicia - Wednesday, Dec 19, 12 @ 10:26 am:

    I have worked in special education for the public school system for 25 years. I’ve worked with many students of high school age whom have Asperger’s or other autism spectrum disorders. I’ve never witnessed or heard of a violent attack by any of these students against others, let alone something of the nature involving mass murder.

    These jerks on cable and other TV networks need to stop bringing up this disorder every time they mention Lanza’s name. Many experts have commented already there is no connection between violence of this type and the developmental disorder. As wordslinger points out, it is not a mental illness.

    All these idiots are doing is stigmatizing people with autism and related disorders, which includes my teenage daughter who never had a violent incident in her life.


  6. - Give Me A Break - Wednesday, Dec 19, 12 @ 10:29 am:

    Groups like NAMI-Illinois have tried for years to address the problem of getting people into treatment against their will. This issue moves quickly from a discussion of medical needs to personal freedom and individual rights. A judge once told me, “there are time someone does not meet the standard for involuntary commitment until the bullet leaves the chamber.”

    About ten years ago, Shirly Allen of Roby, Illinois was the subject of the national media and many anti-goverment groups when her family sought an order for an involuntary evaluation.

    During the process, she refused to go and holed up in her home (with a weapon). ISP became involved and it turned into a weeks long standoff. The far right called it Big Government forcing her into treatment.

    The bottom line is, MH law is complex and not an easy thing to change.


  7. - I don't want to live in Teabagistan - Wednesday, Dec 19, 12 @ 10:31 am:

    Destigmatize mental health issues. Rich, you called people like that “crazy” many times in your talk at the City Club yesterday. Why don’t you practice what you preach?


  8. - mythoughtis - Wednesday, Dec 19, 12 @ 10:32 am:

    Please also keep in mind that in this case the person was over 18. Mom and Dad couldn’t do anything but pay for whatever the doctor got the young man and the insurance company agreed to in terms of care. The young man may never have signed the paper that said Mom and Dad could have a conversation with the doctor about his care.
    There is provision for the young man to be insured under his parents, but no provision for them to help determine treatment. So Mom may not have known a diagnosis if there was one.


  9. - Rich Miller - Wednesday, Dec 19, 12 @ 10:35 am:

    ===Why don’t you practice what you preach? ===

    I’m trying.

    But here’s the thing, if you want me to be sympathetic to this guy after his killing spree, you’re outta luck and out of line.


  10. - dupage dan - Wednesday, Dec 19, 12 @ 10:35 am:

    ZC, it’s worth mentioning here that part of Obamacare involves requiring states (like our fiscally hopeless Illinois) to provide the increased funding that Medicaid will need to provide the expanded services.


  11. - Bee - Wednesday, Dec 19, 12 @ 10:35 am:

    ~Is the mental health community able to provide competent care to all of these new patients?~
    I work in a county health department and I can tell you that, no, we are not able to provide competant care to all these new patients.

    We consistently have a waiting list of over 50 people. Some people have been on the waiting list for over a year. Several new counselors have just been hired, part time, to get our waiting list down to 50 people. We only see people who have no insurance or who are on the state medical card.

    Funding to providers have been cut, the list of acceptable medications have been cut, state operated mental health facilities have been closed and the need for mental health services continues to grow. Family docotrs are less willing to prescribe psychotropic meds because of the complexity of the cases.

    It has been said that 1 in 4 people suffer from a mental health issue, we need more funding.


  12. - Secret Square - Wednesday, Dec 19, 12 @ 10:37 am:

    “All these idiots are doing is stigmatizing people with autism and related disorders, which includes my teenage daughter who never had a violent incident in her life.”

    I agree. I too have a teenage daughter with autism who has never had a violent incident in her life.

    In my experience, auties/Aspies are far more likely to be the victims of bullying than to be bullies themselves. They tend to have a very strong sense of right and wrong, interpret what people say literally, and obey rules to the letter. They also tend to be unconcerned about what is trendy or in fashion, or what “everyone else” is doing, which is a quality I wouldn’t mind seeing in MORE youth and adults.


  13. - Liberty First - Wednesday, Dec 19, 12 @ 10:39 am:

    Journalists (generally liberals) are terribly narrow in their understanding of the world.

    What police do in Illinois is confiscate guns, often illegally. All they have to do is yank your FOID card based on some “incident.” You then have to go to a judge to get them back.


  14. - Ahoy! - Wednesday, Dec 19, 12 @ 10:42 am:

    Amen! We also need the majority of people to grow up and discuss issues rationally and with an open mind. You know, let’s have facts come before ideology.

    Rich, you’re part of the solution; you’re one of the most rational level headed media folks there is.


  15. - Confused - Wednesday, Dec 19, 12 @ 10:44 am:

    “I would again point out, however, that Asperger’s, from which the Newtown shooter allegedly suffered, is not a mental illness but a developmental disorder.”

    I’d be willing to bet a lot that he had a psychiatric illness going on instead of or in addition to Asperger’s. There is no law that says a 20 year old with Asperger’s can’t also have his first psychotic break due to paranoid schizophrenia, for example.


  16. - so... - Wednesday, Dec 19, 12 @ 10:44 am:

    ==Destigmatize mental health issues. Rich, you called people like that “crazy” many times in your talk at the City Club yesterday. Why don’t you practice what you preach?==

    Uh, shooting up an elementary school IS crazy.


  17. - The Captain - Wednesday, Dec 19, 12 @ 10:46 am:

    It’s worth mentioning that mental health spending is one of the first items to get cut the minute budgets get tight. When legislators are less likely to cut education or public safety the cuts usually come out of human services so any refocus on mental health programs that come out of the wake of this shooting are likely to be short lived and inconsistently funded. It would be nice if the legacy of this tragedy was a long-term focus on mental health but history suggests otherwise.


  18. - John D. - Wednesday, Dec 19, 12 @ 10:48 am:

    In one of my many previous jobs, I worked closely with several mental health out-patient facilities. Over the 5 years or so in that position, I watched as funding and resources for these facilities was reduced, cut or simply left unfunded.

    While many of the doctors and psychiatrists I worked with admitted that the old system of institutionalizing patents was flawed, they said it had provided a safe place for thousands of people that are now at the mercy of the Medic-Aid / Medi-Care system.

    Every aspect of the patients lives is now a “billable code” that has to be charged to some agency or facility. Even full-time mental health case managers can’t get past the paperwork to give patents real care.

    This nations mental health safety net needs to be repaired. Not just to prevent tragedies like Colorado or Connecticut from happening again, but to provide care for people that can not care for themselves.


  19. - zatoichi - Wednesday, Dec 19, 12 @ 10:48 am:

    Having a mental illnes does not automatically make a person some sort of uncontrollable killing machine. The vast majority of people with a mental illness are law abiding individuals who just want to go about their lives like everyone else. Are there exceptions? Of course. They show up in the news all the time. Just like most people can drink alcohol and simply have fun, others become violent/agressive. A solid idea on what caused Lanza’s actions may eventually come out, but whatever that thing eventually is, there will be thousands of people facing the exact same issues who would never do what he did. How to identify the Lanzas of the world is extremely tough. Watch for all the calls for gun control and then listen for the calls for increased mental health funding. Odds are neither will happen. In Illinois, community based mental health services just keep getting sliced every year.


  20. - Anonymous - Wednesday, Dec 19, 12 @ 10:52 am:

    =There’s no doubt the mother of the shooter in Connecticut loved her kid but what was she thinking by traininh him to use a weapon of war?=

    =There are reports today that Lanza’s mother was seeking to institutionalize him, causing him to snap=

    There were also previous reports that Lanza’s mother had collected her arms–and trained him to use them–in prep for an economic collapse. And one of the motives being cited is that he was “jealous” of the time she might have spent volunteering with kindergarteners last year (who would have been in first grade this year), but last I heard (it might have changed since then), no one can verify what role, if any–including volunteering, she had with the school?


  21. - Yossarian Lives - Wednesday, Dec 19, 12 @ 10:53 am:

    I believe the public does have a legitimate interest in learning about the perpetrators of horrible deeds like the Sandy Hook Elementary shooting. On the other hand, one of the ugly results of all the media attention is the tendency to jump to conclusions about whether the parents didn’t do enough to prevent it, whether they were in fact bad parents, etc. When we don’t know all the facts (and quite possibly never will), I think it’s reprehensible to judge people (one of whom is dead - a victim of her own son) for their parenting choices.

    Rich, I don’t think we need to be “sympathetic” to the shooter if that means excusing or justifying his behavior. Events like this challenge our beliefs about mental illness and beg the question of whether a “sane” person could commit such an act or whether a person who kills defenseless children for no particular reason is by definition mentally ill, all other evidence aside. These occasions beg the question of whether evil exists apart from biochemistry. So I get where you’re coming from. At the same time, “crazy” is heard by many people as a term denigrating the mentally ill - not just the mentally ill who are violent, so I concur that it’s less than useful.


  22. - dupage dan - Wednesday, Dec 19, 12 @ 10:58 am:

    From my position I can add that getting the mentally ill treatment that they would otherwise eschew is going to be very difficult given the current treatment philosophy. During the time of Randall McMurphy, folks were routinely hospitalized for little cause and frequently held for many years with little legal recourse to secure their release. It was during the 60s that this began to change with the advent of psychotropic medications. Prior to that the mentally ill were subjected to electro-convulsive treatment, insulin shock treatment, prefrontal lobotomy, hydro-therapy - amongst many others.

    The conditions found at the state psych institutions were severe enough that changes began to occur along with the advent of the new Rx meds. The pendulum has swung the other way, perhaps too far according to some. Persons diagnosed with major mental illnesses (schizophrenia, bi-polar and their offshoots and combinations) have the right to refuse medications and placements in facilities that provide care. Only by court order can a person be hospitalized against their will for any appreciable period of time. The law currently allows for a maximum commitment period of 180 days per court order. Rx can be forcibly administered ONLY while in a locked psych hosp - maximum period is 90 days per court order. Persons can be forcibly placed into an outpatient facility (nursing home) after having been court commited to a psych hosp AND being court commited to the outpt facility. Maximum duration of the commitment is 180 days. I am not aware of a NH going back to court to get a further court order extending the outpt commitment.

    Criminal proceedings can result in longer commitments - typically, a person found unfit to stand trial (UST) or not-guilty by reason of insanity (NGRI) can be held for a maximum period not to exceed the typical prison term for the offense commited.

    Guardianship can NOT be lawfully used to force a person to take psychotropic Rx or be forced into a locked psyh unit at a hospital or into a NH or other type of residential treatment program for the mentally ill. Those actions are the province of the Mental Health Code and Mental Health Court.

    There are strong advocates for persons who are mentally ill. They will not sit quietly while the rights of the MI are stripped for ANY reason. Any changes to the Mental Health Code will require enormous effort.

    While I agree that changes should be made - I wonder if we can really get into the mind of a mentally ill person to understand what they are thinking and or planning. Anonymous also mentioned that parents frequently are not able to recognize or accept that their child is severely mentally ill and in need of forced treatment. I can state that from my 20 plus years in the field this is a real impediment to the mentally ill getting treatment. The signs are frequently there but folks around the dangerous person are frequently too close to see it, recognize it or be willing to act on what they see. Those folks are, many times, the “first line” of defense.

    Community based treatment programs, BTW, are woefully underfunded and work well only for those mentally persons who are motivated to succeed in the community. They can NOT make a mentally person do anything that person does NOT want to do. The only way folks could be compelled to accept treatment in the community would be thru a process whereby they would have to appear regularly & submit to blood tests to determine Rx compliance. If they fail to do that, would we bring in law enforcement to find and apprehend the person? Can we expect success in that area in the long term? Or do we re-open the state hospitals and fill them up again?


  23. - Lincoln Lad - Wednesday, Dec 19, 12 @ 10:59 am:

    Rich - I was also at City Club and can tell you some of your comments caused many of us to pause. Institutionalizing people (in the past) was seen as and was inhumane in many cases. There are no easy answers… And I many of us who might question choice of words also recognize your intentions are also good.


  24. - Rich Miller - Wednesday, Dec 19, 12 @ 11:00 am:

    ===Institutionalizing people (in the past) was seen as and was inhumane in many cases.===

    The point is, it’s gone way too far the other way.


  25. - Formerly Known As... - Wednesday, Dec 19, 12 @ 11:06 am:

    1. This audit came out around April. I simply assumed steps were being taken to remedy these flaws since then. Apparently not much progess has been made during the past 8 months or so.

    2. === I’m trying. ===

    And it’s a good start. In this case, however, I’m with you - fundamental sympathies reside with the children and their families, not the shooter.

    3. === That is not a mental illness ===

    @wordslinger, excellent points. The Washington Post actually ran a solid post on this yesterday: “Confusing Asperger’s with mental illness, and mental illness with evil”.


  26. - Loop Lady - Wednesday, Dec 19, 12 @ 11:07 am:

    Lincoln Lad: I must say that committing someone to lock up is an idea easier said than done.

    1) Most hospitals will keep folks for a maximum of 14 days. This is usually not enough time for meds and therapy to reach therapeutic levels.

    2)There are few to no low cost long term facilities in this state and/or many others.

    No one is suggesting that we lock up folks that are a danger to themselves or society at large forever and throw away the key. People for the most part, respond totherapy and meds over time. We cannot allow our jails to serve as mental health facilities, because they are not.

    Currently, most health care plans do not pay for therapy that costs about $100/hour in the Chicago region.

    There’s alot of work to do and we as a society must demand it if we are to stop these mass killings.


  27. - Bulloney - Wednesday, Dec 19, 12 @ 11:10 am:

    The Circuit Clerks have an established procedure for reporting all case dispositions. Automatic Disposition Reporting (ADR) is in place statewide and it has ALL the necessary information that the State Police needs. Rather than blame the Circuit Clerks (which have become the favorite dumping ground for the legislature) direct your attention at ISP’s failure to extract this information in an efficient manner. Circuit Clerks are only (County) keepers of the Court record. They should not be expected to do the work for inept state agencies.


  28. - Small Town Liberal - Wednesday, Dec 19, 12 @ 11:16 am:

    I’ve definitely been guilty of being too lose with derogatory terms toward the mentally ill, this is something I will improve.

    I think the entire country needs to see mental health and physical health as equivalent issues, in fact as the same issue of general healthcare.

    ACA is certainly a good step toward providing better access to mental health resources, but I hope it doesn’t take another 50 years for the next major expansion of healthcare access.


  29. - MrJM - Wednesday, Dec 19, 12 @ 11:18 am:

    Journalists (generally liberals) are terribly narrow in their understanding of the world. What police do in Illinois is confiscate guns, often illegally. All they have to do is yank your FOID card based on some “incident.” You then have to go to a judge to get them back.

    Can you see why these naked assertions aren’t compelling to the vast majority of us?

    – MrJM


  30. - Some people call me Maurice - Wednesday, Dec 19, 12 @ 11:19 am:

    What about the mental health parity act…it’s a start..


  31. - Eugene - Wednesday, Dec 19, 12 @ 11:25 am:

    Community mental health programs have been severely cut, as previous commenters have pointed out. What is not as widely understood is that literally 98% of state psychiatric hospital beds have been closed over the past few decades. Much of what remains is used for forensic patients, those unfit to stand trial or not guilty by reason of insanity. However there is a terrible shortage of forensic beds, which means the mentally ill are filling up Cook County and other county jails.

    State hospital civil beds are limited to short term stays that stabilize persons who otherwise reside in the community. There are a tiny handful of long-term civil patients. The Quinn administration wants to close pretty much all of what remains of state mental health beds, civil and forensic. Most private hospitals do not want the mentally ill hanging around their emergency rooms, with or without insurance.

    Despite the happy talk, the Quinn people are motivated by money. I am afraid we are putting together the pieces for our own tragic incident in this state. Then everyone will wring their hands and ask what happened.


  32. - Loop Lady - Wednesday, Dec 19, 12 @ 11:31 am:

    Here, here, Eugene…


  33. - 47th Ward - Wednesday, Dec 19, 12 @ 11:39 am:

    Calling it a “broken mental health system” implies that it was ever a functioning thing in the first place. We used to institutionalize patients in prison-like facilities, which was essentially warehousing them out of sight and out of mind.

    My high school class once visited the Manteno Mental Health Center campus. They showed us the rooms where the electric shock “therapy” was conducted. They showed us the frontal lobes which were removed from some patients. It was barbaric.

    Today’s advances in pharmaceuticals have brought tremendous advantages in treatment, but we rely on out-patients to self-medicate. Some do, some don’t. Community based settings have replaced the warehouses, but they have many limitations. Too many people in need of help are falling through the cracks.

    There has to be a way to combine these extremes, but more importantly, we as a society need to understand that mental illness is like any other illness. If I tell you I had a heart attack last year, you might say “wow, I’m glad you’re OK.” If I tell you I was diagnosed as bi-polar last year, you might look at me as defective or dangerous.

    For too long we’ve tried to ignore or hide from the very real problems of mental illness. If my sister was a diabetic and also schizophrenic, I’d have no problem telling you about one of her diseases, but I wouldn’t volunteer the other.

    Until we get past this stigma, and until mental health achieves parity with other medical health issues, we won’t be able to create a functioning mental health “system.”


  34. - Formerly Known As... - Wednesday, Dec 19, 12 @ 11:40 am:

    === There are few to no low cost long term facilities in this state and/or many others. ===

    Closing the Tinley Park Mental Health Center and 1/2 of Chicago’s mental health clinics didn’t help matters, either. They weren’t sparkling new facilities, but they were the best and only options for many in the region.

    Unfortunately, hospitals in the area simply do not have the number of beds or capacity to fill this new gap in “bed days” available.

    Law enforcement officials and prosecutors will tell you from first-hand experience that the prison system winds up filling that gap for some of those folks.

    Silly us! Of course, there’s nothing to worry about. According to the Department of Human Services, Mayor Emanuel and Governor Quinn, everything will be just fine.


  35. - ArchPundit - Wednesday, Dec 19, 12 @ 11:42 am:

    ===As for institutionalizing the truly dangerous mentally ill, I’d imagine Sheriff Dart would tell you he has his hands full down at 26th and Cal trying to do a job that his office is not designed or equipped to handle.

    Actually I think he’d say he’s already doing the job without being given the resources. There is a high rate of mental illness amongst the incarcerated and not good treatment for people who mostly are coming back out to our streets.


  36. - ArchPundit - Wednesday, Dec 19, 12 @ 11:46 am:

    ==These jerks on cable and other TV networks need to stop bringing up this disorder every time they mention Lanza’s name. Many experts have commented already there is no connection between violence of this type and the developmental disorder. As wordslinger points out, it is not a mental illness.

    Yes, Aspergers (now just a part of ASD-Autism Spectrum Disorder) has no connection to violence. Autism does sometimes lead to fits in kids that can be violent, but those are almost always due to immediate stimuli. There is certainly no connection to Autism/Aspergers that leads to premeditated violence. Mostly, Aspergers level ASD tends to lead to very socially awkward people who cannot read social cues so people think they are weird. I would imagine people talking to the news about Lanza being awkward is adding to their horrible coverage. Lanza clearly had some mental health issues not related to Aspergers.


  37. - sam m - Wednesday, Dec 19, 12 @ 11:47 am:

    Mr Miller-your call for rational thinking and reporting is appreciated.The hysteria on all sides of this situation,the waving of flags by the anti-gunnners,and the circling of the wagons by pro-gunners,and the political posturing will make your suggestions even more difficult to become reality.This was a purely evil, unspeakable massacre incomprehensible to the average citizen and many don’t want to listen to reason,they find it simpler to jump on varied mob type causes.It’ll be tough to stop these varied stampedes.I don’t think we just don’t have the leadership,on either side of the aisles.


  38. - ArchPundit - Wednesday, Dec 19, 12 @ 11:48 am:

    ===Can you see why these naked assertions aren’t compelling to the vast majority of us?

    I remember an incident like he’s talking about. My uncle waving guns at my aunt and cousins for the umpteenth time, but this time they did something about it. But he wann’t a bad guy really, just had a problem when he was drinking–which was all the time.


  39. - John D. - Wednesday, Dec 19, 12 @ 11:53 am:

    == == Despite the happy talk, the Quinn people are motivated by money. I am afraid we are putting together the pieces for our own tragic incident in this state. Then everyone will wring their hands and ask what happened. == ==

    This is exactly what happened during my previous job. The State of Hawaii cut mental health benefits by 1/2 during their 2009 legislative session with an effective date of July 2009. By December 2009 there were 3 horrific crimes on Oahu alone were tied to schizophrenic patients that were no longer getting treatment.

    Additionally, the hospitals were overwhelmed by the number of patients that were being brought in to the emergency rooms. Caregivers were no longer able to help patients that were in crisis. They couldn’t call case managers or get into doctors offices because the funding for those visits was gone. The net result for the State was a loss because the emergency room visits wound up costing much more than the “preventative” case management that they had cut.


  40. - 47th Ward - Wednesday, Dec 19, 12 @ 11:54 am:

    === just had a problem when he was drinking===

    Addiction disorders are a HUGE mental health issue, and like other mental health problems, the person who has it is often extremely reluctant to seek help.


  41. - dupage dan - Wednesday, Dec 19, 12 @ 11:55 am:

    ArchPundit has a point. The largest provider of mental health services in the state of Illinois is the Department of Corrections.

    47th Ward is correct - the system never really was functioning properly.

    Sorting this tragedy out with an eye towards forming a treatment system that can identify mentally ill persons who are likely to commit violent acts towards other persons is a VERY difficult proposition.

    Another twist on this whole thing is that there are groups out there (think Scientology) that do not believe there is a disease called mental illness. Many subscribe to the philosophy and “teachings” of Thomas Szaz. There was a case several years ago that was in Time Magazine where a pt at Chester MHC who fought an involuntary court order and had as an atty someone from the Church of Scientology. Can’t say the name of the pt. Interesting situation.


  42. - wordslinger - Wednesday, Dec 19, 12 @ 12:11 pm:

    –Actually I think he’d say he’s already doing the job without being given the resources–

    Arch, that’s exactly what I meant to say, but I can see now I wasn’t making my point clearly.

    I’ve heard Dart say quite often that he operates the largest facility for the mentally ill in the state. That’s clearly not his mandate, nor does he have the resources to do it.


  43. - ArchPundit - Wednesday, Dec 19, 12 @ 12:14 pm:

    -Arch, that’s exactly what I meant to say, but I can see now I wasn’t making my point clearly.

    Great minds. Or not so great minds…


  44. - amalia - Wednesday, Dec 19, 12 @ 12:33 pm:

    amen, Rich.

    please everyone start by not saying that Asperger’s is the cause of violence. while there may be Asperger’s syndrome folks who are violent, an Asperger’s diagnosed individual is not by definition violent. and, as I stated a couple of days ago on a thread, I really worry about someone I know who is a professor who is Asperger’s diagnosed, in that I worry about what he is hearing in the news now, that it stigmatizes him. and I hate that. he’s an awesome, smart person, who acknowledges his social awkwardness but contributes so much to discussions we have with a group of friends he occasionally visits.

    and for those who have friends or family who suffer from issues which have or might put them into a facility, I feel your difficulty. it is hard to deal with that. and often frightening. there should be more to help everyone involved.


  45. - geronimo - Wednesday, Dec 19, 12 @ 12:47 pm:

    You have to wonder how the shooter in Connecticut could so intelligently plan out his events. From the clothing worn, to the packing of the ammunition and guns, to shooting out the school window and finally, having the sane thought of destroying himself as he heard responders. Sounds very logical, methodical and sane. Does everyone who creates violence upon another person get the label of mentally ill? Or do we just say that because there doesn’t seem to be any other explanation other than maybe, morally ill? I worry that it’s a convenient label that somehow explains the actions but misses the mark. Mentally illness is not usually the equivalent of violence but there are other factors, maybe more important that drive people to these kinds of actions.


  46. - reflector - Wednesday, Dec 19, 12 @ 1:01 pm:

    Rich,Once again you are right.


  47. - dupage dan - Wednesday, Dec 19, 12 @ 1:21 pm:

    geronomo, legal insanity and mental illness are not necessarily the same thing. I know that’s not exactly the question that you are posing, tho. A person can be very seriously mentally ill and be able to do exactly what the Conn murderer did - including all the planning and the like. Someone who could be found not guilty by reason of insanity would be so wrapped up in the psychosis as to not be aware that the act was criminal and could, therefore, not even attempt to plan or hide the actions.

    The actions of a murderer may seem like that of a madman - it is entirely possible that the perpetrator is quite sane, tho. Therein lies the problem with trying to prevent these types of crimes by revamping the mental health treatment programs that exist. The programs may miss the likely violent mentally ill person. The person may not exhibit behavior that would immediately bring the person to the attention of the mental health authorities. Very hard to address this issue.

    Asperger’s syndrome is not typically connected with the type of actions that took place in Conn. At least I have never heard of such an instance. Unfortunately, some in the MSM have painted a darker picture of persons with this diagnosis and that is very troubling.


  48. - 47th Ward - Wednesday, Dec 19, 12 @ 1:55 pm:

    The shooter in Connecticut was 20 years old, which is about the time schizophrenia often manifests itself in men. We’ll probably never know what caused this man to do what he did, but it was almost ceraintly not directly related to Asperger’s, assuming he was so diagnosed as reported.


  49. - Secret Square - Wednesday, Dec 19, 12 @ 2:10 pm:

    “I’d be willing to bet a lot that he had a psychiatric illness going on instead of or in addition to Asperger’s.”

    “The shooter in Connecticut was 20 years old, which is about the time schizophrenia often manifests itself in men.”

    That is most likely the case. If he were just beginning to manifest symptoms of paranoid schizophrenia or something similar, it might not have been formally diagnosed and on record yet. His Asperger’s/autism, however, was apparently on record (this is usually diagnosed in preschool or early grade school) so that is what the media latched onto, unfortunately.


  50. - Liberty First - Wednesday, Dec 19, 12 @ 2:24 pm:

    - MrJM - Wednesday, Dec 19, 12 @ 11:18 am:

    Journalists (generally liberals) are terribly narrow in their understanding of the world. What police do in Illinois is confiscate guns, often illegally. All they have to do is yank your FOID card based on some “incident.” You then have to go to a judge to get them back.

    Can you see why these naked assertions aren’t compelling to the vast majority of us?

    – MrJM

    Pew Research Center 2007 journalist self identification 39% moderate 19% liberal - Annenberg confirms the data with jounalists leaning to the left at twice the rate of the general populace while only 10% claim to be conservative. On the gun issue- Courts in NY just ruled police have to have a reason to ask if they are in possession of a gun. If you think police are going to tell you your rights, your mistaken.


  51. - dupage dan - Wednesday, Dec 19, 12 @ 2:25 pm:

    From some recent reports it seems that the shooter had been having difficulty for many years - not sure if that difficulty can be tied directly to the rampage. It appears that the brother had attempted to assist but became estranged and the mother was left alone, post divorce, to deal with him. That wouldn’t necessarily take schizophrenia off the table. Reports are that the mother may have been planning on seeking a court ordered hospital admission and the son, finding out, decided on a different course of action.

    Not impossible other diagnoses were present but I would agree with 47th Ward - I have never heard of this type behavior associated with Asperger’s.


  52. - Cincinnatus - Wednesday, Dec 19, 12 @ 3:24 pm:

    FWIW:

    http://www.gallup.com/poll/159422/stop-shootings-americans-focus-police-mental-health.aspx?utm_source=alert&utm_medium=email&utm_campaign=syndication&utm_content=morelink&utm_term=All%20Gallup%20Headlines%20-%20Politics


  53. - I don't want to live in Teabagistan - Wednesday, Dec 19, 12 @ 3:29 pm:

    Rich, what’s gone too far the other way? That we don’t involuntarily institutionalize mentally ill people who haven’t been arrested? Basically, the people at Tinley and other MH facilities were/are either “acute” i.e., they showed up to an ER and exhibited a mental illness or “forensic” i.e., they got arrested and they exhibited a mental illness. I think DHS testified the average stay at a state-run MH facility for an acute client is 14 days.

    We aren’t going back to the pre-1960’s.


  54. - dupage dan - Wednesday, Dec 19, 12 @ 4:48 pm:

    IDWTLIT,

    I think Rich meant that we went so far to the side of the mental health recipient rights side of things - meaning we bend over backward to accomodate the rights of the mentally ill as opposed to the rights of the rest of the population. In the 19th century and the first 50 years of the 20th, folk were routinely placed in institutional care for sometimes petty, minimal, reasons and kept there for the balance of their adult lives w/little recourse to seeking release. No one wants that to happen again. However, living with the acutely psychotic in our midst with no means to know if they are prone to violence results in the Conn massacre or the pushing of that main onto the tracks in NYC, among other tragedies.

    14 days at TPMHC is nothing. Many who visit there sign in late in the month so as to have 3 hots and a cot until the check comes on the 3rd. Sure there are the severely ill who should be held until they are no longer a danger to self or others. However, we know from recent experience that some of the mentally ill don’t end up in hospitals at all for whatever reason. The first time they come into contact with authorities is after the mayhem and they are about to kill themeselves when they hear the sirens in the distance.


  55. - robin the retriever - Wednesday, Dec 19, 12 @ 6:10 pm:

    I used to work in the public school system and unfortunately dollars affect who receives care. If the school district already has the maximum number of special ed students assigned to a teacher, then the next diagnosis requires another teacher to be hired. Coincidentally, the diagnosis might be delayed a year or so.


  56. - steve schnorf - Wednesday, Dec 19, 12 @ 6:58 pm:

    I definitely agree it would be good to substantially improve our mental health programs and treatment here in Illinois. And that will cost a lot of money. And we don’t have any money. We will be very lucky if funding for mental health services aren’t cut in each of the next few budgets. And that’s not Gov Quinn’s fault, because if they aren’t then some other services areas are going to be cut even more than otherwise necessary. Because we have no money. If the tax increase is made permanent we still don’t have any money. If it isn’t, then we have even less, and things get cut more-including mental health services.

    If I can be of any further assistance in explaining what we face, feel free to ask.


  57. - wishbone - Wednesday, Dec 19, 12 @ 9:36 pm:

    Anyone diagnosed (not adjudicated) by a competent medical authority as having a severe mental disability should be prohibited from buying, owning, or having access to a firearm. Every such diagnosis should be reported to local law enforcement for followup action. If we can deny access to aircraft without a full adjudicatory hearing (the no fly list) we can do the same for guns. I am a strong supporter of the Second Amendment, but it doesn’t apply to crazy people.


  58. - RNUG - Wednesday, Dec 19, 12 @ 10:57 pm:

    robin the retriever @ 6:10 pm:

    Speaking from experience, in Special Ed the squeeky wheel gets the grease. If you show up with a 6 inch thick stack of the school districts own paperwork re evaluation and needs that shows they’ve been giving you the run-around, and explain they can either find a slot for your kid or that stack will be exhibit A in the lawsuit you are filing under ADA, a slot magically opens up.


  59. - just thinking... - Wednesday, Dec 19, 12 @ 11:15 pm:

    - wishbone - Wednesday, Dec 19, 12 @ 9:36 pm:

    It is estimated that 20% of the US population will have a mental illness in their lifetime. Denying 1 in 5 Americans a constitutional right means the right and the Constitution is worthless.

    A severe mental disability is often a matter of when the person is evaluated. Many mental illnesses are cyclical and the persons have good days and bad days (and this applies to all mental illnesses not just bipolar).

    Further, requiring all persons with a mental illness to be reported to police is the surest way of insuring people will not seek help until it is too late and almost certainly causing another tragedy.


  60. - wishbone - Thursday, Dec 20, 12 @ 12:30 am:

    “Further, requiring all persons with a mental illness to be reported to police is the surest way of insuring people will not seek help until it is too late and almost certainly causing another tragedy.”

    In virtually every recent mass shooting that I am aware of medical personnel and/or family members knew the shooter had a “serious” mental health problem well in advance of the tragedy. Having non uniformed law enforcement intervene early in those cases to deny access to firearms would have saved countless lives. Again the no fly list is the kind of approach needed. Having to go to court first in each case simply makes the legal system complicit in mass murder. If a person believes they have been unfairly denied their rights under this system, of course they can appeal to the courts for redress. It is time to put the safety of the majority ahead of the feelings of the severely mentally ill. I have enough trust in the skill and integrity of mental health professionals to believe that they can be entrusted with this responsibility.


  61. - whetstone - Thursday, Dec 20, 12 @ 12:51 pm:

    A couple things to be careful about:

    1. Diagnosing the shooter anytime soon. Read Dave Cullen’s “Columbine,” or the pieces that preceded it. We didn’t have a good psychological profile of Harris and Klebold until five years after. And they left an unprecedented trail of evidence.

    2. Drawing much if any conclusions for awhile. Almost every initial report was wrong. We’re already on our third report about whether the shooter played violent video games (he did; he didn’t; he did). One thing that does seem apparent so far is that he had few friends and left little in the way of an online presence. He could be unusually difficult to figure out, not just for journalists but for law enforcement.


  62. - whetstone - Thursday, Dec 20, 12 @ 1:21 pm:

    “The actions of a murderer may seem like that of a madman - it is entirely possible that the perpetrator is quite sane, tho.”

    I’d take a look at the research of Joe Newman at UW-Madison and his colleagues (it comes up briefly in Dave Cullen’s work). Psychopathy (the closest diagnosis we have to “evil”) sort of is and isn’t sane–they’re aware of good and evil, they just don’t feel it, react to it, or value it.

    Newman’s theory is that it’s like a learning disability, and he’s got some interesting lab and neurological evidence to back it up. The neurology of psychopathy is in its infancy; it may change how we think of it as “sane” or not. Having a mature conversation about mental health has to recognize what we don’t know.

    As a side note, I don’t know what to make of the discussion about sympathy. The portrait emerging of the shooter is that his life was horrid, perhaps entirely as a result of his own brain. Can I be sympathetic to that, without being sympathetic to him as a mass murderer? Is it even a useful question? I have no idea.


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