Mental health questions brought up by the Navy Yard killings

       The commentary on Monday's shooting at the Navy Yard in DC has focused on the availability of guns, the effectiveness of security background checks and how a person could enter a military base with a shotgun.  As more is becoming known about the shooter it is apparent that he was a deeply troubled individual who was able to not just go untreated but allowed to perform work at a secure military base.  From the description of his behavior it appears that he would be diagnosised as suffering from paranoid schizophrenia.  This is a mental health condition that usually shows up in adulthood.  Persons with this condition are usually not a threat to the community but it is hard to clearly know when a person with this diagnosis could do harm to others in their delusional state.
       Monday's tragedy does point out that our mental health system still struggles with how to adequately address individuals with significant mental health problems.  I worked in the mental health field in the early 1970's during the transition from mental health care being delivered in an institutional setting (mental hospitals) to a system with the potential to have this care provided in the community. This effort was championed by mental health advocates who could point out the horrid conditions of many of our mental institutions. With the development of the psychotropic medications that were developed at this time there was hope that individuals with significant mental health problems, like schizophrenia, could function well enough to be placed in community settings.  During this time period I worked in a psychiatric halfway house that was transitioning many patients from St. Elizabeth's (St. E's to all of us) mental hospital that has existed in DC for over 100 years.  Many of the individuals who were placed at the halfway house were medicated with powerful tranquilizers, mainly Stelazine and  Thorazine.  The psychiatrists who placed schizophrenic individuals at the halfway house always alerted us to watch for the signs of regression which were usually hallucinations and irrational speech.  When I heard that Aaron Alexis claimed to have heard voices and felt vibrations I remembered that these were the two most common signs of deterioration of someone with schizophrenia.
      Monday's tragedy points out how forty years after the push to deinstitutionalize persons with mental health problems we still struggle with how to adequately manage their needs in the community.  The promised community health system that was to be developed during the deinstitutionalization process is woefully inadequate to manage the number of persons in our community with mental health needs.  Talk to any relative of an individual with mental health issues and they will tell you of the frustrations and inadequacies of our community based systems.  Walk around the downtown area of any of our major cities and you will see how poorly the mental health needs are being addressed.  Somewhere between locking people up in institutions and leaving them to struggle in our communities (and on our streets) a system should be developed to provide more humane care for individuals who struggle with mental health problems.
     So what's the reason we find ourselves in this situation today?   One word----MONEY.   We as a society still look at mental health needs differently than physical health needs.  We are willing to provide considerable financial resources for expensive physical health care but place very broad restrictions on how much mental health care for which insurance companies will  pay.  Often is it restricted to 5 or 10 mental health visits with a therapist. The stigma of mental health problems still profoundly impacts our willingness to address this treatment need.  We no longer lock these individuals away out of sight but it doesn't mean that we have adequately addressed how to treat these issues in our communities.  Monday's event are sadly a legacy of that failure.

P.S.
   If you are looking to support a good mental health organization in Howard County look at NAMI.

P.S.1

      You may have driven by St. Elizabeth's as you travel on Route 295 in DC without noticing it.  In the past couple of years the new Homeland Defense headquarters pictured above has been being built on the grounds of St. E's.  Homeland Defense in the foreground and St. E's in the background.

P.S.2
    Monday's blog will show the progress on the interior of the old Rouse Building as it slowly becomes a Whole Foods store.