How About the 99 Percent of People with Mental Illness Who Are Not Violent?

By Rusty Selix, Principal Co-Author of Proposition 63 (with Senate President Pro Tem Darrell Steinberg) and Executive Director California Council of Community Mental Health Agencies and Mental Health Association of California

In the aftermath of the Newtown shootings it is a hopeful sign that there is broad societal concern about our failures in addressing the problems of mental illness. Like so many other media reports the recent Sacramento Bee editorial focused on that very small number of people whose mental illness is so disabling that they cannot care for themselves and must be considered for conservatorship. The Bee also addressed the even smaller number who have committed crimes or threatened violent acts and should be offered treatment through a mental health court or some form of court ordered treatment.

Yes there are such people and the families who care so deeply about them are right in their concern. However, those issues are irrelevant for the vast majority of people with mental illness. In fact neither Adam Lanza nor Scott Thorpe, the person responsible for killing Laura Wilcox for whom Laura' law is named, would meet the criteria of having a history of violence and resistance to treatment.

The perception in the media, and among some families, police and psychiatrists that this is a norm among people with mental illness is greatly misplaced. When we began the successful outreach and supportive "whatever it takes" voluntary programs that is the focus of Proposition 63 we focused on those at the greatest risk. These are the people homeless on the streets or hospitalized or incarcerated due to the neglect of their mental illness. Police, parents and psychiatrists said that less than half would accept that voluntary care because that had been their experience as authority figures. However, over 90% willingly accepted the care when outreach came from others with mental illness who had been homeless and from specially trained social workers. These proposition 63 programs are now serving 60,000 people which is the number we thought it would need to serve when we first wrote it ten years ago.

However, that 60,000 is a not a net gain of 60,000 people. Due to cuts in other funding during the recent recession counties have had to cut most of their other programs. As anyone who looks at the streets or our jails or hospitals can tell we still have a long way to go and Proposition 63 funding alone won't do the job. My co-author, Senate President Pro Tem Darrell Steinberg's call for the state and federal government to do more for this population is right on target.

We also need more funding for crisis residential programs. The state hospital association has reported that 70% of the people taken to hospitals for psychiatric emergencies don't meet the hospitalization criteria but would meet the criteria for such programs- if only they existed, but hardly any do. It is unrealistic to expect Proposition 63's limited dollars to meet that need even though that is an eligible use of those funds. Adding new state and federal funds would be needed.

However, that still represents a small percentage of the people with mental illness most of whom suffer silently and needlessly when only modest investments in a few therapy sessions and or medications could help them early in the onset of their illness and before their condition becomes disabling. To do so would save lives and dollars. 911 call data shows that 10% of young people ages 15 -25 attempt suicide during those years. Even greater numbers fail in school or can't work due to their untreated mental illness.

Nearly all see doctors occasionally and 1/3 of teenagers wind up in the emergency room each year due to accidents or physical health problems. It would be quite easy to include assessment and support for mental illness as a routine part of visits to primary care doctors or an emergency room. To do would not only save lives but also save dollars as studies show that when mental illnesses in the brain are not treated the rest of the body also suffers. People with untreated mental illnesses have significantly greater incidence of diabetes, heart disease hypertension obesity, smoking and other costly medical conditions.

Addressing mental health problems has historically not been included in primary care or emergency room services. Based on the studies showing that it is cost effective, it is a new emerging best practice to do this for mental health problems but it is not yet a standard activity.

Similarly classroom teachers know who these students are but we don't provide our schools with the support or connection to our health care system to provide the supports on campus where they will do the most good.

There is much work to do. Perhaps this latest tragedy can be the wake up call to address these longstanding neglected parts of our healthcare system.

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