Mental Illness Prevention Or Cause

Prevention is prevention, prevention is not causing, this is a point some mental health professionals just don’t seem to get. Let me make this point by taking a critical look at today’s editorial in The Oklahoma News. Entitled Prevention should be the focus of mental health fund, the body of editorial on what is seen as the need for more preventive measures in Oklahoma is quoted below.

THE statistics are seared into Terri White’s mind. Only one-third of Oklahomans who need mental health treatment receive it. Only 5 percent of youths who need substance abuse ever receive it. Most mental illnesses show themselves during the teenage years, yet there’s generally a six- to 23-year delay in treatment.

Apparently our statistics aren’t taken from the number of people actually receiving treatment; our statistics instead are taken from an estimation of the number of people suspected of needing treatment. How can you do this kind of thing without making a leap, and doing a hell of a lot speculation? Were this speculation the case, then prevention would be a matter of getting more people into treatment, but isn’t prevention more about keeping people out of treatment than getting them into it? Let me put this a different way, isn’t prevention about preventing people from receiving a diagnosis of mental illness rather than a matter of making more such diagnoses?

White, the state’s secretary of health and head of the state’s Department of Mental Health and Substances Abuse Services, says Oklahoma has made important strides in mental health care. But she also worries Oklahoma’s declining economy will erase the progress. It’s a valid concern.

Hold on, Ms White! Do you mean progress in manufacturing mental illness, or do you mean progress in preventing mental illness? This is an important distinction to make, and it’s just the kind of distinction I am trying to make here. By progress do you mean progress expanding the mental health service business, or by progress do you mean potentially contracting that business by managing to get people out of the racket entirely?

It’s hardly a secret that tough budget times make for tough choices. Schools and child welfare services typically fare better than other agencies. As White points out, that generally pits the mental health agency against corrections. The timing couldn’t be worse.

I wouldn’t have any arguments with you, mam, if your money actually went toward prevention. As can be seen, I just don’t think that is the case.

The science on behavioral health has come a long way in recent years, giving more insight than ever into how the health of the brain affects physical health. White said the state has some impressive treatment programs that have been nationally recognized. But Oklahoma, she said, desperately needs to focus more attention — and money — on prevention and early intervention to ward off the very expensive consequences of untreated mental health problems.

There we go again with those untreated mental health problems. Are mental health problems that don’t lead to treatment actually mental health problems at all? Answer that one for me, mam.

“If you have these diseases, you are more likely to see the inside of a police car, a jail cell or a prison cell than you are to ever see a medical professional,” she told The Oklahoman’s editorial board. “That has got to change in Oklahoma. If we don’t start actually doing early intervention and treating these diseases, we’re not going to be able to avoid all the negative consequences that come as a result of it. And unfortunately, we can’t afford it as a state.”

Here I don’t have any argument with the woman. If you close hospitals, and you don’t provide any sort of preventive services, well, what do you expect! Jails and prisons, as other people have put it, begin to serve as our treatment facilities, or more precisely put, warehouses. Where we have an argument is coming up.

To Oklahoma’s credit, the development of mental health and drug courts has helped many Oklahomans get the assistance they need. And with proof of success, the Legislature in recent years has set more money aside for those programs. Those programs need to grow as funding allows, but also need to be balanced against more efforts to identify mental health and substance abuse problems before they hit crisis level.

White touts the need for more preventative mental health screenings for adults and children that are neither extremely time consuming nor outrageously expensive. That seems a wise approach.

Mental health courts and mental health screenings are not, and I must be emphatic about this fact, preventative. Mental health courts would divert people from the criminal court system into the mental health system, and there is nothing preventive about doing so. People in crisis wind up in the criminal court system because of our lack of effective preventive measures, it is not a preventive measure itself.

Mental health screening has a very high false positive rate. It is generally a matter of throwing a net out there in the community hoping to catch a few more of those people with untreated mental illnesses speculation would have residing in the community at large somewhere. If a person has had a bad day, and answered test questions honestly about that bad day, doing so could give the person an unwanted and unneeded psychiatric diagnosis.

An 84% false positive rate given for one of the more popular screening programs illustrates that given one of these tests a mentally well person is more likely to be tagged mentally ill than a mentally ill person is likely to be found mentally ill. Again, not preventative.

Preventative is doing something about homelessness and poverty. Where life and survival are hard and precarious you will find high mental illness rates. When people have food in their bellies, a roof over their heads, a bed on which to snooze, a job in town, and caring companions, they are less likely to wind up in the state hospital.

Equally, if not more, preventative measures to take involve opening and supporting such often peer run community services as drop-in centers, crisis stabilization units, crisis respite centers, battered women shelters, safe houses, and other places of refuge for people in crisis. These are the kind of facilities that keep people out of jails, prisons, hospitals, and mental health courts. If you want to put your money into a place that would pay off in the end, then consider these other options. If you want to throw your money away on contributing to what constitutes an epidemic of mental illness, then, sure, mental health courts and screenings are the way to go.

Oklahoma may not be able to put more money toward mental health services in the next year or two. But it would be a mistake — a costly one down the road — to let the need for more and better mental health services fall completely off the radar.

Yes, and no. Spending no money on mental health care is preferable to spending lots of money on bad programs that further contribute to the spread of mental illness. You can throw your money away on expanding a broken mental health system, or you can work on creating a system that actually gets people seamlessly reintegrated into the community at large. When people recover from serious mental illnesses, the system is working; when people spend their lives in mental health treatment, the system isn’t working. We don’t need to get bogged down dealing with more people in that system than we had in that system previously, instead we need to see more people leaving that system.