Is Mental Illness the Problem?

The school shooting in Connecticut is a sign that we are way overdue for some adult conversations about mental illness. While Liza Long has started the conversation in her viral piece "I Am Adam Lanza's Mother," not all people with severe mental illness are violent. But she raises a valid question: Is mental illness the problem?

Treatment Barriers are the Problem

When President George W. Bush commissioned the New Freedom Initiative, the study found that a major barrier to mental health treatment is "unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance”. Simply put, there's a double standard for mental illness. While parity is the law, many private insurance companies have used loopholes to get out of paying for it. This makes mental health treatment difficult to access for people lucky enough to have insurance.

It gets worse the more severe the mental illness. According to the American Journal of Psychiatry, nearly 50 percent of people seeking mental health care are forced to rely on self-payment for treatment. Gina Eckart, of Wishard Memorial Hospital, writes “This is a growing population and it's putting a strain on the community mental health center systems, whose mission it is to serve the seriously and persistently mentally ill. Often patients do not qualify for Medicaid or Medicare because the severity of the mental illness does not meet criteria or the duration of symptoms and impairment of functioning. While troublesome to the individual, the illness is not significant enough to meet eligibility for these federal programs. Resources available to treat those persons with mental health concerns who do not fall into the severe and persistent category are limited.”

Without treatment, symptoms of mental illness often become more severe. And that's the last thing a person with severe mental illness needs.

Stigma of Mental Illness is the Problem

Part of the reason people with mental illness do not always seek treatment is stigma. The stigma attached to mental illness is so strong that a National Mental Health Association (NHMA) survey ranked it the number one barrier to treatment. According to former U.S. Surgeon General, Dr. David Satcher, nearly two-thirds of all people with diagnosable mental disorders do not seek treatment, in large part due to mental illness stigma.

Unfortunately, the media often do more to perpetuate the stigma than to eliminate it. In the 1999 Mental Health: A Report of the Surgeon General, Satcher notes that in the 1950s, about 13 percent of people surveyed considered individuals with psychosis as violent. In the 1990s, that number rose to 31 percent. According to a NMHA survey, only 27 percent of the general public believes that successful treatment exists for schizophrenia, compared to 47 percent of caregivers and 58 percent of people with schizophrenia. Fifty percent of the general population thinks people with depression can hold jobs and 49 percent of the general population thinks people with depression can raise families, but only 14 percent of the general public feels that a person with schizophrenia can do either.

Satcher writes: “Why is stigma so strong despite better public understanding of mental illness? The answer appears to be fear of violence: people with mental illness, especially those with psychosis, are perceived to be more violent in the past. This finding begs yet another question: Are people with mental disorders truly more violent? Research supports some public concerns, but the overall likelihood of violence is low. The greatest risk of violence is from those who have dual diagnoses, i.e., individuals who have a mental disorder as well as a substance abuse disorder. There is a small elevation in risk of violence from individuals with severe mental disorders (e.g., psychosis) especially if they are non-compliant with their medication. Yet the risk of violence is much less for a stranger than for a family member or person who is known to the person with mental illness. In fact, there is very little risk of violence or harm to a stranger from casual contact with an individual who has a mental disorder. Because the average person is ill-equipped to judge whether someone who is behaving erratically has any of these disorders, alone or in combination, the natural tendency is to be wary.”

Where To Now?

Now is the time for a serious conversation about these two barriers to mental health treatment. We need to make it easier to access treatment, and we need to make it acceptable to seek help. We need to treat mental illness the same way we treat physical illness. Because anything that can be done to prevent another mass killing by someone with untreated severe mental illness is worth it.