Why mental health treatment is not an easy solution to violence

Nikolas Cruz, who was charged with 17 counts of murder in the Parkland school shooting, in February 2018. AP Photo/Mike Stocker

Sarah L. Desmarais, North Carolina State University

In the wake of mass shootings and other tragedies, a frequent refrain is: Why don’t we get those dangerous people off the streets? And, just as frequently, people suggest that mental health treatment is the answer.

Yet, for two main reasons, mental health treatment is not an easy solution to violence. The process of treating mental illness is difficult and complicated. More importantly, the vast majority of people with mental illnesses are not violent and the vast majority of lethal acts of violence are not perpetrated by people with mental illnesses.

I am a forensic psychologist and professor of psychology. I have studied mental illness, violence and mental health treatment at length. Here are some reasons that mental health treatment is not going to “cure” violence.

Identifying symptoms of mental illness

Recognizing that someone is experiencing mental health problems is a necessary first step to treatment. This requires that either someone recognizes and discloses his or her own symptoms of mental illness, or that others identify a person’s symptoms.

People with mental illness often do not recognize they are ill. Photographee.eu/Shutterstock.com

People may not want to come forward with their symptoms because of stigma and concerns that friends and others will view them as dangerous. They also may not recognize that they have a mental illness. Indeed, lack of insight or unawareness of symptoms is a feature of many serious mental illnesses, such as schizophrenia or bipolar disorder.

Alternatively, mental health and other professionals can use universal screening protocols to screen everyone in a given setting, such as a school, workplace or doctor’s office, for symptoms of mental illness. These are short questionnaires that survey a range of symptoms that may indicate the presence of mental illness.

A positive screen does not mean that someone has a mental illness, however. It means that he or she may be at risk. To be diagnosed after a positive screen, that person would have to receive an in-depth evaluation by a health care professional.

Routine screening requires a place of regular contact. Federal laws mandate that Medicaid-eligible children are screened for mental health conditions and recommend screening in schools more generally. The American Academy of Pediatrics also recommends routine screening of children and youth in primary care settings.

But many schools and primary care offices don’t conduct routine mental health screening. Even when they do, they are not equipped with the skills or resources to follow up with comprehensive mental health treatment.

Challenges to providing treatment

Providing mental health care is not necessarily a straightforward task. People with mental illnesses may not want to seek treatment, and family, friends or teachers can’t simply force them to go. People with mental illnesses also have the legal right to refuse treatment, except in severe cases.

In such cases, discussion typically turns to involuntary treatment. Every state has civil commitment laws that establish criteria for determining when involuntary treatment is appropriate.

Although the specific legal standards vary by state, these laws generally describe criteria relating to the physical danger a person presents to himself or herself or to others due to a mental illness. In other words, for someone to be treated against their will in a hospital or in the community, a mental health professional must determine that: a) the person is suffering from a serious mental illness; b) he or she presents a serious, typically physical, threat to himself, herself or others; and c) that the threat is due to the mental illness.

Civil commitment is a legal process. There are two key points here. First, if the threat to self or others cannot be attributed to serious mental illness, then involuntary treatment standards do not apply. Second, a caregiver cannot make this decision; it must be made by a court. People looking for solutions to violence should not overlook these points.

People with mental illnesses are as heterogeneous as those without when it comes to the causes and motives for violence. While some have symptoms that lead them to act violently, others have symptoms that are not relevant or even decrease their risk of violence.

And, while some mental health conditions are more clearly and strongly linked to violence, such as personality disorders and substance use disorders, these conditions would not typically meet involuntary treatment standards.

Long waits and limited resources

What happens when someone seeks mental health treatment voluntarily or is involuntarily committed? It depends. Our mental health services are overburdened and under-resourced. For example, we need somewhere between 40-60 beds per 100,000 people, but there are only about 11 beds per 100,000. Mental health settings across the United States have long wait lists and are under pressure to discharge patients quickly because of overcrowding, limitations on what insurance will cover, or lack of insurance altogether.

A recent report on barriers to outpatient mental health services in Massachusetts, for example, found that children, those who needed a psychiatrist, and adults covered by Medicaid were among those who waited the longest – often months. While waiting for treatment, symptoms may worsen. Untreated symptoms can result in acute mental health crises that lead to stays in hospital emergency departments or in jails, where their symptoms worsen.

Long waits and limited coverage are barriers to mental health treatment. Chinnapong/Shutterstock.com

In addition, while there are many treatments with demonstrated effectiveness, providers may be limited in terms of the services they can provide and bill for. For example, insurance may not cover certain types of treatment or may limit the number of treatment sessions. There also can be challenges to the implementation of evidence-based practices in mental health settings that reduce their availability. Many people with serious mental illnesses have publicly funded insurance, such as Medicaid, or are uninsured, further limiting their treatment options.

About one-third of those diagnosed with mental illness do not receive mental health services.

Treatment for mental illness isn’t going to lower rates of violence

If we were able to successfully treat people with serious mental illnesses, how would this change rates of violence in the United States?

Not much.

Although serious mental illnesses are associated with increased risk for violence, the rate of violent incidents in the United States that is attributable to mental illness is quite small – only about 3-5 percent. And, the rate of gun violence perpetrated by adults with mental illnesses is even lower – about 2 percent.

In fact, adults with mental illnesses are much more likely to be victims than the perpetrators of violence.

There are many social, legal, and even financial reasons why providing mental health treatment – and increasing funding to do so – is the right thing to do. But my research, and that of others, shows that addressing violence in the United States just isn’t one of them.

Sarah L. Desmarais, Professor of Psychology, North Carolina State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

What’s the 411 on the new 988 hotline? 5 questions answered about a national mental health service

The 988 Lifeline will connect callers with specialists trained to assist with mental health crises, including psychotic symptoms and substance abuse.

Derek Lee, The Ohio State University

Beginning July 16, 2022, people struggling with mental health crises can now call 988, a new number focused on providing lifesaving suicide prevention and crisis services. But 988 is not just a shorter, easier-to-remember replacement for the current suicide hotline. Congress and the Federal Communications Commission also established the 988 Lifeline to address longstanding concerns in mental health care.

The Conversation asked Derek Lee, a PhD student at The Ohio State University in Counselor Education and Supervision and a therapist, to explain the new service and how it is different from the old hotline. Lee’s academic and research focus is on suicide, including training, intervention and prevention.

What is 988?

The three-digit number is part of a new national mental health program. In 2020, the Federal Communications Commission designated 988 as the help line number, and Congress authorized funding for the 988 Lifeline Program.

Can people still call 1-800-273-TALK?

Sure. The soon-to-be old number has been operational since 2005, but it will not be going away just yet.

July 16 is when 988 went live nationally and callers can also begin using it to call, text or chat.

What’s wrong with the old number?

The system behind it, including its 200 call centers currently in the national crisis line network, according to a 2019 report on the program.

A major problem is that call centers don’t always have the staff or the technology to handle growing numbers of calls.

Calls that in-state centers are unable to answer get rerouted to centers out of state through the system’s backup network. This means that the operator may be less familiar with local crises, according to a spokesperson for Vibrant Emotional Health, the nonprofit that administers the crisis line program. Or incoming calls might simply “bunch up,” creating a telephone logjam, and leave callers waiting on hold “too long,” a time period the report does not define.

The report does note, however, that there isn’t a consistent standard for wait times, staffing or other operational aspects of the call centers. State governments regulate them, and they are independently operated.

How will 988 be different?

That’s unclear. Vibrant hasn’t released specific plans. Congress hasn’t either, but the Behavioral Crisis Services Expansion Act introduced last year requires call centers to “offer air traffic control-quality coordination of crisis care in real-time.”

Where will the money come from to pay for all this?

The shift to 988 comes with funding at the state and federal levels, as well as federal oversight to assure equitable access. Initial funding is coming through federal channels, including the American Rescue Plan, Community Mental Health Services Block Grant and President Biden’s proposed 2022 fiscal year budget. Most of the long-term funding will come from individual states.

Why is all this happening now?

Much of the discussion began during the pandemic, which really brought mental health issues to the forefront. A study of 8 million calls to help lines in 19 countries and regions found that call volumes jumped during the initial wave of coronavirus infections. At the six-week peak, the total number of calls was 35% higher than before the pandemic.

In the U.S., the coronavirus national emergency and the widespread lockdown that followed brought nationwide increases in the number of people struggling with depression, anxiety and other mental conditions. Alcohol use increased, particularly among women and college students.

Who does 988 benefit?

Anyone who needs help with their mental health, particularly people in crisis. A major goal of the 988 Lifeline is creating equity in mental health services, especially for those who have not always had consistent or reliable access to mental health care.

For example, Vibrant will provide operators who speak both English and Spanish and telephone interpreter service in over 150 additional languages.

One improvement experts would like to see is the implementation of virtual visits with mental health professionals for those who can’t travel to in-person appointments, like people with disabilities or those in rural areas.

Editor’s note: This story has been updated to reflect Vibrant Emotional Health’s most recent plans for the 988 Lifeline.

Derek Lee, Doctoral Student in Counselor Education and Supervision, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Star City Community Gazette January 24th

 

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It is a New year, Many surprises have came with the birth of this year, Everything from the Increase in Cell Data Limit to Mega. Simply Put we can build larger builds, have more action code etc. Tart sugar Is hosting The 8th EBTS in the world of Wild which judging starts from 11th February until 24th February, and the winners will be announced on Saturday 4th march. They have some fantastic prizes for the EBTS 8 Which are as follows

1st place is $125.00

    2nd place is $50.00

    3rd place is $25.00

    These prizes are from donations , Thank you Contributors !

    I have also learned That Nursemom Has Handed over all of the Free hosting accounts to Maxpoly and for Free hosting you can Contact him or Visit him in Winter world.

    Star City has several Projects planned for this year, A New Citizen Area, An Actual Landing Zone Area and a possible Building contest in the new future if all things pan out. Of course we still have lots available for all citizens to build on and though we aim towards a more futuristic style builds we do not really have a set theme, So there will be no limitations on your imagination or builds.

    We also have a Maglev Train build in progress, TenYearsGone is the main builder on that project amongst all the other projects he kindly donates his time to as well. 

    I want to take this moment to say thanks to all of the builders that have contributed to Star city Thus far and some special thanks to the Loose Screw Crew AKA Star City Staff  for all their hard work and time spent helping me on The Star City Project. Also I want to thank those whom have helped to promote Star City and their events and those who were there from the beginning giving me support and even nudging me to move forward.

    Now a new year is here, let us all learn to work together for the common goal of making our beloved AW the best 3d Environment / Chat / Sandbox & community we can.