Thursday, December 12, 2013
By DR. JAMES H. MAIER
SCARBOROUGH - The recent tragedy in Arizona highlights the need for more widespread resources for the treatment of emerging serious mental illness.
ABOUT THE AUTHOR
Dr. James H. Maier of Scarborough is a PIER program psychiatrist.
The excellent recent Press Herald story describing the Portland Identification and Early Referral program ("Experts: Screening cuts chance of violence," Jan. 17) underscores Portland's good fortune to have outstanding "early intervention" available to vulnerable young people who may be at risk of a first psychotic episode.
Among the many teenagers and families referred, a variety of mental illnesses have been recognized and successfully treated, not just those most commonly associated with psychotic symptoms, such as schizophrenia or severe mood disorders.
Ten years ago, Surgeon General David Satcher's ground-breaking report on children's mental health revealed that one in 10 children and adolescents in America suffer from mental illness "severe enough to cause some level of impairment." A tragic fact is that in any given year only one in five such people receive needed treatment.
A year later, in 2002, President Bush's New Freedom Commission proposed a blueprint to better integrate the nation's fragmented mental health treatment systems. Early screening was strongly recommended, as well as widespread public education about early indicators of potential psychiatric problems.
Satcher had also recognized that greater awareness among parents, teachers, coaches and all who have contact with children and adolescents could lead to effective and early treatment before problems worsen and cause more serious impairment.
So why haven't these very logical recommendations been more widely implemented in the decade since?
The "usual suspects" are only part of the problem. A chronic shortage of adequate funding for agencies and programs is linked to legislators' and the public's failure to recognize that brain-based psychiatric illnesses are medical illnesses as much deserving of treatment as heart disease or diabetes.
There is still insufficient awareness that success rates today for treatment of many psychiatric illnesses (in past years mistakenly judged "incurable") are in fact better than success rates for state-of-the-art, high-tech cardiac surgery. A reluctance persists to refer for screening individuals who are as obviously impaired as the young man in Tucson.
There are concerns about possibly violating their civil liberties. There are often fears of unpredictable reactions to even well-meaning attempts by police or authorities to insist on screening and critically needed treatment, even if this could prove potentially life-saving for the impaired individual and others.
Further deterrents to seeking medically necessary treatment for psychiatric illness are sometimes more cynical and self-serving. Avowed enemies of psychiatry such as Scientologists (often masquerading as Concerned Citizens for Human Rights) spread disinformation about an alleged conspiracy of doctors and pharmaceutical companies to invent fictional "disorders" to sell expensive drugs.
Some families may believe that screening of exuberant active children will lead to their being labeled and stigmatized, or worse yet, forcefully medicated into becoming little zombies less likely to cause trouble in overcrowded classrooms.
Ironically, parents often discover that after making the responsible voluntary decision to have their child evaluated, a potentially disabling childhood disorder such as severe ADHD may be detected and quickly treated. Teachers are thrilled to see a previously "unteachable" child who is now far more able to learn and progress academically and socially.
As parents, all of us may understandably want to minimize, deny or explain away problematic behaviors of our children that confuse or worry us. We hope that these behaviors will just disappear on their own.
Fortunately, many do, but some over time just grow ever more concerning, and compel a closer look by a trained mental health professional. The need for mental health screening takes on added urgency anytime a child may be reporting thoughts or feelings of wanting to harm himself or herself or anyone else, or may be having hallucinations, bizarre and irrational fears or beliefs, or other symptoms of developing psychosis. (To download the pamphlet "Let's Talk Facts About Warning Signs of Serious Mental Illness," go to www.psych.org).
Sometimes the devil we don't know feels less scary than a devil that we might have to face and tame to preserve our children's health and well-being. (No, psychiatric illness is not in fact caused by devils or demons; but the dramatic and almost unrecognizable departures from normal moods and behavior occurring with severe bipolar disorder, for example, can seem like demonic possession.)
Most childhood and adolescent disorders are less serious. As with everything else in medicine, early diagnosis and treatment can be more effective, less costly and potentially life-saving.
- Special to the Press Herald