Maine has a severe public health crisis in mental illness.

The Lewiston mass killings are a dramatic symptom of untreated or undertreated mental illness, resulting in the death of a person with apparent mental illness and the deaths of those unwittingly exposed to him. The Lewiston “case” is only one, full-blown example that spread out of control to reach a tragic end. There are many other cases of unrecognized, untreated mental illness of unknown degrees of seriousness in every community in Maine. It is a serious public health and humanitarian problem. It suffers from the deconstruction of care for people with mental illnesses over a period of many years and the absence of a focused, classic public health approach.

This is a crisis that has also lacked public interest, public attention, public compassion and strong, visible public advocacy for people with mental illnesses.

Perhaps the Lewiston tragedy may have changed some of these variables? Perhaps, now, there may be a timely renewal of interest in addressing the plight of people with mental illnesses as a serious and very real public health problem.

Classic public health everywhere – and for every illness – has three preventative aims. It aims to (a) by preventive measures, reduce the incidence of new cases of illnesses/conditions that, untreated, pose widespread dangers to both the patient and the public; (b) to identify and deliver early treatment to those who are ill and prevent the expansion of their untreated illness with consequences for both the patient and the public; and (c) to promote the rehabilitation of identified treated cases and provide services that will return them to productive community living as much as possible.

We’ve been here before. Neglect of people with mental illnesses, followed by campaigns for their treatment, followed by neglect – it’s a cycle as old as humanity.

We need to begin again. We need to think and plan how to address the present public health crisis of mental illness. To do things correctly, there is a need to understand the extent and varieties of the problem. Numbers, please. Spread and distribution throughout the state. Treatment resources and their distribution. Who are the people and professions with most frequent contact? Law enforcement, medics, family. What do they have to say?

How is mental illness defined and regulated by the law? What are the legal trends over the past 50-plus years? Have they enabled the present public health crisis in mental illness, or have they helped to identify cases, enforce care and treatment and lead to a reduction in unidentified, untreated cases? There is a similar need to review legislation that has been aimed at people with mental illnesses. Has state legislation helped or hindered a public health approach?

There is no “quick fix.” Reconstruction of a public health approach to mental illness cannot be fixed with one legislative bill. It requires a determined, dedicated and very serious commission to study and develop a comprehensive approach to the three levels of mental illness prevention and the programmatic “tools” (services) to carry it out.

Rep. Laurel Libby’s proposed bill, pertaining to certificates of need, is extremely well-intended, but it addresses just one idea and puts the cart before the horse.

The strong horse needed to pull the very heavy wagon of mental illness in our state is a tried and proven public health analysis and a well-designed blueprint for action. We badly need action, but not impulsive action that lacks a comprehensive overview.

It has been a long journey to our current situation. It will be a long journey to repair a badly broken system. It must be undertaken. I would suggest that our legislative leaders put a public health program for mental illness at the top of their to-do list as soon as possible. Otherwise, we are faced with a series of emergencies waiting to happen. Lewiston was not a freakish “one of a kind.”

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