No easy answers

Joining other mental health advocates in discussing stigma
Joining other mental health advocates in discussing stigma

In the wake of yet another senseless crime — this one, which struck close to home in Saco — there is a renewed debate about what to do with people who suffer from a mental illness.

Earlier this month, Connor MacCalister allegedly slit the throat of an unsuspecting grandmother, Wendy Boudreau, in a Shaw’s supermarket.

According to a story about the incident in the Portland Press Herald, “[h]orrific crimes like this, committed by individuals with profound mental illness, are rare in Maine, yet each time they occur, the same question arises: How could someone like that be out on the street, in a position to commit such a brutal crime?”

Though I consider myself a self-appointed advocate of mentally ill people, I struggle with the question because it hits home for me.

As mentioned several times throughout this blog, I suffer from a mental illness, with a range of diagnoses.

As of this writing, there are more than 67 reader comments on the Portland Press Herald story. Those comments run the gamut of reactions. Some say we need better access to outpatient mental health services. Others say mental illness is nothing more than a ploy to escape responsibility for a crime. Still others say, patients should be forced to take their medications, while others say we should go back in time and warehouse individuals with mental illness in institutions like AMHI (The Augusta Mental Health Institute).

Admittedly, it’s pretty damn hard to argue for the civil liberties of the mentally ill, especially in the wake of a horrific murder. Where are the advocates for Wendy Boudreau’s civil rights?

Ms. Boudreau’s only mistake was to go to a supermarket to buy ice cream. She had done nothing wrong other than being in the wrong place at the wrong time.

Stigma on a slippery slope

On the other hand, we tread a slippery slope when we generalize mental illness.

For example, how exactly do we define a “profound” mental illness, as the Press Herald story did? How do we know in advance that a mentally ill person is going to commit such a heinous crime?

In fact, violent acts committed by people with serious mental illness comprise an exceptionally small proportion of the overall violent crime rate in the U.S.

Mentally ill persons are far more likely to be the victims of violence, not its perpetrators, according to the National Association of Social Workers (NASW)

In its March 2011 article, “Budgets Balanced at Expense of Mentally Ill,” the NASW newsletter also mentions a new report by the U.S. Substance Abuse and Mental Health Services Administration that documents a nationwide decline in behavioral health care spending as a share of all health care spending, from 9.3 percent in 1986 to just 7.3 percent, or $135 billion out of $1.85 trillion, in 2005.

According to the Centers for Disease Control, one in five Americans suffers from some sort of mental illness. Of course, the statistics include depression, anxiety and treatable bipolar disorders. Put me in that category.

But what do we do with people who suffer from more extreme cases of these symptoms and other issues including paranoid-schizophrenia.

There have been times when I have been in that category, too.

Should the government force me to take medications? Should I be confined to the Riverview Psychiatric Institute?

Every day, I get up, take a shower, get dressed and go to work. Just like you.

I pay my taxes, enjoy the company of my friends and take care of my home and pets. Just like you.

I have been married to the love of my life for nearly 13 years. I successfully raised two stepsons. I give back and volunteer in my community. How do I do all that if I have a moderating mental illness?

First, I take a wide range of medications every day. Two, I see a therapist every two weeks; and third — perhaps most importantly — I have a support network of caring family members and friends, not to mention safe and stable housing.

These things are unfortunately out of reach for many people with a mental illness.

A broken system

I have relatively good and comprehensive health insurance, but even so it took me weeks to get connected to a psychiatrist after my last hospitalization, some two years ago. There is a profound lack of psychiatric beds in the state of Maine.

There are budget constraints to consider. Many mentally ill people — especially those with more profound illnesses — do not have access to premium health insurance. They live on the edge, relying on the minimum benefits of Medicaid (Maine Care). Still other insurance plans offer minimal coverage for mental health services, both for outpatient and inpatient care. For example many plans will pay for only 12 sessions of outpatient therapy (capped).

Supposedly, after three months, you are cured and ready to hit the streets.

Mental health providers do not choose their occupation to “get rich,” as suggested in the reader comments of the Press Herald Story. Social workers salaries are among the lowest of college-educated professionals. A manager of a fast-food restaurant typically makes more than a social worker.

Social workers do not choose their occupation as a way to get rich quick off the back of taxpayers.

Psychotropic medications are some of the most expensive on the market. Patient records are confidential, and sharing them between providers is a complex, burdensome task.

So what do we do? How do we fix a broken system?

Is it a matter of more money? Do we round up everyone we think might have a mental illness and lock them away? Do we criminally charge people for crimes they may commit in the future?

I do not know the answers to those questions. I do not know if Wendy Boudreau would still be alive today if we had better community-based mental health services. I do not know if her murder was preventable.

But I do know that Wendy Boudreau’s death was utterly senseless, and she did not deserve what happened to her on that hot August day in a supermarket.

 

 

 

Advertisements

What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s