Talking to Children About Tragedies & Other News Events

After any disaster, parents and other adults struggle with what they should say and share with children and what not to say or share with them.

The American Academy of Pediatrics (AAP) encourages parents, teachers, child care providers, and others who work closely with children to filter information about the crisis and present it in a way that their child can accommodate, adjust to, and cope with.

Where to Start – All Ages

No matter what age or developmental stage the child is, parents can start by asking a child what they’ve already heard. Most children will have heard something, no matter how old they are. After you ask them what they’ve heard, ask what questions they have.

Older children, teens, and young adults might ask more questions and may request and benefit more from additional information. But no matter what age the child is, it’s best to keep the dialogue straightforward and direct.

Avoiding Graphic Details & Exposure to Media

In general, it is best to share basic information with children, not graphic details, or unnecessary details about tragic circumstances. Children and adults alike want to be able to understand enough so they know what’s going on. Graphic information and images should be avoided.

Keep young children away from repetitive graphic images and sounds that may appear on television, radio, social media, computers, etc.

With older children, if you do want them to watch the news, record it ahead of time. That allows you to preview it and evaluate its contents before you sit down with them to watch it. Then, as you watch it with them, you can stop, pause, and have a discussion when you need to.

Children will generally follow good advice, but you have to give them some latitude to make decisions about what they’re ready for. You can block them from seeing the newspaper that comes to the door, for example, but not the one on the newsstand. Today, most older children will have access to the news and graphic images through social media and other applications right from their cell phone. You need to be aware of what’s out there and take steps in advance to talk to children about what they might hear or see.

Talking to Very Young Children

The reality is that even children as young as 4 years old will hear about major crisis events. It’s best that they hear about it from a parent or caregiver, as opposed to another child or in the media.

Even the youngest child needs accurate information, but you don’t want to be too vague. Simply saying, “Something happened in a faraway town and some people got hurt,” doesn’t tell the child enough about what happened. The child may not understand why this is so different from people getting hurt every day and why so much is being said about it. The underlying message for a parent to convey is, “It’s okay if these things bother you. We are here to support each other.”

Talking to Gradeschool Children & Teens

After asking your child what they have heard and if they have questions about what occurred during a school shooting, community bombing, natural disaster, or even a disaster in an international country, a parent can say something such as:

“Yes. In [city], [state]” (and here you might need to give some context, depending on whether it’s nearby or far away, for example, ‘That’s a city/state that’s pretty far from/close to here’), there was disaster and many people were hurt. The police and the government are doing their jobs so they can try to make sure that it doesn’t happen again.”

A parent can follow-up as needed based on the child’s reactions and questions.

Talking to Children with Developmental Delays or Disabilities

Parents who have a child with a developmental delay or disability should gear their responses to their child’s developmental level or abilities, rather than their physical, age. If you have a teenage child whose level of intellectual functioning is more similar to a 7-year-old, for instance, gear your response toward her developmental level. Start by giving less information. Provide details or information in the most appropriate and clear way you can.

Talking to Children with an Autism Spectrum Disorder (ASD)

What’s helpful to a child with an ASD may be different. For instance, the child may find less comfort in cuddling than some other children. Parents should try something else that does calm and comfort their child on other occasions. Ask yourself, “Given who my child is, his personality, temperament, and developmental abilities, what might work for him?”

Signs a Child Might Not Be Coping Well

If children don’t have a chance to practice healthy coping, a parent may see signs that they’re having difficulty adjusting. Some of things to look for are:

  • Sleep problems: Watch for trouble falling asleep or staying asleep, difficulty waking, nightmares, or other sleep disturbances.
  • Physical complaints: Children may complain of feeling tired, having a headache, or generally feeling unwell. You may notice your child eating too much or less than usual.
  • Changes in behavior: Look for signs of regressive behavior, including social regression, acting more immature, or becoming less patient and more demanding. A child who once separated easily from her parents may become clingy. Teens may begin or change current patterns of tobacco, alcohol, or substance use.
  • Emotional problems: Children may experience undue sadness, depression, anxiety, or fears.

Sometimes it can be hard to tell if a child is reacting in a typical way to an unusual event or whether they are having real problems coping, and might need extra support. If you are concerned, talk to your child’s pediatrician or a mental health professional or counselor.

Don’t wait for the signs. Start the discussion early, and keep the dialogue going.

Additional Information on HealthyChildren.org:

​​Additional Resources:

Source

 

Adapted from an eHealthMD interview with David Schonfeld, MD, FAAP, Director of the National Center for School Crisis and Bereavement and member of the AAP Disaster Preparedness Advisory Council
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Emergence of mental health: Possible threat to business profitability

“Stress reduction & mindfulness don’t just make us happier and healthier, they are a proven competitive advantage for any business that wants one”

– Arianna Huffington
Editor-in-chief  |   The Huffington Post

What does the World Health Organization say?
From 2016 to 2030 12 billion workdays will be lost every year due to mental health issues. Accumulated costs to the global economy will be $900 billion.

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The epidemic is real, and it’s growing. In the US alone, mental health issues cost the economy a whopping $190 billion a year. Despite the growing problem and the potential costs, many companies are not doing enough to address the issue. Many current corporate wellness programs place huge emphasis on physical wellness and pay little to no attention to improving employees’ mental well-being.

The stigma associated with mental health issues also mean that employees are unwilling to face up to potential problems and mental illnesses often go un-diagnosed.

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Demolishing the Stigma

Breaking down mental health stigma is all about removing negative assumptions about the problem. Communicate to your employees that mental suffering is a real problem just like any other health problem you would seek help for. Improve attitude towards the issue by openly emphasizing how much the company values employee mental health.

Consider holding mental health seminars to raise awareness. Employee engagement firms such as wellteq offer mental health themed programs infused with gamification, educational features to de-stigamise and bring the issue to the forefront.

Creating a safe environment

Many people are unwilling to face up to a mental issue at work because there is fear of not knowing what will happen if they do, fear of colleagues finding out, fear of isolation, and worst of all, fear of losing their job. Employees need to feel safe about asking for help.

Bring to their attention all resources available, including hotlines, articles, videos and specialist help. Emphasize how people seeking help can expect total confidentiality.

Zero Tolerance to

Workplace Bullying

Workplace bullying can be described as the deliberate and repeated abusive behaviour directed at a co-worker. Victims of workplace bullying can experience intimidation, hostility, threat, sabotage, isolation and verbal abuse.

Such disruptive behaviour cannot be allowed to exist even in it’s slightest form. Implement a zero tolerance policy towards office bullying by making clear to employees what constitutes bullying behaviour and the consequences for offenders.

Identify risks and warning signs

Feeling sad or stressed is part of normal life and it can be hard to distinguish those feelings from a true mental problem. Train managers and supervisors to be observant of vital signs, which can include:

  • –  Mood swings and anger prone behaviour
  • –  Uncharacteristic withdrawal and self isolation
  • –  Declining productivity in familiar or regular tasks
  • –  Lapses in memory, concentration and logical thinking

Re-evaluate Workloads and Timelines

Employees often take on additional workload and projects without complaining to impress their bosses. Unfortunately, employers sometimes fail to recognise that these are often performed beyond regular bandwidth.

From time to time, re-evaluate your employees’ workloads, projects, timelines and priorities. Make sure they are receiving the support and encouragement necessary to foster mental health and productivity at the same time.

Recognize and

Reward

Everyone likes a pat on the back and be told that they are doing a good job. Regularly bringing individual accomplishments to the attention of the office makes employees feel recognized. The euphoric sense of having one’s achievements amplified and publicly acknowledged can be a fantastic counter to a hard day’s stress.

Besides creating a sense of belonging, individual validation and positive reinforcement, think about how to reward employees’ accomplishments in more tangible ways such as bonuses or awards.

Emphasize Work Life

Balance

Every boss loves a hard working employee, one who goes above and beyond regular hours to complete tasks, but don’t forget that employees don’t bring their home problems to the work place, so there’s no reason they should be bringing work issues back home either.

The best way to deal with mental stressors sometimes is to completely step away from them temporarily. Give your employees enough breathing space away from work to focus on their personal lives. Consider implementing occasional “family time”, letting employees leave office 2 hours early to go home to their families.

Are you ready to improve workforce mental health and positively impact business profitability

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Let us help you start a great mental wellness program

  • Learn how to implement the most effective employee engagement program for your workforce with Vital Time’s diverse range of solutions from consultation to programing, we will devise a strategy to improve your teams mental health!
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      • questions@behavioralhealth.us
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Research brief: overview of mental health issues and counseling services on college campuses!

The purpose of this research brief is to provide an overview of mental health issues and counseling services on college campuses. The findings from several national surveys are reviewed to estimate the prevalence of anxiety and depression, suicide and suicidal ideation, and violence among college students. Common prevention and treatment programs are then described with particular attention to innovative campus-wide programs. Student outcomes research is examined to determine whether receiving counseling services is associated with academic performance and the likelihood of graduation. The brief concludes with a set of recommended practices to improve the effectiveness of counseling services on campus.

Recommended Practices

Basic Functions

  • Maintain counseling services as an “in-house” service and provide adequate financial and administrative support for counseling center treatment and prevention programs (e.g., suicide prevention), psychoeducational events (e.g., stress reduction), faculty and staff training, and program evaluation (Brunner et al., 2014; Drum & Denmark, 2012).
  • Clearly delineate the duties of academic and career advising from counseling and psychological services (Bundy & Benshoff, 2000; Reetz et al., 2014).
  • Establish a strong outreach function in the counseling services center to educate students, staff, faculty, and parents about the early symptoms of mental illness, availability of relevant campus resources, and issues regarding client confidentiality (Mowbray et al., 2006).
  • Build reliable partnerships and referral systems with off-campus service providers who can attend to students whose treatment needs exceed campus resources. Counseling center staff should be charged with ensuring that students referred for services outside of the counseling center are successful in connecting with a mental health provider (Mowbray et al., 2006).
  • Allow the counseling center to be administratively autonomous to avoid using scarce resources to respond to campus requests for confidential student information. Many state and federal laws as well as ethical codes require or mandate the confidentiality of student information obtained through counseling services (IACS, 2014; Sokolow et al., 2009).

Staffing

  • Ensure the counseling center is properly staffed with a ratio of at least 1 mental health professional staff member per 1,000 to 1,500 students (International Association of Counseling Services (IACS), 2014; Hardy et al., 2011; Mowbray et al., 2006).
  • Provide for and require continuing education for all professional staff to ensure the use of current evidence-based therapies (Joffe, 2008; Lee, 2005). Continuing education should also be used to improve the ability of support staff to direct students to appropriate resources (Mowbray et al., 2006).

Programmatic Considerations

  • Ensure that the campus crisis prevention and response system (a) allows students with urgent care needs to make counseling appointments within 24 hours; (b) notifies parents of a crisis with prior informed consent or facilitates notification by the student; (c) establishes a protocol for using campus security; and (d) contains a plan for debriefing students, faculty, and staff after an incident (Mowbray et al., 2006).
  • Enhance the cost-effectiveness of counseling services by utilizing self-help resources whenever supported by empirical research (Mowbray et al., 2006). Self-help resources without therapist contact may require periodic usage prompts (Clarke et al., 2005).
  • Facilitate continuity of care through a seamless referral system that coordinates counseling services, campus health services, and disability services (Mowbray et al., 2006).
  • Current and prospective student clients should participate in program development and evaluation processes to improve the utilization of counseling services (Mowbray et al., 2006).

Accessibility

  • The counseling services center should be centrally located on campus while ensuring that the public cannot discern which students are clients. Students should be able schedule appointments during normal business hours as well as during evenings and weekends (Mowbray et al., 2006).
  • Implement a “no wrong door” policy that provides multiple pathways for students to request mental health services beyond the counseling services center, including the disability services center, residential halls, and the campus medical clinic (Mowbray et al., 2006).

The brief concludes with a set of recommended practices to improve the effectiveness of counseling services on campus.
Prevalence of Mental Health Issues among College Students
• Anxiety affects 38% to 55% of the student body.
• Depression affects an estimated 12% to 33% of students per year.
• Suicidal ideation among college students increased from a low of 24% in 2010-11 to 31% in
2013-14.
• Suicide is the second leading cause of death among college students after vehicular and other
accidents with prevalence rates estimated to be 6.5 to 7.5 per 100,000 students.
• Violent acts (e.g., shootings, rape, assaults) occur at a rate of 56.4 per 100,000 students.
• Attempted or completed sexual assault affects approximately 19% of undergraduate women
(nearly 1 in 5).
Provision of Counseling Services
• Only 8% of two-year colleges had psychiatric services available to students on campus as
compared to 58% of four year institutions.
• 19% of counselors at two-year colleges did not offer mental health services on campus.
• 58% of counselors at two-year colleges continue to be required to provide academic advising
and registration services.
• At four-year institutions, an average of 61% of staff time was allocated to direct counseling
services and an average of 22% of staff time was used for training, supervision, consultation,
and outreach.
• The majority of treatment programs have focused on depression, anxiety, suicide prevention,
and violence prevention.

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Counseling Services and Student Success

Utilization of Counseling Services and Relation to Student Success
• The percentage of students seeking counseling services has remained constant at an average
of 10% to 15% of the student population over the last 7 years.
• Students who receive counseling relative to comparison groups report higher self-rated
academic, social, and emotional adjustment.
• Students who receive counseling services are more likely to persist or graduate within six years
than those who do not.
Recommended Practices

Basic Functions
• Maintain counseling services as an “in-house” service and provide adequate financial and
administrative support for counseling center treatment and prevention programs (e.g., suicide
prevention), psychoeducational events (e.g., stress reduction), faculty and staff training, and
program evaluation (Brunner et al., 2014; Drum & Denmark, 2012).
• Clearly delineate the duties of academic and career advising from counseling and
psychological services (Bundy & Benshoff, 2000; Reetz et al., 2014).
• Establish a strong outreach function in the counseling services center to educate students,
staff, faculty, and parents about the early symptoms of mental illness, availability of relevant
campus resources, and issues regarding client confidentiality (Mowbray et al., 2006).
• Build reliable partnerships and referral systems with off-campus service providers who can
attend to students whose treatment needs exceed campus resources. Counseling center staff
should be charged with ensuring that students referred for services outside of the counseling
center are successful in connecting with a mental health provider (Mowbray et al., 2006).
• Allow the counseling center to be administratively autonomous to avoid using scarce
resources to respond to campus requests for confidential student information. Many state
and federal laws as well as ethical codes require or mandate the confidentiality of student
information obtained through counseling services (IACS, 2014; Sokolow et al., 2009).

Staffing
• Ensure the counseling center is properly staffed with a ratio of at least 1 mental health
professional staff member per 1,000 to 1,500 students (International Association of Counseling

February 2016

3

Services (IACS), 2014; Hardy et al., 2011; Mowbray et al., 2006).
• Provide for and require continuing education for all professional staff to ensure the use of
current evidence-based therapies (Joffe, 2008; Lee, 2005). Continuing education should also
be used to improve the ability of support staff to direct students to appropriate resources
(Mowbray et al., 2006).

Programmatic Considerations
• Ensure that the campus crisis prevention and response system (a) allows students with urgent
care needs to make counseling appointments within 24 hours; (b) notifies parents of a crisis
with prior informed consent or facilitates notification by the student; (c) establishes a protocol
for using campus security; and (d) contains a plan for debriefing students, faculty, and staff
after an incident (Mowbray et al., 2006).
• Enhance the cost-effectiveness of counseling services by utilizing self-help resources whenever
supported by empirical research (Mowbray et al., 2006). Self-help resources without therapist
contact may require periodic usage prompts (Clarke et al., 2005).
• Facilitate continuity of care through a seamless referral system that coordinates counseling
services, campus health services, and disability services (Mowbray et al., 2006).
• Current and prospective student clients should participate in program development and
evaluation processes to improve the utilization of counseling services (Mowbray et al., 2006).

Accessibility
• The counseling services center should be centrally located on campus while ensuring that
the public cannot discern which students are clients. Students should be able schedule
appointments during normal business hours as well as during evenings and weekends
(Mowbray et al., 2006).
• Implement a “no wrong door” policy that provides multiple pathways for students to request
mental health services beyond the counseling services center, including the disability services
center, residential halls, and the campus medical clinic (Mowbray et al., 2006).

4

Counseling Services and Student Success

College Counseling and Student Success

Counseling has been defined as “…a professional relationship that empowers diverse individuals,

families, and groups to accomplish mental health, wellness, educational, and career goals” (Kaplan,
Tarvydas, & Gladding, 2014, p. 368). College counseling in particular involves both long- and
short-term counseling; consultation with faculty and staff; working with interns in the counseling
center; crisis and emergency services; and more (Brunner, Wallace, Reymann, Sellers, & McCabe,
2014; Francis, 2011; Hodges, 2001; Sharkin, 2012). While the vast majority of students traverse
the developmental period of entering and graduating from college without a serious problem, a
substantial number are seeking counseling services for various mental health issues, ranging from
difficulty concentrating to suicidal ideation (Iarovici, 2014; Lippincott & Lippincott, 2007). A recent
national survey indicated that 16% of college students sought counseling services after starting
college (Center for Collegiate Mental Health, 2016). In addition, Bundy and Benshoff (2000) found
that over 70% of community college students stated that access to personal counseling would
be helpful for them. Counseling services are thus in high demand. Left untreated, mental health
issues can impact college retention and time to degree (Beiter et al., 2015) as well as increase the
likelihood of suicide (Yozwiak, Lentzsch-Parcells, & Zapolski, 2012) or violence against others (Van
Brunt, 2012).

The purpose of this research brief is to provide an overview of mental health issues and

counseling services on college campuses. First, the findings from several national surveys are
reviewed to estimate the prevalence of anxiety and depression, suicide and suicidal ideation,
and violence among college students. Second, common prevention and treatment programs are
described with particular attention to innovative campus-wide programs. Finally, student outcomes
research is examined to determine whether receiving counseling services is associated with
academic performance and the likelihood of graduation.
Mental Health Issues of the Student Body

Attending college as a traditional student (18-25 years of age) represents a developmental

milestone in the lives of young people. This is also a time when many mental health concerns
develop due to various reasons from biology to lifestyle (Beiter et al., 2015; Iarovici, 2014; Kessler
et al., 2007; Lippincott & Lippincott, 2007). This section examines the prevalence of mental health
issues, anxiety and depression, suicide and suicidal ideation, and violence on campus.

February 2016

5

Prevalence of Mental Health Issues

The increasing complexity of mental health problems and the greater utilization of counseling

services within the college population has been well documented for the last decade (American
College Counseling Association (ACCA), 2014; American College Health Association (ACHA),
2014; Benton et al., 2003; Bundy & Benshoff, 2000; Center for Collegiate Mental Health, (CCMH),
2015; Gallagher, 2014; Hardy et al., 2011; Hunt et al., 2012; Kay & Schwartz, 2010; Reetz et al.,
2014; Watkins et al., 2012). Results from the Higher Education Research Institute’s Freshman Survey
revealed that just over 50% of students rated themselves at “above average” or “highest 10%” for
emotional health in 2014. This is the lowest percentage of students selecting these ratings since
the administration of the Freshman Survey began in 1966. Additionally, 10% of freshman students
surveyed frequently felt depressed, a 3.4% increase over those surveyed in 2013 (Eagan et al., 2014).

The percentage of students seeking counseling services has remained constant at an average of

10% to 15% of the student population over the last 7 years (Rando et al., 2007; Reetz et al., 2014).
However, the perception of the severity and complexity of the presenting issues has risen (Bishop,
2006; Hardy et al., 2011; Hunt & Eisenberg, 2010) as has the number arriving with psychotropic
medications (Carter & Winseman, 2003). Francis (2015) reviewed 10 years (2004 – 2014) of data
from the Gallagher College Counseling Center Survey and found that the percentage of students
receiving counseling who already had been prescribed psychotropic medication had risen from a low
of 23% in 2007 to a new high of 26% in 2014. Indeed, the rise of mental health problems on campus
has been primarily attributed to improvements in the effectiveness of treatment during adolescence,
which have permitted more students with mental illness to attend college (Hunt & Eisenberg, 2010;
see also Kitzrow, 2003).
Anxiety and Depression

Depression and anxiety are two of the most common mental health issues on a college campus.

Anxiety has surpassed depression as the primary issue faced by college students, affecting 38% to
55% of students (Beiter et al., 2015; CCMH, 2015; Reetz et al., 2014). The high prevalence of anxiety
has been attributed to issues such as “academic performance, pressure to succeed, post-graduate
plans, financial concerns, quality of sleep, relationship with friends, relationship with family, overall
health, body image, and self-esteem” (Beiter et al, 2015, p. 93). Yet, depression continues to be a

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Counseling Services and Student Success

serious issue on college campuses, affecting an estimated 12% to 33% of students per year (ACHA,
2014; Chung et al., 2011; Lee, 2005; Nilsson et al., 2004). A large national survey (n = 79,266)
revealed that in the last 30 days many students felt things were hopeless (7%); overwhelmed with
all they had to do (16%); very lonely (11%); very sad (11%); so depressed it was difficult to function
(5%); and overwhelming anxiety (9%) (ACHA, 2014). These symptoms are also considered risk
factors for suicide, particularly when combined in clusters or with other risk factors (e.g., borderline
personality disorder). The consequences of untreated depression and anxiety include poor academic
performance, difficulty concentrating, sleep disturbance, low self-esteem, mood dysregulation, and
relationship problems (Baez, 2005).

Related to anxiety and depression is the increased prevalence of non-suicidal self-injury (CCMH,

2015; Whitlock et al., 2011; Wilcox et al., 2012). Whitlock et al. (2011) found from a large sample of
college students (n = 14,372) that 15% had participated in some form of non-suicidal self-injury over
their lifetime (e.g., banged, punched, or cut self). The function of this behavior was to either regulate
or control negative emotions; induce self-punishment or physiological stimulation; solicit a social
response; or relieve an overwhelming urge.
Suicide and Suicidal Ideation

Suicide and suicidal ideation continue to challenge the resources of college counseling centers

with the level of suicidal ideation among college students increasing from a low of 24% in 2010-11
to 31% in 2013-14 (CCMH, 2015; Taub & Thompson, 2013). Suicide is the second leading cause of
death among college students after vehicular and other accidents (Taub & Thompson, 2013; Turner
et al., 2013) with prevalence rates estimated to be 6.5 to 7.5 per 100,000 students. In contrast,
among the same age group of people who are not enrolled in college, the suicide rate is estimated
to be 11.0 per 100,000 (Keyes, 2013). This suggests that college attendance provides a preventative
effect against suicide. In addition to the impact on family and friends, an attempted or completed
suicide can have devastating effects on the college community due to the proximity of living
conditions in residence halls and apartment complexes (Keyes, 2013).
Violence

Violent acts against students have occurred for decades (Davenport, 2009; Hart & Miethe,

2011). But it was not until the Virginia Tech mass shooting and subsequent news stories that college

February 2016

7

counselors became more intentionally involved in the assessment of violent intent of students who
could be potential perpetrators (Van Brunt, 2012). Violent acts (e.g., shootings, rape, assaults) occur
at a rate of 56.4 per 100,000 students according to the 1995-2005 National Crime Victimization
Survey (Hart & Miethe, 2011). Moreover, national survey results have shown that many students
report having experienced violence in the last 12 months, including being involved in a physical fight
(5%); experiencing a physical assault (4%); and experiencing a verbal threat of violence (17%) (ACHA,
2014). Approximately 19% of undergraduate women have experienced an attempted or completed
sexual assault while in college (Krebs et al., 2004). Counseling center staff are thus increasingly being
asked to assess students for risk of violence as more students arrive on campus with serious social
and emotional issues (Davenport, 2009; Joffe, 2008; Van Brunt, 2012).
College Counseling Services

The type and scope of services provided is dependent upon the structure of the student affairs

division of the institution; campus culture and history of use of counseling; the type of institution
(e.g., two-year, four-year); budget and resources; and staff size and training (Francis, 2011; Sharkin,
2012). Counselors at community and technical colleges generally have the broadest responsibilities
that include admissions, academic advising and registration, testing, teaching, consultation with
faculty, career coaching and counseling, crisis and intervention, psychoeducational programming,
mental health evaluation, referrals for long term services, and personal counseling (ACCA, 2014;
Bishop, 2006; Bundy & Benshoff, 2000; Sharkin, 2012). In contrast, counseling services at four-year
institutions can be considered more congruent with traditional mental health counseling and include
personal counseling to all students; consultation services to faculty and staff; workshops focused on
prevention and remediation; couples counseling; therapy and structured groups; and sexual assault
prevention (Reetz et al., 2014).

In a survey of nearly 500 counseling center directors at four-year institutions, an average of 61%

of staff time was allocated to direct counseling services, and an average of 22% of staff time was
used for training, supervision, consultation, and outreach (Reetz et al., 2014). Conversely, the broader
focus of counseling services at two-year institutions frequently decreases the amount of time spent
providing direct and indirect mental health services (Reetz et al., 2014). The results from a national
survey revealed that only 8% of two-year colleges had psychiatric services available to students on
campus as compared to 58% of four year institutions (ACCA, 2014). Additionally, 19% of counselors

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Counseling Services and Student Success

at two-year colleges did not offer mental health services on campus. Instead, of these 19%
responding, 20% outsourced the mental health work; 22% immediately referred the student to offcampus resources; and 20% addressed problematic mental health issues through threat assessment
or behavioral intervention teams. Forty-nine percent of counselors at two-year colleges noted that
the severity of student mental health concerns has increased, but 58% continue to be required to
provide academic advising and registration services (ACCA, 2014).

As a consequence of the increased prevalence of mental health issues among college students;

the greater utilization of counseling services; and the lack of staffing to meet these needs,
counseling centers are either referring students with more serious issues to outside providers or are
placing students on waitlists for services (Brunner et al., 2014; Hardy et al., 2011; Mowbray et al.,
2006; Owen et al., 2007). The effectiveness of outsourcing counseling services, though, remains
questionable. Owen et al. (2007) found that 42% of students referred for services outside of the
counseling center were unsuccessful in connecting with a mental health provider. Additionally,
students of color had lower rates (43%) of successful referrals than Caucasian students (58%). One
counseling center using a triage system to assist students with more severe issues sooner found
greater attendance rates, higher client satisfaction, and an increase in the availability of initial and
crisis sessions, but the system did not eliminate the waitlist for services. Researchers concluded
that increasing the number of providers was still necessary but impossible given the budgetary
constraints of the institution (Hardy et al., 2011).
Common Treatment Programs

Several programs have been developed in college counseling with varying degrees of

effectiveness. The majority of programs have focused on anxiety and depression (Baez, 2005;
Beiter et al., 2015; Chung et al., 2011; Lee, 2005; Minami et al., 2009; Reynolds et al., 2011) and
suicide intervention and prevention (Drum & Denmark, 2012; Gould et al., 2003; Haas et al., 2008;
Joffe, 2008; Keyes, 2013; Wilcox et al., 2010). An emerging area of study is the role of the college
counselor on behavior intervention teams (Eells & Rockland-Miller, 2011; Rockland-Miller & Eells,
2008; Sokolow et al., 2009; Van Brunt, 2012; Van Brunt et al., 2015).

Anxiety and depression. Multiple standard treatments for anxiety and depression are provided

across college campuses that follow best practices in the medical and mental health fields, such as

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cognitive behavioral therapy, group counseling, and psychopharmacological interventions (Baez,
2005; Cuijpers et al., 2013; Olatunji et al., 2010). A critical strand of research on standard treatment
models has focused on improving access to care (Chung et al., 2011; Marsh & Wilcoxon, 2015).
Chung et al.’s (2011) Chronic (Collaborative) Care Model (CCM) enlisted the college’s medical clinic
to provide depression screening for all incoming students who sought healthcare services and might
not otherwise consider services at the counseling center. Once screened and identified, students
with depression were offered medication, evidence-based psychotherapy, or both. Results showed
that of the 801 students identified with depressive symptoms, 86% completed a 12-week course of
treatment. The close coordination of medical and counseling services appears to be a promising
approach to enhancing access to treatment for depression and other mental health problems.

There are also innovative programs that use standard treatments in conjunction with the university

community and its resources to increase the likelihood of student success, reduce the stigma of
mental illness, and promote a campus environment conducive to psychological well-being (Field et
al., 2006). For example, the Action for Depression Awareness, Prevention, and Treatment (ADAPT)
program at Suffolk University and other institutions draws on the field of community psychology to
conceptualize the problem of depression as part of the social context of the student in the university
community. Bell et al. (2014) summarized ADAPT’s programmatic features:
The first phase of the ADAPT program included disseminating information about depression
and suicide, providing educational sessions concerning how to prevent and treat depression,
and instituting workshops to teach individuals how to talk with, and be helpful to at-risk
students. Further efforts of the Counseling Center concentrated on creating and distributing
brochures, dedicating a section of the website to information about ADAPT and depression,
and collaborating with the Performing Arts department to develop and produce a short play
that illustrated the story of one student’s journey through depression. The play, which the
Counseling Center developed in an educational video, is followed by discussion groups and
relaxation techniques training for attendees. (p. 230)

Field et al.’s (2006) evaluation revealed that 98% of ADAPT participants rated the program’s

impact as good to excellent. Different stakeholders identified unique benefits of participation:
increased confidence among resident advisors in helping depressed students; greater ability of

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Counseling Services and Student Success

faculty to identify and refer students with suicidal ideation to university resources; and a better sense
among students of ways to manage their own stress and well-being to help prevent or lessen the
impact of depression.

Suicide prevention. College counseling centers enforce various policies and implement a variety

of prevention programs (Drum & Denmark, 2012). The common elements in the majority of programs
have included outreach and education; bystander training of students, faculty, and staff; specific
training for residence hall staff; and new web-based applications that help students manage stress or
connect with mental health staff (Asidao & Sevig, 2014; Drum & Denmark, 2012; Haas et al., 2003;
Haas et al., 2008; Keyes, 2013; Taub et al., 2013). One such program has been in place for several
years at the University of Illinois at Urbana-Champaign (Joffe, 2008). Any student who demonstrates
suicidal ideation or behavior is automatically required to attend four sessions of mandated
assessment provided by a Suicide Prevention Team. The prevention team focuses on assessing the
student’s plan and access to means for suicide; reconstructing the circumstances that incited suicidal
thinking and behavior; recording the student’s lifetime history of suicidal ideation; and reviewing the
self-welfare policy of the university and consequences for failing to adhere to the policy. A suicidal
threat of any level will trigger this campus response. As described by Joffe (2008):
The same mandate applies to a student taking three Tylenol (with intent of dying), a student
taking 100 Tylenol, or the student who buys 100 Tylenol for the purposes of killing himself or
herself. No distinction is made between those who clearly want to die and those who appear
to want to exercise leverage over another person….The program’s philosophy is that anyone
who has crossed the threshold is at increased risk for eventual suicide. (p. 91)

The University of Illinois at Urbana-Champaign utilizes an exemplary approach to tailoring a

suicide prevention program with a variety of internal and external resources. However, little is known
about the efficacy of such prevention programs. In his descriptive pre-post comparison, Joffe (2008)
observed that the suicide rate at the University of Illinois at Urbana-Champaign was 45 percent
lower during the first 21 years of program implementation (3.8 suicides per 100,000 students)
relative to the prior 8-year period (6.9 suicides per 100,000). More generally, gatekeeper training
that informs campus staff how to detect suicidal intent has been shown to improve knowledge and
skills appropriate for intervention, but the effect on suicidal ideation and behavior has not yet been

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examined (Gould et al., 2003; Taub et al., 2013; Tompkins & Witt, 2009).

Behavior intervention teams. Behavior Intervention Teams (BIT’s) were largely created as a result

of the shootings at Virginia Tech in 2007 and have evolved from threat assessment teams and crisis
response teams to what they are today, a group of campus professionals who gather on a regular
basis to identify students who are at risk or disruptive in some way on campus and then intervene
with services before a serious problem arises (Sharkin, 2012). Ninety-two percent of BIT’s have
someone from the counseling center as a member, generally the counseling center director (Van
Brunt et al., 2015). However, the role of the counseling staff on a BIT is limited due to the nature of
confidentiality and privacy laws that will not allow the release of student information without written
consent (Eells & Rockland-Miller, 2011). Exceptions are made in the case of serious and foreseeable
harm to self or others such as potential suicide, violence, and homicide, as outlined in various
state laws and professional codes of ethics (American Counseling Association, 2014; American
Psychological Association, 2010). Nonetheless, a counselor’s ability to provide information through
the use of case studies, educational information, diagnostic impressions, and information about the
tendencies of similar students of concern is valuable as the BIT crafts interventions for students (Van
Brunt et al., 2015).
Impact on Student Success

Several evaluations of counseling services have focused on perceived academic distress,

academic performance, persistence, and graduation. A number of studies have indicated that
students who receive counseling relative to comparison groups report higher self-rated academic,
social, and emotional adjustment (Choi et al., 2010; DeStefano et al., 2001; Lockard et al., 2012).
Research on the effect of counseling services on academic performance, though, has yielded mixed
results (Cholewa & Ramaswami, 2015; Illovsky, 1997; Lee et al., 2009). Most recently, Cholewa
and Ramaswami (2015) found that exposure to counseling among underprepared freshmen was
positively associated with fall grade point average.

Past research generally supports the notion that students who receive counseling services are

more likely to persist or graduate within six years than those who do not (Kharas, 2014; Lee et al.,
2009; Moss, 2015; Turner & Berry, 2000; Wilson et al., 1997). For example, Lee et al.’s (2009) analysis
of over 10,000 freshmen and transfer students at a public university revealed that exposure to

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Counseling Services and Student Success

counseling services during the first year increased the odds of retention one year later by a factor
of three, relative to a comparison group. Moreover, participation in both individual and group
counseling was associated with higher academic performance and credit completion than was
individual counseling alone. Additional research is needed to better understand the relationship
between programmatic variations in counseling services and subsequent student success.
Conclusion

The provision of counseling on a college campus impacts students’ success in their academic,

personal, and professional lives by supporting their emotional and developmental growth and
mental stability. The “ripple effects” (Nafziger et al., 1999, p. 9) of this service can be seen in lower
academic distress, better grades, and a stronger likelihood of finishing an academic course of study
in a timely fashion. Yet, as researchers have demonstrated, the prevalence of complex mental health
issues and distress among undergraduates is on the rise. College counselors are also increasingly
being asked to participate in new programs to ensure a safe and secure campus; prevent or
decrease distress through educational programming; and to intervene and sometimes evaluate
students who present as a danger to themselves or others.
Recommended Practices

Basic Functions
• Maintain counseling services as an “in-house” service and provide adequate financial and
administrative support for counseling center treatment and prevention programs (e.g., suicide
prevention), psychoeducational events (e.g., stress reduction), faculty and staff training, and
program evaluation (Brunner et al., 2014; Drum & Denmark, 2012).
• Clearly delineate the duties of academic and career advising from counseling and
psychological services (Bundy & Benshoff, 2000; Reetz et al., 2014).
• Establish a strong outreach function in the counseling services center to educate students,
staff, faculty, and parents about the early symptoms of mental illness, availability of relevant
campus resources, and issues regarding client confidentiality (Mowbray et al., 2006).
• Build reliable partnerships and referral systems with off-campus service providers who can
attend to students whose treatment needs exceed campus resources. Counseling center staff
should be charged with ensuring that students referred for services outside of the counseling

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center are successful in connecting with a mental health provider (Mowbray et al., 2006).
• Allow the counseling center to be administratively autonomous to avoid using scarce
resources to respond to campus requests for confidential student information. Many state
and federal laws as well as ethical codes require or mandate the confidentiality of student
information obtained through counseling services (IACS, 2014; Sokolow et al., 2009).
Staffing
• Ensure the counseling center is properly staffed with a ratio of at least 1 mental health
professional staff member per 1,000 to 1,500 students (International Association of Counseling
Services (IACS), 2014; Hardy et al., 2011; Mowbray et al., 2006).
• Provide for and require continuing education for all professional staff to ensure the use of
current evidence-based therapies (Joffe, 2008; Lee, 2005). Continuing education should also
be used to improve the ability of support staff to direct students to appropriate resources
(Mowbray et al., 2006).

Programmatic Considerations
• Ensure that the campus crisis prevention and response system (a) allows students with urgent
care needs to make counseling appointments within 24 hours; (b) notifies parents of a crisis
with prior informed consent or facilitates notification by the student; (c) establishes a protocol
for using campus security; and (d) contains a plan for debriefing students, faculty, and staff
after an incident (Mowbray et al., 2006).
• Enhance the cost-effectiveness of counseling services by utilizing self-help resources whenever
supported by empirical research (Mowbray et al., 2006). Self-help resources without therapist
contact may require periodic usage prompts (Clarke et al., 2005).
• Facilitate continuity of care through a seamless referral system that coordinates counseling
services, campus health services, and disability services (Mowbray et al., 2006).
• Current and prospective student clients should participate in program development and
evaluation processes to improve the utilization of counseling services (Mowbray et al., 2006).

Accessibility
• The counseling services center should be centrally located on campus while ensuring that
the public cannot discern which students are clients. Students should be able schedule

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Counseling Services and Student Success

appointments during normal business hours as well as during evenings and weekends
(Mowbray et al., 2006).
• Implement a “no wrong door” policy that provides multiple pathways for students to request
mental health services beyond the counseling services center, including the disability services
center, residential halls, and the campus medical clinic (Mowbray et al., 2006).

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15

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Prevention, 30(2), 131-149. doi: http://dx.doi.org/10.1007/s10935-009-0171-2
Turner, A. L., & Berry, T. R. (2000). Counseling center contributions to student retention and
graduation: A longitudinal assessment. Journal of College Student Development, 41(6), 627-636.
Turner, J. C., Leno, E. V., & Keller, A. (2013). Causes of mortality among American college students: A
pilot study. Journal of College Student Psychotherapy, 27(1), 31-42. doi: http://dx.doi.org/10.108
0/87568225.2013.739022

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Counseling Services and Student Success

Van Brunt, B. (2012). Ending campus violence: New approaches to prevention. New York, NY:
Routledge.
Van Brunt, B., Reese, A., & Lewis, W. S. (2015). The 2015 NaBITA Whitepaper: Whose on the team?
Mission, membership, and motivaiton. Berwyn, PA: National of Behavior Intervention Team
Association.
Watkins, D. C., Hunt, J. B., & Eisenberg, D. (2012). Increased demand for mental health services
on college campuses: Perspectives from administrators. Qualitative Social Work: Research and
Practice, 11(3), 319-337. doi: http://dx.doi.org/10.1177/1473325011401468
Whitlock, J., Muehlenkamp, J., Purington, A., Eckenrode, J., Barreira, P., Abrams, G. B., Marchell, T.,
Kress, V., Girard, K., Chin, C., & Knox, K. (2011). Nonsuicidal self-injury in a college population:
General trends and sex differences. Journal of American College Health, 59(8), 691-698. doi:
http://dx.doi.org/10.1080/07448481.2010.529626
Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2010).
Prevalence and predictors of persistent suicide ideation, plans, and attempts during college.
Journal of Affective Disorders, 127(1-3), 287-294. doi: http://dx.doi.org/10.1016/j.jad.2010.04.017
Wilcox, H. C., Arria, A. M., Caldeira, K. M., Vincent, K. B., Pinchevsky, G. M., & O’Grady, K. E. (2012).
Longitudinal predictors of past-year non-suicidal self-injury and motives among college students.
Psychological Medicine, 42(4), 717-726. doi: http://dx.doi.org/10.1017/S0033291711001814
Wilson, S. B., Mason, T. W., & Ewing, M. J. M. (1997). Evaluating the impact of receiving universitybased counseling services on student retention. Journal of Counseling Psychology, 44(3), 316320. doi: http://dx.doi.org/10.1037/0022-0167.44.3.316
Yozwiak, J. A., Lentzsch-Parcells, C. M., & Zapolski, T. C. B. (2012). Suicide and suicidal ideation
among college students. International Journal on Disability and Human Development, 11(3), 185189. doi: 10.1521/suli.2009.39.6.671 http://dx.doi.org/10.1515/ijdhd-2012-0042

Midwestern Higher Education Compact
105 Fifth Avenue South, Suite 450
Minneapolis, MN 55401
Phone: 612-677-2777 Fax: 612-767-3353
E-mail: mhec@mhec.org

 

Mental Health 101

How common are mental health issues?

Studies have shown that 1 in 4 individuals globally struggle with a mental health issue at any given time. If you expand that to the course of a lifetime, the number increases to 1 in 2. That means if it’s not you who is struggling, it’s someone you know or love.

Why is it important to talk about stigma?

When discussing mental health, two main types of stigma exist. One type is external stigma, which refers to the attitudes held by society that people with mental health issues are somehow lacking, incapable, incompetent, or not worthy of dignified and equitable treatment. The other type is internal stigma, which is the attitude held by the person with mental health challenges that they are unworthy, unlovable, and unvalued.

Stigma does a lot of harm to our society. For the people struggling with a mental health challenge, they often lack hope in recovery and don’t pursue treatment because they either don’t believe they can get better or fear discrimination from others. For those who don’t struggle but hold positions of power (such as law enforcement, educators, landlords, community leaders, etc.), stigma can lead to discrimination, which is the unfair treatment of those with mental health challenges.

Having honest conversations about stigma and sharing our personal stories of recovery are small steps we each can take to making our society more equitable and inclusive.

Is recovery actually possible?

Absolutely! One of the biggest misperceptions in society is that mental health issues are a life sentence.

Recovery means many things to many people and is personal in nature. For some, recovery is the complete absence of symptoms. For others, recovery means successfully managing symptoms as a normal part of life with no disruption to daily activities. Research has shown that even for those with the most serious mental illnesses, the right treatment can have someone living an independent, fulfilling, and successful life.

Does everyone with a mental health diagnosis need medication? What alternatives to medication exist?

It’s a common thought that the only cure to a mental health diagnosis is medication and if one stops taking his or her pills, it’s all downhill from there. While medication works for some people, it is hardly a cure-all. In fact, some medications can have side effects that are more harmful than the symptoms of the mental health challenge!

Deciding to try medication is a personal decision. The good news is that it is not the only option. Research has shown that other types of therapies can be extremely effective in maintaing a person’s level of wellness, including mindfulness, talk therapy, peer support, physical activity, and visual and performing arts, to name a few.

So, do I have to share my mental health issue with the world?

Not unless you want to! Some people are very open about their mental health issues because they value transparency and/or want to be an example of recovery. Others may not feel comfortable because they fear stigma, or simply don’t want the world knowing their personal business. Some may choose to tell family and close friends, but not coworkers or acquaintances. There is no right or wrong answer. You should do what makes you comfortable. If you want to start dialogue around mental health but aren’t quite sure if you’re ready to share your experiences, you can always frame the conversation around wellness, which applies to everyone, diagnosis or not.

What should I do if someone discloses their challenge to me?

Just listen. Providing a supportive ear is the best thing you can do for someone who chooses to open up. It’s not always easy to share something so personal with another human being, so taking a genuine interest and being free of judgment can go a long way and do a lot of good.

Feeling Anxious?

When most people think about anxiety, they picture the typical nervousness folks experience before taking a test at school, or perhaps speaking in public. Their pulse may quicken a bit, their face may feel a bit flushed, they may have “butterflies in their stomach,” but that is about it. It is a temporary feeling, and is generally considered to be a normal human reaction.

For some people though, anxiety rises to the point where a person’s ability to work or lead a normal life is impacted. According to the Centers for Disease Control and Prevention (CDC), in the U.S. the estimated lifetime prevalence of any anxiety disorder is over 15%, while the 12-month prevalence is more than 10%.

For example, if a child is so anxious about going to school that they regularly cannot get out the door on time, it may be time to see a mental health professional.  If a person avoids socializing with friends because the thought of being around people makes them feel lightheaded and nauseous, this may be cause for concern. Worse, if a person feels these sorts of symptoms WITHOUT a triggering event, then a conversation with a medical professional is may be warranted.

There are a number of anxiety disorders including:  generalized anxiety disorder, specific phobia, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and selective mutism.

Panic Disorder

Let’s take a closer look at Panic Disorder. This disorder is known for the occurrence of “panic attacks” which is when the body’s “fight or flight” response kicks into overdrive, seemingly for no apparent reason. People who experience this describe feelings of imminent death, being unable to breathe properly, having sweaty palms and/or tingling hands or feet, of feeling pain in their chest and the belief that their racing heart will suddenly stop and they will die. In other words, an abject feeling of terror; again, coming on without warning after no apparent triggering event.

Treatment for Anxiety Disorders

There are common medical treatments for anxiety disorders. Medication, such as simple antidepressants like Lexapro or Prozac can be effective. Sometimes, anticonvulsant medicines (typically taken for epilepsy) and low-dose antipsychotic drugs can be utilized in conjunction with antidepressants. Other medications can include benzodiazepines (such as Klonopin, Xanax, Librium, Valium, etc.), or opioids (OxyContin, Vicodin, codeine, morphine, etc.). Care however must be taken, as these sorts of medications can become addictive.

Other, non-pharmacological interventions can be employed as well and include Dialectical Behavior Therapy (DBT), Cognitive Behavioral Therapy (CBT), meditation, mindfulness, breathing exercises, or even yoga. If the person has had a traumatic event in their past which acts as a trigger to their anxiety disorder, there are also therapies which can address and defuse trauma: EFT (Emotional Freedom Technique), EMDR (Eye Movement Desensitization and Reprocessing), art therapy, and even trauma informed yoga. Some folks have even had good results with therapy animals, such as dogs, cats, horses, or even guinea pigs or rabbits. Positive changes in diet and exercise have also proven to be beneficial.

Bottom Line

If you or a loved one is experiencing an anxiety disorder, treatment is readily available.

Congress listened

Throughout the  year, we’ve asked Congress to stop health reform efforts that would hurt Americans with mental illness—and we’ve urged them to forge bipartisan solutions to stabilize the health insurance markets.

We have good news: Congress listened.

Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) announced a bipartisan agreement to help keep insurance markets sound and more affordable. If this bill passes, it will help protect mental health coverage for Americans with mental illness.

The Alexander-Murray bill will also keep vital patient protections in place, including stopping health plans from:
Dropping coverage of mental health and substance use
Charging higher premiums if an individual has a preexisting condition, like depression or anxiety
Charging more simply because a person has a mental health or substance use condition

The Alexander-Murray bill will strengthen and stabilize the health care system, reducing the risk of sharp premium increases and lack of insurance options. It maintains important cost-sharing reduction (CSR) subsidies and financial assistance, which help low- and middle-income people pay for out-of-pocket costs and insurance premiums.

Your continued advocacy matters.

Contact your senators and tell them to support this bipartisan effort and protect mental health coverage for million of American Students.

 

Griffin Ambitions Ltd is nonpartisan. We support policies that help people with mental health conditions and their families.

Griffin Ambitions is here for you.

 

Misintent : Hazing Students | Mental Health

Notice:  This piece was selected for publishing as an open opinion piece by an unaffiliated contributor.


How is what YOU do, in any way similar to fraternity/sorority HAZING? Before you say “in NO way!”…stop and reflect a little.

I know, not all fraternity “hazing” ends in death, though it is now illegal in California. But no matter how benign it seems, having to jump a lot of hurdles in order to GAIN ACCESS, is a problem for people seeking mental health treatment…or even getting the listening ear of a friend or parent.

Can we prevent the emotional/social pain sometimes inflicted on someone SEEKING ACCESS? Getting access to faith-based or mental health services, to school counselors, to peers or even distracted parents, can sometimes feel like “hazing”…the things we are asked to do, the price we are asked to pay.

How bad does someone want or need access? To what extent are hurdles placed in the way to find out “how high they will jump”? Some people “do what they are told”…are they considered fools (even by those whose services they seek) for not knowing when to stop seeking?

This Atlantic story is sad, but thought provoking.

Checkout: UNAFFILIATED ARTICLE ON THE NEWS STORY

It brings to my mind, another old story about a woman seeking help for her ill daughter, which suggests that even caregivers can learn from care seekers. Her daughter dying, the woman bowed down before the healer (as required by custom) and begged him to help her. His first response was, “It’s not good to take the children’s bread and throw it to the dogs.”, meaning…he’s only going to heal the really sick people, and those who are in my neighborhood, so to speak. To that, she said, “Yes, but even the dogs feed on the crumbs which fall from their owners’ tables.”. Comparing herself with hungry dogs seemed to make a difference. With that, he said, “Your faith is great and it shall be done for you as you wish.” And he healed her daughter at once.

I know scripture readers might argue with my interpretation here, but my point is, even Jesus felt he was only there for certain people and she had to do a little cajoling to get what SHE BELIEVED HE COULD DO. Compassionate or convicted – either way you interpret it – the healer, healed.

But why did she have to beg first? Did he know before she even started the conversation that he was going to help her? Was he “hazing” her a little? Did she have to prove her faith in him first? Or did he have to find her “worthy” of his time? Or did the “hazing” actually show him that his “treatment” was going to work on her prepared/faithful soul? Maybe there was another way to get THAT information…

In the end, she had her daughter back, healthy and whole. I wonder how SHE felt after that conversation. Of course, she felt grateful to the healer for his work. But I wonder if SHE felt healthy and whole, too.

 

“Advocate for mental health. Work to end STIGMA of mental illness.”

 

Campus Mental Health FAQs

Campus Mental Health: Frequently Asked Questions

Campus Mental Health: Frequently Asked Questions
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Many students attending colleges and universities experience anxiety, depression, and other mental health problems. According to the 2016 National College Health Assessment, almost 40% of college students reported that they felt “so depressed it was difficult to function” at some point in the prior 12 months, 19% felt overwhelming anxiety, and 10% had seriously considered suicide. If you are a college or graduate student experiencing one of these challenges or another mental health issue, you may be worried about its effect on your academic progress, disciplinary status, or ability to participate in social or other activities at your school. In this guide, we hope to answer some of your questions about your rights as a student with mental illness, as well as about the legal protections, accommodations, and resources available to you.

Which Laws Protect My Rights as a College or Graduate Student with a Disability?

Nearly all universities are subject to the Americans with Disabilities Act (ADA), either because they are publicly funded or, in the case of private universities, because they are considered public accommodations.1 Most universities and colleges also receive federal funds in some form, and will therefore be subject to Section 504 of the Rehabilitation Act of 1973 (Section 504).2 Colleges that provide housing—including dorm housing—must also comply with the Fair Housing Act (FHA).3 Many states also have anti‐discrimination laws that apply to universities.

The ADA, Section 504, and the FHA prohibit discrimination on the basis of disability, defined in the ADA as “a physical or mental impairment that substantially limits one or more major life activities of [an] individual; a record of such an impairment; or being regarded as having such an impairment.”4 Because the definition of “major life activity” is broad and includes activities such as “thinking, concentrating, sleeping and communicating,” your mental health issue will usually be considered a disability under these laws.5

Under the ADA, Section 504, and the FHA, a university may not exclude an otherwise qualified individual from a program, activity, or facility (such as a dorm or library) because that person has a disability.6 These laws also require that universities provide “reasonable accommodations” to students with disabilities that are designed to help them participate fully in university life. For more information on what constitutes a reasonable accommodation, see below(Source #1)

In addition, two laws—the Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA)—protect your privacy, including the confidentiality of any disciplinary or medical records related to your disability. These laws limit the information school administrators may request from your mental health provider and usually prevent them from disclosing information related to your disability, or your academic or disciplinary record, without your permission.

What Kinds of Accommodations Are Reasonable?

The ADA and Section 504 require schools to provide students with disabilities with “reasonable accommodations.” A reasonable accommodation in the academic context is a “modification to . . . academic requirements [that is] necessary to ensure that such requirements do not discriminate or have the effect of discriminating, on the basis of [disability], against a qualified . . . applicant or student.”7 For instance, a student might need extra time to complete exams, permission to take a leave of absence, or access to assistive technology or transportation services.

Under the FHA, schools must also make reasonable accommodations to housing policies when they are necessary to provide equal access for students with disabilities.8 In this context, reasonable accommodations may include providing the student a private room or allowing the student to keep a service or emotional support animal in campus housing.

A school may refuse to provide an accommodation only if providing it would fundamentally alter the nature of its academic or residential program or would impose an undue burden on the school, which balances factors like the nature and cost of the proposed accommodation and the school’s resources.9

How and When Should I Request an Accommodation?

All schools that receive federal funding must designate a staff member or administrator as a disability services coordinator (DSC). When requesting an accommodation, the DSC and his/her office should be your first point of contact. The DSC can guide you through your school’s internal process for requesting accommodations, which may require you to disclose some information in writing related to your disability and the types of accommodations you need. You should not, however, be required to provide extensive medical documentation. Similarly, you should not be required to disclose your entire medical history or the content of sessions with a mental health provider. At most, the DSC should request a letter from your healthcare provider or counselor stating that you have a disability and explaining that disability’s relationship to your ability to function in college. The DSC should also serve as your liaison with professors, administrators, and other school officials in all matters related to your disability. If you are seeking accommodations in your dorm, it is also a good idea to speak with your school’s Dean of Students or residential advisors, who may be more familiar with the housing accommodations your school can provide.

You should request accommodations from your school’s DSC as soon as you think they are needed, regardless of whether it is the first day of your college career or the last week before graduation. A school is not expected to accommodate a need of which it is unaware. If your needs change, you can always ask that the DSC modify the accommodations provided or request additional accommodations(Source #2).

I Am Facing Discipline for Conduct Related to My Disability. What Should I Do?

A student with a disability should not be disciplined for the disability itself (for instance, a school may not discipline a student because that student complains of hallucinations). But schools may seek to discipline a student for behaviors that arise as a consequence of a disability if those behaviors violate a code of conduct or other disciplinary rules, so long as the school applies the rules in a non‐discriminatory manner. In other words, a student who hallucinates may be disciplined if these hallucinations cause him or her to disrupt a class, just as a non‐ disabled student would be disciplined for the same disruptive behavior (but note the discussion below about a school’s obligation to provide reasonable accommodations in the student disciplinary process). In addition, schools should not seek to discipline students who engage in or threaten to engage in self‐harming behaviors, which are often linked with mental illness.

If university personnel seek to discipline you for conduct related to your disability, they will most likely provide you with an opportunity to appeal their decision in writing or contest it in a hearing. Information about the various steps in the disciplinary process should be available on the school’s website. During this process, you should consider disclosing that you have a disability if you have not done so already. This will enable you to request a reasonable accommodation to the school’s discipline policies, such as a leave of absence rather than disciplinary action, or to present the disability as a mitigating circumstance. It may also be helpful to show that, with appropriate supports, you can prevent the disability‐related behavior from recurring. A letter from your mental health provider could help you do this. In general, the more evidence you have to demonstrate that the school is seeking to punish you for behavior related to your disability, the better the chances are that you may avoid disciplinary action.

If school administrators make use of information contained in your academic record to make a decision related to discipline, you have the right to request that such information be shown only to individuals with a “legitimate educational interest” in that information.10 In the case of a disciplinary determination, this might mean that members of the school’s judiciary committee or the Dean of Students can access relevant parts of your academic record, but others (including professors, other students, or your parents) have no right to do so without your express permission.

What Are My Rights Regarding Medical Leaves of Absence?

If you find yourself struggling with the academic or other demands of your educational program as a result of your disability, you may decide to take a medical leave of absence to focus on your recovery. Rarely, your school may require that you take a leave of absence if it decides you cannot safely remain on campus. In either situation, you retain the right to be treated fairly and without discrimination. You should consult your school’s polices regarding leaves of absence before making the decision to request such a leave(Source #3).

Voluntary Leave

Most schools permit students to take a voluntary leave of absence for mental health reasons. When deciding whether to take a voluntary leave of absence, you may wish to consult with your school’s counseling center or another mental health professional. The counseling center may be able to help you secure a formal leave of absence from the school.

If you choose to take a voluntary leave of absence, your school should not place any treatment‐related restrictions on your ability to return to campus, though they may ask you to wait until the beginning of the next quarter, semester, or academic year to resume taking classes. Students on voluntary leaves of absence should be permitted to attend campus events, visit friends on campus, and access campus facilities.

Involuntary Leave

The decision to impose an involuntary leave of absence on a student should only be made in extraordinary circumstances. Imposing a leave of absence is justified only if a student cannot safely remain at a university or meet its academic standards, and the risk cannot be reduced to an acceptable level with accommodations. Similarly, a student may only be barred from university housing if he/she cannot safely remain there, even with accommodations.

Schools use different procedures to make decisions concerning involuntary leave, but they must conduct an individualized assessment, based on objective evidence, that considers the nature, severity, and likelihood of the risk, and whether the risk can be reduced through reasonable accommodations.11 In conducting this inquiry, most schools will consult with or ask for an assessment by mental health professionals. In most cases, a student faced with an involuntary leave will be given basic procedural protections. For example, the school will typically notify the student or his/her representative of the action under consideration and may provide a written explanation of that action. The school will also usually give the student or his/her representative an opportunity to respond and explain why he/she should not be required to leave. In framing your response, it may be helpful to seek the advice of a psychiatrist or other mental health professional, who can provide an independent evaluation of your mental health and suggest ways to address the school’s safety concerns. If you are ultimately required to withdraw, your school should provide the same arrangements for withdrawing from classes and obtaining a tuition refund as it would for a student withdrawing for another reason (e.g., a physical injury related to an accident).

A school has the right to access limited medical information about your mental health status and disability when it is considering imposing a leave of absence. Your school may therefore request recent mental health records to determine whether you may safely remain on campus, and it may inquire into your current mental health condition. But your school may not request unlimited access to your health or medical records, and you may limit the release of confidential medical information to specific dates. You also have the right to review all records your school requests before access is granted(Source #4).

Conditions on Returning from Involuntary Leave

A school has the right to impose limited conditions on your ability to return, particularly in the case of an involuntary leave. Even so, a school may not impose more onerous requirements on students returning from a leave of absence for mental health reasons than on other students returning from other types of leaves.12 Your school cannot require that your mental illness be cured, but it is allowed to ask you to demonstrate that the risk that motivated your initial removal no longer exists or has been sufficiently mitigated. Some schools will request that you have your mental health provider send a report stating that you attended treatment and are ready to return to school. They may also request that you sign a behavioral contract, stipulating (for example) that you will abide by the terms of the university’s code of conduct, and in some circumstances may ask that you commit to taking certain steps to preserve your mental health. You have the right to decline this contract and/or negotiate its terms, though it is possible you will not be allowed to return without signing the contract. Ultimately, decisions about whether your mental health permits you to return to campus, including the determination that it is safe for you to return, should be made by a mental health professional rather than by the school administration.

My School Is Denying the Accommodations I Requested and/or Imposing Discriminatory Disciplinary Procedures. What Can I Do?

If your school is refusing to accommodate you, denying you access to certain parts of its academic or residential program, or subjecting you to discriminatory disciplinary procedures, you should first follow your school’s internal grievance or appeal process. Information about these processes should be available on the school’s website.

If that fails to resolve your issue—or you feel the process was itself discriminatory— you have the right to file a complaint with the Department of Education’s Office for Civil Rights (OCR). If OCR determines that your complaint has merit, it will take action against your school and require it to rectify the situation. Complaints must be filed within 180 days of the event you believe to have been discriminatory.

Before filing a complaint, it may be useful to seek legal advice. In addition to helping you draft your complaint, a lawyer will advise you on state and federal law applicable to your situation. Your lawyer can also help you decide whether to consider a lawsuit against the school.

Resources

If you have difficulty getting the accommodations you need from your school or need assistance requesting a reasonable accommodation, try contacting the National Alliance on Mental Illness, Active Minds or NAMI on Campus, your state Protection and Advocacy organization (P&A), or a local legal aid organization(Source#5).

If you believe your school has discriminated against you, you can file a complaint with the Department of Education’s Office for Civil Rights (OCR) at: https://www2.ed.gov/about/offices/list/ocr/complaintintro.html.

If you believe university administrators have made inappropriate use of your medical information, you can file a complaint at: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf (select the HIPAA option).

If you believe your right to privacy has been violated, you can file a complaint with the Department of Education, Family Compliance Office, at: http://familypolicy.ed.gov/sites/fpco.ed.gov/files/EComplaint%20form%20FERPA_052217.pdf.

1 See 42 U.S.C. § 12131(1)(A); 42 U.S.C. § 12181(7). Note that the ADA does not cover “religious organizations or entities controlled by religious organizations,” a category that may include some religiously affiliated colleges. 42 U.S.C. § 12187.
2 29 U.S.C. § 794(a) (“No otherwise qualified individual with a disability . . . shall, solely by reason of her or his disability, be excluded from participation in…any program receiving Federal financial assistance”). Universities that accept students benefitting from Pell Grants or other federal financial aid programs are considered to be “programs receiving federal financial assistance.”

3 42 U.S.C. §§ 3601 et seq.4 42 U.S.C. § 12102(1).
5 Id. at § 12102(2).

6 If you have been accepted to a university, you are considered to be “qualified” to attend. See, e.g., Resolution Letter to Spring Arbor University from the Office for Civil Rights, OCR Complaint No. 15‐10‐2098 at 10 (Dec. 16, 2010) (because the complainant had been accepted into the academic program and had not been subsequently disqualified as a result of academic or disciplinary factors, he remained a qualified individual).

7 34 C.F.R. § 104.44(a).
8 42 U.S.C. § 3604(f)(3)(B); see also 34 C.F.R. § 104.45(a) (university housing for students with disabilities must be “comparable, convenient and accessible . . . at the same cost as to others”).
9 42 U.S.C. § 12182(b)(2)(A)(iii); see also 34 C.F.R. § 104.44 (“requirements . . . essential to instruction pursued by each student [or] directly related to licensing requirements will not be regarded as discriminatory”).
10 20 U.S.C. § 1232g(b).
11 See 28 C.F.R. § 36.208(b).
12 See Resolution Letter to Spring Arbor University from the Office for Civil Rights, OCR Complaint No. 15‐10‐2098 at 10‐11 (Dec. 16, 2010).

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Focusing on Mental Health Policy Issues

The recent spate of high-profile mass shootings has inspired yet another “national conversation” about mental illness, with everyone agreeing that the country has a problem. Unfortunately, isolated instances of violence are how the subject typically ends up in the news cycle. But the more mundane social repercussions of mental illness, while perhaps not as headline-worthy, are pervasive and acutely felt nonetheless.

On any given day, one in five people in jail or prison has a severe mental illness. This means that people with serious mental illness are ten times more likely to inhabit a jail cell than a hospital bed. Besides contributing to jail and prison over-crowding, mentally ill people are especially vulnerable to victimization by fellow prisoners, spend more time in solitary confinement, and become suicidal behind bars at higher rates than non-mentally ill inmates. They also cost the correctional system considerably more than otherwise healthy prisoners.

The challenge facing prisons is just one consequence of decades of de-institutionalization policies. From a nationwide peak of around 560,000 psychiatric beds in 1955, the census has been whittled down to about 35,000 today — about half of what experts estimate is actually needed. In the absence of such beds, patients will continue to be warehoused behind bars, lie on emergency-room gurneys for days, and languish in nursing homes. One-third of the nations homeless will still be comprised of the untreated mentally ill, who are at far greater risk of being preyed upon than of harming someone else.

The lesson of downsizing state psychiatric facilities — no less powerful for being familiar — is that good intentions are not enough. Too many sick people are now caught in a pernicious cycle, rotating in and out of emergency rooms, crisis hospitalization, incarceration, homelessness, and back again. Its no wonder some of the strongest supporters of mental-health reform are police, district attorneys, corrections officials, and emergency-room physicians.

These problems afflict roughly 10 million Americans, or just over 4% of the population. Mainly diagnosed with schizophrenia, bipolar (manic-depressive illness), or major depression, such individuals are chronically or periodically unable to care for themselves or are suicidal. At times, they may be dangerous to the public. Relative to other psychiatric patients, those with severe mental illness are far more likely to need medication, intensive supervision, and even involuntary treatment at some point in their lives. But they arent getting the help they need, and the governments good intentions are often the very thing preventing their getting appropriate treatment.

To understand a key source of the problem, we should compare severe mental illness to “mental health.” The Centers for Disease Control describes mental health as a composite of “emotional well-being,” “psychological well-being,” and “social well-being.” According to government statistics, only about 17% of adults are considered to be in a state of optimal mental health — the rest, apparently, need some kind of professional assistance to achieve optimal “wellness.”

Sandwiched between mental health and severe mental illness is a clinical category called mental illness. One recent national survey estimates that nearly 18% of those individuals older than 18, or about 43.7 million people annually, are mentally ill — meaning they fulfill diagnostic criteria for any condition listed in psychiatrys official diagnostic handbook, ranging from attention deficit disorder to panic attacks to anorexia. The severity and chronicity of these conditions varies dramatically, with most conditions resolving on their own, while others are best served with time-limited psychiatric care; some may require hospitalization and long-term medication and therapy.

The distinction between mental health, mental illness, and severe mental illness is crucial, because it leads us to different clinical and policy prescriptions. The vague boundaries of “mental health” enabled a variety of advocates whose true agenda is grievance and social reform to claim that their concerns fell under its rubric, as historian of psychiatry Gerald Grob has observed. As a result, he writes, “persons with serious and persistent mental illnesses…[are] forced to compete, often unsuccessfully, with other groups that now [define] their needs in terms of mental health.”

The problem we have today is that the system is geared more toward mental health than severe mental illness. In fact, the federal governments lead agency on mental health, the Substance Abuse and Mental Health Services Administration, part of the Department of Health and Human Services, has explicitly stated this as its goal. Rather than focusing on reducing homelessness, hospitalization, or incarceration among people with serious mental illness, it concentrates federal and state efforts on delivering amorphous “behavioral health” to everyone else.

This is profoundly misguided. But it may not be surprising after a half-century of inept leadership, Medicaids financial incentives gone awry, and clashing ideas about the nature of the forces (psychological, biological, and social) that lead to psychopathology — and that, in turn, point toward the best possible therapeutic strategies. Ours is a problem-ridden system that could be markedly improved with strong political leadership.

We need a mental-illness system in which care for the sickest of the sick is a priority. If the federal government intends to take mental illness seriously, Congress and the next administration must be keenly responsive to the most vulnerable patients.

a troubled legacy

To understand what should be done, a review of the dynamics that led to the current state of disarray is in order. Four key elements are to blame.

The first emerged in the late 1950s, as officials emptied state hospitals of even the most debilitated patients without adequately planning for their continued treatment. The second contributing factor came with the creation of Medicare and Medicaid in 1965, as new policies limited access to community hospital beds. The third factor is the growing complexity of competing ideas about the causal and remedial factors involved in mental illness, and the resulting complications in policymaking. And fourth is the disproportionate leverage wielded by anti-psychiatry forces in an era of victim politics. This last influence builds upon a longstanding debate regarding the civil liberties of individuals whose capacity to manage their freedom is badly compromised by dysfunction in their brains.

Until half a century ago, the care of people with mental illness had been the responsibility of the states. This changed in 1963 when President John Kennedy ushered in the era of federal support by championing the Mental Retardation Facilities and Community Mental Health Centers Construction Act. The new law mandated the creation of a user-friendly archipelago of 1,500 federally funded community clinics nationwide to supplant the large state asylums and to allow patients to live in their communities while receiving treatment. “When carried out,” Kennedy said of the act, “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.” The presidents interest was personal, stemming from the tragic experience of his sister Rosemary, who was born with mild mental retardation and eventually underwent a frontal lobotomy for schizophrenia.

The nation was primed for the change the president sought. Two decades earlier, Life magazine had run “Bedlam 1946,” a searing photo-journalistic exposé of Pennsylvanias Philadelphia State Hospital at Byberry and Ohios Cleveland State Hospital. Books like Albert Deutschs The Shame of the States and popular entertainments like the movie The Snake Pit, both of which appeared in 1948, exposed shocking conditions of filth and abuse in state facilities.

State-initiated efforts improved the conditions at state hospitals in the mid-1950s, and, thanks to the availability of Thorazine, an anti-psychotic medication introduced in 1954, some patients were successfully moved into the community. But with Kennedys community centers under construction in the mid-60s, the campaign to empty out state facilities took on new urgency. Some patients did well upon discharge, but the sickest were caught in a revolving door: Without closely supervised treatment, many failed in the community and went back to whatever institutions were left. Others ended up in a kind of limbo, neither institutionalized nor embedded in a community.

The state-hospital population was further eroded by legal decisions issued in the 1960s and 70s that made it hard for judges to order necessary treatments for patients who were wildly psychotic or immobilized by depression but were refusing care. A convergence of strange bedfellows — fiscally conservative state officials, progressive reformers, former patients, and politically liberal civil-rights lawyers — formed a strong advocacy coalition for deinstitutionalization policies.

In 1965, as the exodus from state hospitals was well underway, Congress passed legislation establishing Medicare and Medicaid. The new law included a provision that unwittingly planted the seeds of the current shortage of public hospital beds. It did so by prohibiting Medicaid from paying for care delivered to patients between the ages of 22 and 64 if that care was provided in an “institution for the treatment of mental diseases,” or IMD. An IMD is defined as a treatment facility with more than 16 beds of which at least half are dedicated to mentally ill patients. The so-called “IMD exclusion” was intended to spur momentum for community treatment by barring the doors to the asylum, which Congress saw more as a warehouse than a treatment facility anyway.

The IMD exclusion did not affect general hospitals and nursing homes. They remained eligible for Medicaid reimbursement. Thus, states had a strong incentive to shift patients from state psychiatric hospitals to Medicaid-eligible institutions, even if those venues were more costly or less effective. With fewer and fewer psychiatric beds available, emergency rooms became holding areas for those who needed inpatient treatment; others spilled out onto the streets and into run-down, questionable boarding houses and jails.

It did not have to be this way, which is clear given how well Medicaid has worked for people with intellectual and developmental disabilities. They, too, could be found living in state hospitals in the mid-20th century, but Medicaid treated them differently. If they still needed residential or intermediate care, Medicaid reimbursed the state for their stay. Then when these patients were discharged into the community, Medicaid covered wraparound services such as vocational assessments, family counseling, medication management, and transportation. Today, these services are provided under a “community options” waiver that “swaps” a Medicaid-covered inpatient bed for a similarly covered, community-based slot.

Unfortunately, no such waiver exists for individuals with serious mental illness, because the IMD exclusion prohibits federal coverage for adults. The ensuing problem of fragmented services is formidable. Between orchestrating disability entitlements, housing, and treatment of medical problems, case management can require organizational skills that are beyond most of us, let alone people who are also overwhelmed by depression, difficulty concentrating, or jumbled thoughts. Even when there are quality services covered by Medicaid, such as nursing-home placement, funds are not always tailored to young or middle-aged able-bodied psychiatric patients. Meanwhile, entire subpopulations of poor, young men are not covered at all in many states.

Thus, as Harold Pollack of the School of Social Service Administration at the University of Chicago explains, “Deinstitutionalization has, on the whole, worked well for the intellectually disabled because they and their supporters could crank the political valves required to make it work. Equally worthy claimants who lacked the same political muscle or public embrace fared much worse. Thats one key lesson of the deinstitutionalization fight.”

The next major step toward our current dysfunctional approach to treating mental illness seems at first glance to have begun with a semantic, rather than a policy, decision. When Jimmy and Rosalynn Carter entered the White House in 1977, they already had an interest in mental illness. President Carter wasted no time in establishing the Commission on Mental Health. According to historian of psychiatry Gerald Grob, “the [commissions] decision in 1977 to use mental health rather than mental illness…was based on the application of a public health model that emphasized the role of the environment, social services, and prevention rather than the traditional psychiatric focus on the diagnosis and treatment of severe and persistent mental disorders.”

The dubious notion that external influences, such as stress, social problems, traumatic experiences, and even coercive psychiatric care itself are the primary causes of severe mental illness still thrives today in influential quarters, as we will see.

the recovery model

A quarter-century after the Carter commission, in 2002, President George W. Bush revisited the problem of public mental-health care by appointing a commission of his own, called the New Freedom Commission on Mental Health. The commission was charged with conducting a “comprehensive study” of the existing system and advising President Bush on improvements. The 2003 report issued some positive suggestions regarding, for example, the need for an increased number of psychiatric beds and better programs to help disabled patients participate in the workforce. But the Bush commission, like Carters before it, elided the distinction between mental health and mental illness and failed to grapple with approaches to patients with severe mental illness who refused to take medication and had a potential for violence.

Instead, the Bush commission promoted an overly optimistic treatment philosophy that came to be called the “recovery model.” It held that with sufficient therapy, housing options, and employment programs, patients with schizophrenia or manic-depressive illness would be able to take charge of their lives. To be sure, a lot of patients are indeed able to do this, especially young people with recent onset of illness. But the recovery models unrealistic one-size-fits-all approach ignored the toughest cases, which often require heavy doses of paternalism because the patients dont acknowledge their own illness — a symptom of being psychotic in and of itself, in many instances. In an un-medicated state, an individuals symptoms remain unabated, behavior remains menacing or erratic, and the risk of violence, particularly if alcohol or cocaine is involved, is increased.

The recovery agenda was inspired by the patients rights movement of the 1960s. This campaign for enlightened care, which included better quality of treatment, collaboration with physicians, and assurance of privacy of health information, was a sensible reaction to the heavy strain of paternalism that marked the medical field at one time. Psychiatry, in particular, attracted the animus of patients rights activists; after all, it is a field whose very nature requires professionals to make fraught judgments about the normal or abnormal thoughts, behaviors, and identities of their patients. Whats more, for better or worse, psychiatrists may impose tacit or actual control over their patients.

Consequently, the psychiatric patients rights movement took on a radical tenor. Spurred by a 1960s ethos of social justice, activists saw themselves as a class of social dissidents and psychiatry as an agent of social control. The Insane Liberation Front was founded in 1970 in Portland, Oregon. In 1971, the Mental Patients Liberation Project and the Mental Patients Liberation Front appeared in New York and Boston, respectively. The next year, former patients in San Francisco organized the Network Against Psychiatric Assault and the Madness News Network. They have championed the rights of severely ill patients to refuse treatment, representing the expressed wishes of their clients (patients) even when they are delusional, and they have campaigned against involuntary commitment, as well as electroshock therapy, which is one of the safest and most effective treatments for severe depression. So what do these activists prescribe as an alternative? Political empowerment.

By the 1980s, the movement had spawned a new identity known as the “consumer-survivor,” which persists to this day. In this iteration of the psychiatric patients rights movement, dynamics such as identity politics (with the mentally ill playing the role of minority population), disability status, and a sense of entitlement to public services play a larger role than they did in the 60s and 70s. Compared to their earlier counterparts who saw themselves as dissenters, not patients, these consumer-survivors actually do see themselves as ill. “Consumer” is the politically correct word for patient, and “survivor” refers to one who has survived psychiatric care. The most vocal anti-psychiatry consumer-survivor groups are the National Empowerment Center near Boston and the Nation Mental Health Consumers Self-Help Clearinghouse in southeastern Pennsylvania. Funded in part by the federal government and state mental-health agencies, these groups lobby against involuntary treatment and electroconvulsive therapy, and they discourage patients from taking medication.

As with the anti-vaccine movement, such trends always have the capacity to be damaging, but vocal, misguided fringe groups are not a rare occurrence in the United States, especially when it comes to health care. The difference is that these groups have the financial support of the U.S. government; thus, taxpayer money is being used to make things worse.

failing the most vulnerable

The Substance Abuse and Mental Health Services Administration, an agency within the Department of Health and Human Services known by its acronym, SAMHSA, bolsters the consumer-survivor agenda ideologically, programmatically, and financially. It is a striking example of government working at cross-purposes to the best interests of its most desperate constituents.

The agencys entire budget for mental health is around $1.1 billion. (The remainder of its full budget of $3.6 billion is earmarked for prevention and treatment of substance abuse.) Of the $1.1 billion mental-health budget, $482 million goes into block grants to the states for mental-health services, and the remainder goes to other programs for adults and children, the homeless, and Protection and Advocacy (described further below). Given that federal mental-health expenditures total $130 billion annually, mostly in the form of Medicaid, the SAMHSA budget seems modest. But the agency manages to leverage its funds in ways that not only shortchange but actively undermine the welfare of the sickest patients.

For one thing, SAMHSA claims to receive much of its policy input from groups of consumers that it occasionally convenes. These people may have psychiatric problems but generally need only low-levels of support, and many do not take medication. They do not represent the most impaired patients — the ones who are languishing in jails, in emergency rooms, or on the streets. Such people are too lost in their psychosis to show up for a focus group or to embrace the “recovery agenda.” Indeed, approximately half of all untreated people with a psychotic disorder do not acknowledge they are ill, which is itself a neurological condition called anosognosia.

There is a vital role for benign paternalism toward this highly vulnerable set of patients, but the culture of mental health as practiced by SAMHSA effectively denies their existence, let alone their needs. To be sure, the psychiatric profession was once dismissive and too pessimistic about many people who were indeed capable of greater independence, but there is no denying that now a subset of the mentally ill needs much more oversight and, at times, even benign coercion.

SAMHSAs worldview is reflected in the nature of its discretionary grants and programs, some of which completely undermine the best interests of patients with severe mental illness. For example, the agency is a major funder of groups that are overtly opposed to medically accepted psychiatric care. The National Empowerment Center, based in Lawrence, Massachusetts, is one beneficiary of SAMHSA funds. Its mission is “to carry a message of recovery, empowerment, hope and healing to people with lived experience with mental health issues, trauma, and/or extreme states.” The NECs Chief Operating Officer has been a long-time critic of the use of psychiatric medications.

The Washington, D.C.-based National Coalition for Mental Health Recovery is a trade group for recipients of agency largesse. Its mission is to ensure “consumer/survivors have a major voice in…policies at the state and national levels.” The coalition and its smaller, composite organizations oppose the type of services — civil commitment, increased hospital capacity — that target the most impaired. Another example is the Alternatives Conference, which is funded by SAMHSA each year. Among other things, attendees with mental illness are taught how to go off their psychiatric medications. In 2011, SAMHSA gave one of its annual “Voice Awards” to an activist who believes that “[p]sychiatry is not medical because it is not scientific. It does not diagnose or treat actual conditions. It is complete fiction. Voodoo witch doctors have a better cure rate.”

Apart from awarding grants, SAMHSA runs its own programs, perhaps the most painfully misguided of which is the Protection and Advocacy program. Established by Congress, the original, benign intent of the Protection and Advocacy for Individuals with Mental Illness Act of 1986, or P&A, was to investigate allegations of patient abuse, neglect, and rights violations in hospital wards or in residential facilities. Mission creep soon set in, however. As Rael Jean Isaac and Virginia Armat documented in their 1990 book Madness in the Streets, P&A quickly devolved into “playgrounds for anti-psychiatric activists.”

The P&A program operates with $39 million, distributed among the states. The local P&A agencies routinely flout congressional intent by lobbying state legislatures against adopting sensible treatment policies and against strengthening their civil-commitment laws. Making matters worse, they do so at the expense of conducting investigations into the mistreatment of patients. Amanda Peters of South Texas College of Law has closely examined P&A programs, and has found that their lawyers and personnel are so preoccupied with fighting civil-commitment policies and trying to liberate undeniably psychotic patients from hospitals that glaring violations of abuse and neglect go unchecked.

Many P&A lawyers are against hospitalization at any cost, to sometimes tragic result. Consider the story of Joe Bruce of Caratunk, Maine, whose psychotic son is now a murderer because of Maines P&A agency. In 2006, 24-year-old William Bruce was a patient at Riverview Psychiatric Center, where he had been committed after assaulting his father. His parents were afraid of their son and begged the hospital to medicate him with the antipsychotic that had previously quelled his paranoia and aggression. Williams psychiatrists, who had observed him for weeks as an inpatient, fought against Williams pleas for release because he remained paranoid and agitated. Nonetheless, the P&A legal advocates insisted that William was “competent” for discharge and openly coached him — as any lawyer would his client — on how to placate the doctors so theyd let him go. William and his lawyers somehow prevailed over his doctors and parents objections, and Riverview discharged him. Two months later, he killed his mother with a hatchet. The Bruce familys story is one of the most dramatic, but by no means one of the only, examples of the reckless “liberation” of dangerous or debilitated patients at the hands of a P&A agency.

For decades, HHS and SAMHSA have mismanaged the mental-illness resources of the federal government, focusing increasingly on “recovery agendas” instead of on the severely mentally ill. Our most vulnerable citizens are slipping through the cracks. It is long past time for a better, more serious mental-illness agenda.

prescriptions for mental health

Like Presidents Kennedy, Carter, and Bush, the next president could do a great deal to improve the nations mental-health system. The most radical, most effective approach might be to propose legislation to abolish SAMHSA altogether, holding on to those pieces worth saving, such as the collection of statistics, by assigning them to the Centers for Disease Control and Prevention, the National Institutes of Mental Health, or other appropriate government agencies. Charges of abuse (such as excessive use of physical restraints) and neglect could be handled by the Department of Justice. The block grants could be distributed by the Human Resources and Services Administration.

Whether or not SAMHSA is shut down, it is imperative that the next director of federal mental-health initiatives, perhaps working directly out of HHS, be a psychiatrist or psychologist with extensive experience treating and managing systems that target severely and persistently ill patients. (Currently, SAMHSA does not employ a single psychiatrist among its staff of 570, let alone in a leadership or key advisory position.) In 2013, an experienced psychiatrist joined as medical director, but she quit two years later because of what she described as “an open hostility toward psychiatric medicine by those at the helm of the agency. The concept of mental disorders as diseases was rejected.”

A SAMHSA leader who understands the clinical needs of the sickest patients and prioritizes these demands — and who is backed by the secretary of HHS — would instinctively make profound changes. He would cease grant-making to advocacy organizations whose members deliberately undermine the validity of professional help and medications and those who lobby against commitment policies at the state and federal levels. The medical-director slot would be filled by a psychiatrist who endorses mainstream views on the value of medication, the importance of promoting tested programs over a feel-good “wellness” and “empowerment” agenda, and the need for inpatient services. An enlightened agency leader would invest in research aimed at the sickest patients and accept the notion that paternalistic strategies are legitimate and necessary for some of them. Finally, such a leader would contain P&As mission creep and ensure that program funds go solely to the investigation of abuse and neglect, as was the programs original congressional mandate.

Medicaid needs improvements, too. To address the bed shortage, for example, Congress could base eligibility for Medicaid reimbursement solely upon an individuals need for care, rather than upon the location in which it is delivered. Another option is raising the limit on the number of psychiatric beds for which Medicaid will pay, to allow larger facilities already specializing in mental illness to fall outside of the scope of the IMD exclusion. Alternatively, more states could be allowed to use Medicaid Section 1115 waivers — as some already are — to draw down reimbursement for services provided in IMDs. Not surprisingly, some advocates argue against these ideas, concerned that they will re-open the door to institutionalization.

Some policymakers suggest simply expanding the number of psychiatric beds in general hospitals, but economies of scale (a benefit of larger psychiatric institutions) would be lost. Nor would general hospital units be able to reproduce the therapeutic milieu that characterizes a quality inpatient unit. Whats more, general hospitals are reluctant to admit the sickest psychiatric patients, who are often disruptive, sometimes violent, and difficult to treat and require additional nursing.

To inform lawmakers debating this complicated issue, the federal Centers for Medicare & Medicaid Services is funding the Medicaid Emergency Psychiatric Demonstration, mandated by the Affordable Care Act. Eleven states and the District of Columbia are using Medicaid funds to pay for inpatient emergency psychiatric care in psychiatric hospitals for patients aged 21 to 65 without the 16-bed restriction. By focusing on psychiatric emergencies, the three-year demonstration, which began in 2012, also attempts to explore a potential remedy to alleviate burdens placed on general-hospital emergency rooms by psychiatric patients for whom no bed is available.

Medicaid administrators also need more flexibility to cover the unique kinds of help, beyond standard fee-for-service visits for medication and therapy, which enable mentally ill individuals to thrive in the community. These may include Fountain House-type clubhouses (private, non-profit community centers that provide job training, socialization opportunities, and computer access) and various other types of assistance with staying in school or holding down a job. Assertive Community Treatment teams — intensive 24-hour outpatient supervision by clinical teams linking patients to needed medical and social services — would save money and reduce days in the hospital, but they currently have no reliable source of public funding. The same is true of Forensic Assertive Community Treatment, an adaptation of the ACT model that has been shown to reduce criminal recidivism through criminal-justice collaborations.

The good news is that there is active experimentation. In addition to emergency-room demonstrations now underway, Congress authorized a $1.1 billion, eight-state demonstration program in 2014 for a new type of community-based clinic focused on behavioral health. The Excellence in Mental Health Act, spearheaded by Democratic senator Debbie Stabenow of Michigan and signed into law in April 2014, created criteria for facilities to become “certified community behavioral health clinics.” (In 2016, Stabenow and Republican senator Roy Blunt of Missouri introduced a bill expanding the law to provide additional funding for 24 states to launch a demonstration program to tackle payment reform in behavioral health.)

These clinics are required to provide a wide range of services, such as the kinds provided by ACT teams. States will apply to develop a prospective-payment arrangement with clinics to cover all necessary treatment, a so-called flexible funding stream that supplants service-by-service reimbursement. After two years, these pilot programs may be replicated nationwide. Ultimately, certified clinics will be eligible for Medicaid reimbursement as the sole source of payment for patients.

Flexible funding streams will figure prominently in approaches to treating young people, generally in their late teens and early 20s, who are in the early stages of schizophrenia. Psychiatrists now know that the amount of time between the onset of psychotic symptoms and the beginning of treatment is very important in determining response to care. An especially promising study, Recovery After an Initial Schizophrenia Episode, just completed its first wave of trials in the fall of 2015 and attests to the value of aggressive intervention for first-episode psychosis. These data, derived from research funded by the National Institutes of Mental Health, show that a tightly coordinated team approach, including the patient, professionals, and family members, led to greater symptom control and more involvement in work and school than experienced by patients receiving treatment as usual. The team provides medication (at the lowest dose necessary), therapy for coping with stress, education for loved ones about the disease, supported employment or education for the patient once symptoms are under control, and personalized case management. Currently, these teams are in the research stage, but when they become standard practice, payment systems will need to accommodate wrap-around services en bloc instead of traditional fee-for-service arrangements.

Some additional relief has come with the Affordable Care Act of 2010, which included a provision to expand Medicaid. Currently, 31 states plus the District of Columbia have opted in to the Medicaid expansion, which means the federal government — rather than those states — will pay for the great bulk of the outpatient and hospital treatment of newly qualified low-income people. This has the potential to help individuals who are mentally ill or in the early stages of serious illness, especially young men, who are not yet designated disabled. (The IMD exclusion remains in place.) The laws requirement that young adults up to age 26 be able to stay on their parents insurance plans is also helpful in this regard, as it preserves access to psychiatric care right at the moment some will first be developing psychosis.

These encouraging developments are tempered, unfortunately, by a looming crisis in public-sector psychiatry, especially in inner-city and rural areas and especially for patients on Medicaid. While the number of all physicians in the United States rose by 45% from 1995 to today, the number of psychiatrists increased by only 12% — and over half are aged 55 or older and will soon retire. Medical students choosing the field of psychiatry are fewer in number than in decades past, in part because many graduates face huge debt burdens, and psychiatry is among the lowest-paid of the medical specialties — especially in clinics and public hospitals where psychiatrists are needed the most.

benign paternalism versus jail time

Even if these reforms were successfully undertaken and the mentally ill were granted broader access to care, however, it would not be enough to ensure that the sickest individuals received the care they needed. One of the hallmarks of severe mental illness is that patients often deny that anything is wrong with them. So for many patients with severe mental illness, a strong dose of paternalism is often required to keep them from descending further into psychosis, self-neglect, and disruptive behavior, which can range from public disturbance or destruction of property to outright violence.

Assisted outpatient treatment, or AOT, a cost-saving and effective form of civil-court-ordered community treatment, is aimed at individuals who have a well-established pattern of falling into a spiral of self-neglect, self-harm, or dangerousness when off medication. AOT allows judges to order these individuals into mandated and monitored treatment while they continue to live in the community. In some states, violation of the court-ordered conditions can result in the individual being hospitalized for further treatment. According to a review of studies by the Virginia-based Treatment Advocacy Center, AOT has reliably reduced homelessness, re-arrest, incarceration, hospitalization, and suicide by half to 74%, thereby cutting long-term health-care costs in half.

The main problem with AOT is that it is too rarely used. Forty-five states permit the use of AOT, also called “outpatient commitment,” but, due to a lack of funding and unfamiliarity with the AOT process or philosophy (which is constantly denounced by activist “consumers” in state houses), it is not applied as robustly as it should be.

In addition to AOT, which is a civil remedy, entities known as Mental Health Courts exist for those charged with criminal offenses. These courts embrace a therapeutic rather than a punitive approach, but use the power of the court to enforce ordered treatment. Defendants who agree to participate receive a treatment plan and other community-supervision conditions. Those who adhere to their treatment plan for the agreed-upon period of time see either their cases dismissed or their sentences greatly reduced. If the defendant does not comply with the conditions of the court, or decides to leave the program, his case returns to the original criminal calendar where prosecution proceeds as normal.

As a rule, most Mental Health Courts use a variety of intermediate sanctions in response to non-compliance before ending a defendants participation. At present, there is only a modest number of courts, but a 2012 Urban Institute evaluation yielded promising results: Participants in two New York City Mental Health Courts were significantly less likely to re-offend than similar offenders whose cases were handled in the traditional court system.

Law enforcement has a large role to play as well. Increasingly, emergency 911 calls for “mental disturbance” are being met by law-enforcement officials who have received crisis intervention training, or CIT. Not only do they learn how to defuse tense, potentially violent situations, but police are also taught to distinguish criminal acts from erratic behaviors due to psychosis. The first CIT program was established in Memphis in 1988, after a police officer shot a man with a serious mental illness. The program came to be known as the “Memphis Model,” and it is now a popular, 40-hour curriculum, developed in collaboration with local academics, family members of ill individuals, and the Memphis police department. It teaches police how to respond safely to a person in crisis, and includes information about the local mental-health system and laws, and about how to recognize mental illness and link people with appropriate treatment, as well as guidelines for interacting with disturbed people who are extremely agitated or aggressive. CIT can reduce arrests, injuries to police, and the need for SWAT intervention. Unfortunately, however, fewer than 20% of law-enforcement agencies train their officers, according to the National Alliance for the Mentally Ill, an advocacy group representing concerned family members.

Finally, individuals who are dangerous to others, suicidal, or unable to care for themselves may need to be hospitalized, regardless of their cooperation. Coerced care has long been a fraught issue. It pits an individuals liberty against societys safety. It also creates a tension between an ill persons “freedom” to act afoul of his own best interests and his potential to benefit from therapeutic intervention. Each case requires courts and lawyers to balance these interests as fairly and delicately as possible. The majority of states have a “grave disability” standard, an explicit and broad designation that focuses on a persons ability to feed, clothe, and protect himself. But the freedom to be psychotic and endangered is not a meaningful freedom at all. More states should adopt the “need for treatment” standard. This approach, which is in effect in about half the states, allows a court to intervene in a crisis. These standards are particularly relevant for individuals who lack insight into their illnesses.

These approaches — AOT, Mental Health Courts, crisis-trained law enforcement, and sensible commitment laws — can help divert mentally ill people from the correctional system. Though states determine their own investments in these options, the federal government could incentivize their use through extra resources or tie block-grant funding to the existence and smooth operation of AOT laws, Mental Health Courts, and need-for-treatment statutes.

the politics of mental-illness reform

Some of these solutions are currently under consideration on Capitol Hill, and constructive changes may be afoot. The furthest-reaching of the proposed mental-health bills introduced in the 114th Congress is the bipartisan Helping Families in Mental Health Crisis Act of 2015, championed by Pennsylvania congressman Tim Murphy, a child psychologist, and Texas congresswoman Eddie Bernice Johnson, a former psychiatric nurse. The cornerstone of the bill is new executive leadership in the form of an assistant secretary for Mental Health and Substance Abuse; this individual would be appointed by the secretary of HHS and subject to Senate confirmation. Funding and authority over SAMHSA would be brought under the assistant secretary who would be required to focus on both severe mental illness — thereby ensuring that adequate resources are targeted at reducing homelessness, arrest, incarceration, hospitalization, suicide, and violence among people with untreated illness — and coordinating the federal governments larger response.

The Murphy-Johnson bill would also rein in the Protection and Advocacy program, mandating an exclusive focus on safeguarding patients rights to be free from abuse and neglect. It also forbids P&A offices from lobbying federal, state, or local governmental entities and prohibits their efforts to secure discharge of patients “with a serious mental illness who [lack] insight into their condition on refusing medical treatment.” In addition, the bill encourages states to develop assisted outpatient treatment capacity and provides a financial bonus when they set up such programs. Murphy-Johnson also clarifies mental-health information privacy standards under the long-contested Health Insurance Portability and Accountability Act, known as “HIPAA,” so that medical personnel can communicate in detail with patients families in emergency situations.

Further, the legislation mandates that Medicaid cover inpatient care, no matter a facilitys bed count, as long as that facility or hospital has an average length of stay of fewer than 30 days. It also allows a Medicaid patient to visit more than one health-care provider in a given day, a boon for coordinated care. Notably, Murphy-Johnson increases the demonstration authority regarding “certified community behavioral health clinics” from eight states to 10 states and lengthens the time frame from two years to four years. The legislation also expands training and educational opportunities to ensure a sufficient number of providers.

The Murphy-Johnson bill has garnered considerable bipartisan support, and a similar companion bill has been introduced in the Senate, co-sponsored by Senators Chris Murphy and Bill Cassidy. But the legislation has met resistance on several fronts. The first stumbling blocks are basic legislative barriers such as the anticipated cost of the bill, crowded committee and floor schedules, and the fact that the bill falls into several different committee jurisdictions. As of mid-February, the Murphy-Johnson bill was wending its way through the House, having been marked up by the Health Subcommittee of the Energy and Commerce Committee.

Second, advocacy groups that receive funding from SAMHSA are protesting because their financial lifeblood is being threatened. More broadly, the mental-health consumer lobby fears that the bills provisions to increase bed space, strengthen commitment laws, and restrict the advocacy system will effectively send patients back to the asylum. According to the National Coalition for Mental Health Recovery — the trade organization representing SAMHSA-funded anti-psychiatry groups — the Murphy-Johnson bill “will set back community mental health care and undermine much of what our movement has worked so hard to achieve.”

Third, despite broad bipartisan support — 185 co-sponsors as of this writing — a cohort of Democrats has lined up against Murphy-Johnson. In a letter to the chairmen of the House Energy and Commerce Committee, the lawmakers expressed their “strong” opposition to elements of the bill that, they claim, “would restrict patients civil rights.” They refer specifically to the privacy-rule clarification (which supposedly “discriminates” against people with mental illness because no other medical conditions are singled out for special privacy considerations). The opponents decry AOT as being too restrictive because it targets patients who are not in immediate danger — the strict commitment standard they endorse — rather than merely at great risk of harm to self or others when untreated. They also reject the proposed limits on the activities of the Protection and Advocacy agencies.

Fourth, the recent, high-profile shootings in Roanoke, Virginia, and Roseburg, Oregon, have jeopardized prospects for mental-health reform. The incidents re-ignited the simmering tension between political parties as to whether such violence is more aptly attributable to the availability of high-powered guns or to the broken mental-health system, whose many fault lines allow ill people who are armed to slip into classrooms, movie theaters, and college campuses. This has resulted in a stalemate: Democrats refuse to move on mental-health legislation because Republicans refuse to pass gun-control legislation.

Some have tried to find common ground, though. Last fall, Republican senator John Cornyn promoted his NRA-endorsed Mental Health and Safe Communities Act of 2015, which tried to achieve consensus by revising the background-check system to help keep guns out of the hands of the mentally ill. But the measure falls far short of what Democrats have labeled “common-sense gun-control policies,” and so the legislation is likely to go nowhere. More encouraging, Democratic senator Al Franken’s measure that provides crisis-intervention training, funding for mental-health courts, veterans-treatment courts, and training for state and federal law-enforcement officers was approved by the Senate. And the omnibus bill passed last December provides funding for assisted outpatient treatment programs, the first time Congress has fully funded these programs. (Notably, separate grants for the same kind of AOT programs remain a major stumbling block in the debate over Representative Tim Murphys mental-health legislation in the House.) Finally, in early January, President Obama announced $500 million for expanding access to mental-health treatment as part of a series of executive actions aimed at curbing gun violence, but did not elaborate on how it would be spent.

treating the american psychosis

The right reforms can reduce the suffering of people with serious mental illness — and can protect them and improve their quality of life. That prescription entails forging better connections between institutions, and providing more quality care and community support and more psychiatric beds. We should not be afraid of creating benign asylums, especially residential psychiatric entities — ideally situated in rural areas so that patients can tend to animals and farms — that are true to the spirit of asylum: places of respite and safety. We should practice humane paternalism when needed.

This last point poses the greatest challenge to creating a system that is fully responsive to the needs of the sickest patients — that small fraction of people with severe mental illness who often require containment or intensive supervision against their will for brief periods of time and sometimes for long stretches. Some cast such intervention as an inexcusable encroachment on personal freedom. But when a persons thinking is warped by hallucination or delusion, he is not able to exercise meaningful freedom and might even endanger himself or others. The very point of involuntary intervention is to improve or restore the patients power of self-determination. Failure to recognize the need for this kind of action amounts to a refusal to face clinical reality.

What is the treatment for this American Psychosis, as it has been called? In the short term, we need more evidence that paternalistic strategies can be used humanely to produce positive results. The more effective they are, the more receptive localities will become to their use. Creating tighter community safety nets and opening up more beds will make these intrusive tactics less necessary in the first place, but the need will probably never disappear — precisely because a common feature of chronic psychosis is a lack of insight into one’s own impairment. Hopefully, over the long term, we might be able to narrow the pipeline of pathology by intervening when early signs of illness appear.

We must get rid of the distractions. We should not use government largesse to bolster opponents of benign paternalism. And we must not pit guns against patients. These are separate issues, each worthy of serious attention. Mental-health reform needs all the champions it can get. Strong political leadership could make a world of difference.

Sally Satel is a psychiatrist and a resident scholar at the American Enterprise Institute.

E. Fuller Torrey is a psychiatrist and founder of the Treatment Advocacy Center, a non-profit working to eliminate barriers to treatment for people with severe mental illnesses.

Facing: Tragedy in Las Vegas at Mandalay Bay

Griffin Ambitions Ltd.  joins the rest of our nation in a collective state of disbelief and heartache as we learn the details of the shooting massacre that took place last night at a music festival in Las Vegas.
So many innocent lives were taken in this heinous crime. We extend our deepest sympathies to the families, loved ones, friends and communities of the victims who were injured or perished during this tragedy. You don’t need to personally know a victim or live in Las Vegas to feel the impact of this horrific event. With the relentless media coverage, it is understandable that any of us might feel emotionally connected to the events.
In the aftermath of a mass shooting tragedy, it’s normal to feel sadness, anxiety, fear, anger or any mix of these emotions. We encourage people to reach out to family, friends or counselors to express their feelings and explore effective and healthy ways to cope with their emotions. In the next few days and weeks, it will be important to look out for each other – be particularly aware of warning signs that someone is feeling hopeless or acute distress. The signs could include withdrawing and isolating oneself, not sleeping or sleeping all the time, increased use of drugs or alcohol and talking about death or dying.
If you or someone you know is experiencing signs of distress, please reach out to a mental health professional or get anonymous, free support by texting START to Crisis Text Line at 741-741 or by contacting the National Lifeline at 1-800-273-8255 (TALK).
At a time like this, the simple things will help – don’t hold feelings in, talk to friends, family and loved ones. Turn off the TV, computer and phone. Get up and get out – tragedies can weigh so heavily on us that it makes it hard to move. Take a walk, go to the gym, run errands, spend time with friends, volunteer to help. And lastly, everyone should take care of themselves and those around them – physical health and emotional connectedness can go a long way toward making you feel like yourself again.
The Griffin Ambitions family of mental health priorities shall continue to embrace the community ideals that make humanity marvelous – connectedness, inclusion, diversity, acceptance, and compassion – it is our hope that these ideals provide the template for healing. Love is louder than violence, hate and pain.

Be well,

JMG