NYT: It Shouldn't Take a Tragedy to Improve Treatment

NYAPRS Note: Today’s New York Times online ‘Room for Debate’ page focuses on ‘Guns, Safety and Mental Health:  Can changes in the American mental health system reduce gun violence without creating more problems?” It includes a number of commentators from different sides of this debate including the following:


It Shouldn’t Take a Tragedy to Improve Treatment

New York Times  January 17, 2013


The recent tragedies in Newtown and elsewhere are especially abhorrent to those of us in the mental health community, particularly since studies have shown that people with mental illness are 12 times more likely to be victims of violence, and no more likely to be violent, if they are not substance abusers.

Nonetheless, horrific acts of violence are inevitably associated with mental illnesses, often because the motivations for them seem unfathomable, and they end up getting sensationalized front page coverage.

This has led to a wholesale vilification of conditions that 1 in 5 Americans share. That’s the sort of profiling that has been the fate of some racial or religious groups.

It’s sad that almost the only time meaningful public attention turns to our community is in the wake of tragedies. Our systems desperately need attention. We now know so much about how to help people in need, but the use of effective approaches is the exception not the rule.

We need more money. But we can also redirect a lot of money invested in outmoded institutional or office-based approaches into community outreach, engagement, relapse prevention and crisis support services. National and state health care reforms can expand the use of these approaches.

On the other hand, the use of court ordered treatment associated with Kendra's Law has not, on its own, proven to be effective.

And the recently approved New York State gun control law requiring clinicians to tell criminal justice authorities about patients who have expressed suicidal or threatening impulses is troubling. This information will be included in state and national data bases, along with information about people who've sought inpatient psychiatric care. And, given the current environment, clinicians will likely over-report their clients, disclosing otherwise confidential information that will be used in ways we may not fully appreciate now. This approach will have the unintended consequence of deterring people from seeking care or trusting in and disclosing to their therapists.

We're not violent, so controlling us will not make you safer. On the other hand, investing in and improving services, as is being done by long awaited health care reforms, will bring critically needed help to millions. We hope that Governor Cuomo will call for more money for our community service system when he releases his budget proposal next week.


Harvey Rosenthal is the executive director of the New York Association of Psychiatric Rehabilitation Services, a member of New York's Medicaid Redesign Team and a person in recovery from a mental illness.