PS Editorial: State Can't Be Inside Patients' Heads

NYAPRS Note: Two thoughtful pieces in the Glens Falls (just south of the Adirondacks) daily.

 

State Can't Be Inside Patients' Heads

Glens Falls Post-Star Editorial  January 19, 2013

 

When you rush a law to passage by ramming it through the Legislature, what you get are dreadful measures like the one in the state’s new gun law that purports to make New York safer by requiring mental-health workers to snitch on their patients.

What the new law does, unfortunately, is undermine the trust between patient and therapist that is fundamental to the success of the therapeutic process.

What all of us should want - for many reasons, including safety - is for people with mental illnesses to receive the best and most effective treatment possible. But by intruding in the process in a way that could damage the patient-therapist connection, the law has the potential to make treatment less effective.

The law requires mental-health professionals who determine, “in the exercise of reasonable professional judgment,” a patient “is likely to engage in conduct that would result in serious harm to self or others,” to report the patient to the state, which will then consider revoking that person’s right to own or carry guns.

The law asks therapists to make a black-and-white call on situations that, in most cases, are colored in various shades of gray.

How is a psychiatrist, psychologist or counselor supposed to distinguish among comments that are threatening, ones that sound threatening but aren’t and others that don’t sound threatening but are?

What is the difference between blowing off steam and revealing an intention? When is a dream a warning? When is a daydream an alarm?

Imagine a school counselor listening to an adolescent talk about his reactions to being bullied, and describing what he daydreams about doing to the bullies. Should that kid be reported? What bullied child has not fantasized about taking revenge on his tormentors?

Thoughts of violence are not restricted to the mentally ill. We are violent by nature, and we all think about and talk about violence sometimes. These thoughts are not indications our rights should be curtailed.

The law requires a report if a patient “is likely to engage in conduct that would result in serious harm to self or others.” But when? Tomorrow? Within a month? Or at some point in that patient’s life?

Some mental-health professionals will feel compelled to inform clients, before a session begins, of the reporting requirement. Some might feel they have to read a disclaimer to every new client about the potential for them to get reported to authorities.

Others might mention the requirement if a client begins to reveal violent thoughts or dreams. In either case, the therapeutic process will be compromised.

The law comes perilously close to making thoughts into crimes by imposing a punishment for acts existing only in someone’s mind.

And the law could make it harder to identify the rare person who is mentally ill and dangerous.

Therapy aims to expose mental-health trouble and trauma by exploring thoughts and feelings through talk. Trust in the therapeutic purpose of the sessions, and their confidential nature, is critical, but will be weakened if the therapist must also act as an agent of the state. We want disturbed people to stay in treatment, where they can be helped, not abandon the process because of worries about being spied on by their therapists.

And we want people who suspect they need therapy to seek it out and not be deterred by fears their therapists will reveal information about them to the state.

To the extent the debate over the Newtown massacre highlights the need for effective and affordable mental health treatment, it has been a good thing.

We do believe therapists presented with a clear and imminent threat of harm from a patient, to himself or other people, are morally and professionally obligated to act to prevent the violence. But the new law goes too far into a gray area that should not be subject to discussion outside the confidential space of a therapist’s office.

 

Local editorials represent the opinion of The Post-Star editorial board, which consists of Publisher Rick Emanuel, Editor Ken Tingley, Projects Editor Will Doolittle and citizen representative Robert Sledd.

 

http://m.poststar.com/news/opinion/editorial/editorial-state-can-t-be-inside-patients-heads/article_8bd43e26-62ae-11e2-94e1-0019bb2963f4.html

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After Newtown: Schools, psychologists look for more than just mental illness

By Jon Alexander  Glens Falls Post Star  January 19, 2013

 

The shooters at Columbine High School, or more recently, the gunman at Sandy Hook Elementary School, represent a problem for mental-health clinicians both in and outside the academic sphere.

By all accounts, the Sandy Hook shooter, Adam Lanza, 20, was a loner, but displayed no symptoms of classic mental diseases.

The two Columbine shooters, both high school students, weren’t paranoid schizophrenics. They were simply part of the “Goth” counterculture that rejected the basic teenage tenants of “cool,” and were picked-on outsiders at their school.

“These aren’t kids with a mental-health diagnosis,” said Dr. Paul Benveniste, a psychiatrist at Glens Falls Hospital. “They are kids that are having a crappy school experience, month after month, year after year, and eventually, it’s too much.”

Humanity has always constructed hierarchies based on size, strength and ability. In fact, picking on the weak stretches back deep into the mankind’s genetic roots, played a significant role in human evolution and shaped much of the species’ predisposed behavior.

The battle for resources across the animal kingdom almost always favors the strong and aggressive.

“Bullies will always be bullies,” said Kathleen Fisch, lead counselor at Queensbury Union Free School District. “We need to target the kids who are the victims. We need to make them stronger so they can stand up for themselves.”

Identifying children and teenagers with classic mental-health diseases is relatively easy compared to flagging those almost exclusively white, male, middle-class wallflowers struggling to control their inner demons, while loaded with post-pubescent testosterone.

“They are not the people who would be identified by the mental-health system,” Benveniste said.

Schools nationwide since Columbine have focused on the postmodern mantra of inclusiveness.

Queensbury school district, for example, has for three years touted its Gay-Straight Alliance, among other school initiatives designed to give formerly marginalized groups a greater sense of inclusion.

While schools try to take a more active role, there has been a nationwide decentralization of services for the mentally ill, the depressed or even just the angry and frustrated over the past few decades.

Ken Kesey’s 1962 novel “One Flew Over the Cuckoo’s Nest” brought the ills of centralized asylums to the masses, largely in the form of Nurse Ratched, whose tactics of control did more harm to her patients than good.

The decentralization wave that followed, though, also means there is a greater disparity for available psychiatric help between the economic classes.

But that doesn’t mean it’s not widely available.

“There are various outpatient services available,” said Rob York, director of Mental Health and Community Services for Warren County and Washington County.

Both counties contribute to a number of nonprofit organizations that offer counseling for the disturbed. York’s office acts as a taxpayer-funded referral service.

“I wouldn’t call it particularly rare,” he said, of the prevalence local teenagers dealing with anger issues and depression.

York’s office receives calls from both schools and parents, he said.

Peer-reviewed research of the phenomenon of angry young, Caucasian males has exploded over the past decade.

And clinicians and educators are increasingly paying attention to the “red flags” typically displayed by someone harboring dangerous levels of anger and depression; a sudden drop in grades and isolation at home and in school are now considered classic examples, Fisch said.

But, still, these symptoms are sometimes much more apparent at home than at school, meaning parents are also being increasingly asked to observe and participate in the diagnoses.

“It’s tricky,” Fisch said. “In the end, we don’t always know who’s being bullied. We just try to make everyone be nice.”

And, because these symptoms alone don’t qualify for any easy to define mental illness, it remains an uphill battle for mental-health professionals.

“Schools have participated in a certain over-diagnosis of some things; like attention deficit disorder. So we have a ton of kids on a ton of medications,” Benveniste said. “Then we have these terrible events taking place and we wonder: ‘Are we doing a good enough job?’ 

 

http://m.poststar.com/news/local/after-newtown-schools-psychologists-look-for-more-than-just-mental/article_76c2a6e0-62ad-11e2-9a99-0019bb2963f4.html