Every reporter should know there’s a difference between poor mental health, mental illness and serious mental illness.
Mental Health is a state of well-being. It’s a good thing. We don’t need ‘mental health’ services. We do need mental “illness” services.
- 100% of population at any age can have his/her mental health improved.
- Anything that made or makes you sad hurts mental health (bad grades, divorce, small apt, poverty, loss of job, etc.)
- Anything that makes you happier or more satisfied improves mental health. (dogs, yoga, cooking, walking, etc.)
- Mental Health Department are very involved in improving mental health in the masses, while leaving the seriously ill unserved.
Mental Illness is anything the APA puts in DSM.
- 20-25% over age 18 have a diagnosable mental illness, i.e., an illness in DSM (Lifetime prevalence about 40%)
- Common ones in include depression, anxiety, and treatable bipolar. Mission creep creates new mental illnesses in every DSM
- Usually successfully treated with meds (sometimes talk). Does not usually permanently affect activities or course of life
- Ex. Me and my friends on Prozac, Zoloft, Etc.
Serious mental illness disturbs thought-processes, mood so profoundly that it significantly impairs life. This is where government should focus.
- Affect only 4% of population over age 18. This is the elephant in the room reporters often ignore by focusing only on mental wellness in the high functioning.
- First occurs in late teens and early twenties. Rarely earlier. Initial onset rarely after age 40.
- Most common/problematic ones: schizophrenia/schizoaffective (1%), severe bipolar (2.2%) and ‘severe, major depression (2%)
- Symptoms may include: hallucinations, delusions, mania, mutism, paranoia, anosognosia (unawareness of illness), flattening of emotion (affect), inability to control your own thinking.
- Consequences of symptoms: Acting out, refusing treatment.
- If you ‘know’ someone planted a transmitter in your head so they can kill you, you will defend self and kill them first.
- Ex. If you know you are the Messiah (“Winning!”, as Charlie Sheen would say), or are so sick you don’t know you are sick (anosognosia) then you won’t accept treatment and you become even more highly symptomatic.
- Homelessness (33%); Incarcerations (15%), Suicide (%?), subway pushings (80%); homicides (10%), etc.
- Schizophrenia is hard to treat, impossible to cure (although 25% remit). People with schizophrenia rarely become high functioning members of society or get employment outside mental health or arts fields.
- People with treatment resistant or untreated schizophrenia are never in PSAs or acknowledged by mental ‘health’ industry.
- Being seriously mentally ill is not always an exercise of free will, it is often the inability to exercise free will (“Bastille of psychosis”)
People with untreated serious mental illness do have a greater propensity towards violence than others.
- The 20% of Americans who may have a “diagnosable mental disorder” are not more violent than others.
- The 4% with the most serious mental illnesses (schizophrenia, severe bipolar, severe major depression) are not more violent than others.
- Those in the 4% group for whom treatment stops working or who go off treatment that previously prevented them from being psychotic, hospitalized, or violent, are more violent than others. This rate of violence increases even more when these groups abuse substances.
- Those who say mentally ill are not more violent are describing the 20% of population or are describing those treated. That only shows that treatment works, not that mentally ill are not more violent.
Serious mental illness is about biology and it CAN NOT be prevented
Every organ of the body can malfunction or get diseased. The brain is no exception. We don’t what causes SMI. Many believe it is related to a complex genetic pre-disposition, activated by an event (infection?) in the third trimester or later. SMI is diagnosed (like Parkinsons) by the actions (which are the last things to occur), not the underlying pre-existing neuroanatomy. Our imaging and computational skills are not yet strong enough to diagnose before the symptoms occur. The first step to treating SMI is to engage a patient. It is often difficult because of anosognosia (the patient being unaware they are ill). Second step is to ameliorate symptoms. almost always with meds that have various efficacy and side-effect profiles. It is trial and error process. WE DO NOT KNOW HOW TO PREVENT SERIOUS MENTAL ILLNESS. WE KNOW IT IS NOT CAUSED BY BAD MOTHERING OR UPBRINGING.
It’s also politics: Getting treatment for SMI is practically impossible: Families beg for treatment and are refused.
The crack is the system: Mental Health departments and programs rarely admit or treat or accept people with serious mental illness until after they become dangerous. Mental health departments serve high functioning. Jails and prisons serve SMI. 10X more are incarcerated than hospitalized.
The solutions are known and ignored
To reduce the sinfully high rates of homelessness, hospitalization, suicide, violence and incarceration of people with serious mental illness we have to
- send people with the most serious mental illnesses to the front of the line for services, rather than the back;
- make it easier to treat people before they become dangerous rather than requiring them to become dangerous,
- make use of Assisted Outpatient Treatment (AOT;
- preserve and expand, not close, psychiatric hospitals.
- Require community programs accept the seriously mentally ill.
- Kids under 18 may have poor mental health, mental illness, or, in rare cases, a serious mental illness
- There is no doubt that we are ‘diagnosing normality’ in children. If you are fidgety with bad grades you will get a diagnosis.
- Many worthwhile programs for children are funded by giving them a diagnosis:
- tutoring, teen parenting skills, mentoring programs, violence prevention, self-esteem classes, etc.
When covering mental illness, it would be nice to STOP:
Stop covering pop psychology
- Stop repeating industry claims about fake new mental illnesses (Bullying, too much time on internet, not enough sex, too much sex, etc).
- Stop repeating industry claims about fake new causes (bad grades, small home, loss of loved ones, spanking, owing money, the internet, illiteracy, etc.)
- Stop covering fake new cures that lack independent evidence they improve a meaningful metric in people with serious mental illness. (Dog Therapy, Horse Therapy, Art Therapy, Group Therapy, Shopping Therapy, Yoga Therapy, DanceTherapy; Tai-Chi Therapy, Surfing Therapy, and every kind of talk, meditation, massage, acupressure, counseling and introspection.
- Stop reporting that there is an explosion of mental illness. There is only an explosion of over-diagnosis and mission-creep (esp. with kids).
- Stop repeating industry claims about “stigma” Whenever there is an incident mental health advocates blame ‘stigma’ and propose more money for their own programs. The media often repeats this. The reason people with SMI do not get treatment is because they can’t afford a doctor, lack transportation, can’t find a program that will accept someone with SMI (esp. if substance abuser), don’t recognize they are ill; and/or are required to become ‘danger to self or others before accessing services. It is not because of stigma. Since mental ‘health’ programs only serve high functioning voluntary patients, giving them more money will not solve the problem. Moving money from mental health to SMI will. Prejudice and discrimination against those with SMI is a problem. Stigma’s not. Use sources informed about serious mental illness (police, DAs, and corrections, not mental health advocates).
- Stop blaming police for failure of mental health department The police go where the mental health system fears to tread: to the aide of people with SMI. For families of persons with mental illness they are heroes. Yes, things sometimes go bad, but that is only because the mental health system has offloaded the care and treatment of the seriously ill to criminal justice. While police can always use better training, a much better approach would be to train the mental health system to stop avoiding the seriously mentally ill.
- Stop blaming parents and environment Serious mental illness is a biologically based illness. It is not caused by parents, parenting, relationships, poverty, etc. Almost all cases of violence occur after parents beg and plead for services for their loved ones and are denied by policies, laws, and practices.
- Stop covering snake-oil programs that claim to ‘prevent mental illness’ We don’t know how to prevent serious mental illness. Period. Diagnosis of SMI can only be made after symptoms start and those are readily apparent to everyone.
When covering serious mental illness, it would be nice to START:
- Start asking about, reporting on and triaging stories by severity of diagnosis When MH Departments or local advocates want PR for a new program, ask (1) what diagnosis the person they are letting you interview has; (2) what the primary diagnosis of most participants in the program are; (3) if the program is exclusively for those well enough to volunteer; (4) will it exclude substance abusers (up to 40% of untreated SMI). In other words, is this story about SMI or something else? Ask to see independent evidence to verify what the program promoter is claiming.
- Start ignoring political correctness In the admirable desire to not offend, reporters avoid reporting truths (the elephant in the room) about SMI. In fact many stories avoid using the term ‘mental illness’ as if it were a pejorative.
- Violence: Most reports on violence starts with the claim ‘the mentally ill are no more violent than others’. That is PC, but misleading.The seriously mentally ill who are not treated are in fact more violent than others. 10X more mentally ill are in jails than hospitals. Only by recognizing the problem, can we solve it. Ignoring that doesn’t help keep patients or the public safer.
- Employment: Most reports state “with proper supports mentally ill can become high functioning productive members of society”. This is not true for many with SMI. I know less than 10 with schizophrenia who are in non-subsidized employment outside mental health or arts fields. Some need long term care. You should not ignore that.
- Cognition: People with SMI can hallucinate, have delusions and otherwise not think clearly. That is important and should be reported.
- Substance Abuse: Up to 50% of SMI self-medicate by abusing substances. It has become part of the illness.
- Inpatient Hospitalization. Not everyone with SMI can live in the community. Some need long-term inpatient treatment. Psych hospitals are not the enemy. The US is short 100,000 psych hospital beds even if we had perfect community based services.
- Start Recognizing Parents are not at fault and are usually the heroes Almost every case of violence occurs after a parent desperately tried to get treatment and either their loved one refused to go or the mental health system refused admission (Ex. Goldstein who pushed Webdale; Bellucci who stabbed both parents on Staten Island). The family has become the institution, but has no ability to enforce compliance. HIPPA laws even prevent them from knowing anything.
- Start reporting on the interplay of science, policy, and law. Every story on serious mental illness has a science angle (what do we know about the illness) and a political angle (why was this person being unserved). Many cases also have a legal angle (involuntary treatment, Kendra’s Law). Unfortunately, the siloing of beats has made reporting on this interplay more difficult.
THANK YOU FOR REPORTING ON SERIOUS MENTAL ILLNESS. LET US KNOW HOW WE CAN HELP.
FOR MORE INFORMATION VISIT https://mentalillnesspolicy.org
Read “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill” by DJ Jaffe.
View this Mental Illness TEDTalk
For help with your reports, contact DJ Jaffe, Exec. Dir.