Thursday, December 20, 2012

Newtown tragedy spotlights fractured mental health care system

Nancy Lanza had a comfortable income, lived in a home worth $700,000 and generally seemed to enjoy an upper middle-class lifestyle.

Being a member of this demographic however, didn?t necessarily guarantee that she did or could access the best mental health care for her son, Adam Lanza, as he was growing up in Newtown.

Adam Lanza, 20, is responsible for the deadliest mass shooting in the United States at an elementary school. After murdering his mother, he forced his way into the Sandy Hook Elementary School five days ago, where he massacred 20 first graders and six teachers before committing suicide as police tried to intervene.

Described in various reports as a quiet, intelligent student, who had a difficult time socializing in school, and possibly exhibiting signs of Asperger?s syndrome, the question has been asked why couldn?t an individual with $289,800 in alimony get the help her son needed to avert this tragedy?

Lanza?s motives and psychiatric history are unknown at this point and will probably remain so until investigators and behavioral scientists piece together some answers.

Alan Kazdin, director of the Yale Parenting Center, and others, said what has to happen first is identifying a child with problems through proper screening and then accessing the right care, sooner, rather than later.

Vicki Veltri, the state?s health care advocate, said once parents and individuals are ?brave enough? to come forward and seek help, overcoming the continuing stigmatization of mental illness, there are not enough clinicians to serve them, the programs are scattered throughout different agencies and insurers don?t always cover care.

She said there is a correlation between where you live, how much money you make and whether you have public or private coverage. Christine Montgomery, vice president at the Clifford Beers Clinic in New Haven, said middle class families particularly lose out in this system.

?That?s not the way to set public health policy,? Veltri said.

Surprisingly some of the best care is covered by Medicaid for children, who become part of the Behavioral Health Network set up by the state and can get at-home care not covered by private insurance. Continued...

?We have a very strong system for families with state insurance, but a more fractured system for families with private insurance or private pay,? Montgomery said.

Unlike other mass shootings in the U.S., this horrific incident seems to have turned the spotlight on the nation?s fractured mental health care system, with advocates encouraged by statements from national and state leaders, including President Barack Obama and Connecticut Gov. Dannel P. Malloy.

?We?re going to need to work on making access to mental health care at least as easy as access to a gun. We?re going to need to look more closely at a culture that all too often glorifies guns and violence,? Obama said at a press conference Wednesday.

Malloy in remarks Monday said the state plans to review policies and procedures that will help prevent future shootings, including reaching out to young people who are clearly in trouble.

The statistics on those who need care and Americans who actually get it are dismal.

Kazdin estimated conservatively that 25 percent of the 311 million people in the United States have a psychiatric disorder. Of those, 70 percent get no treatment with a greater percentage of children, the elderly and minorities on the losing end. According to the National Institutes of Health, almost half the population will experience a psychiatric problem over a lifetime.

Kazdin said they have evidence based treatments that work for a number of disorders, including children experiencing aggressive behavior.

He said any serious changes have to include experts in schools who can screen children who are experiencing problems. ?We need a SWAT team,? Kazdin said.

He offered an analogy to cancer, where there may be great treatments, but they are useless if they are not available to patients or the disease has not been identified.

Other colleagues agreed. Continued...

?We have interventions that have proven effective ...that can actually turn kids and families lives around,? said Steven Marans, director of the Childhood Violent Trauma Center at the Yale Child Study Center, but more clinicians need to be trained in applying them.

?It?s like having discovered penicillin and not having it available to every health care provider in the country,? Marans said.

Veltri, as the healthcare advocate, intervenes when insurers fail to cover treatments and she has found that many psychiatrists and psychologists don?t take insurance, leaving their services out of reach of a large cohort. This is exacerbated by a ?serious capacity issue.?

As a society, Veltri said we have to get over the continuing stigmatization of mental illness. ?Mental health should be integrated into overall health care,? she said. ?We would never tolerate this on the medical side,? she said of the lack of psychiatric beds or long delays for those seeking substance abuse treatment.

Kazdin said lack of clinicians can be helped through use of lay counselors who are properly trained in science-based treatments.

He said there is no one behavior that points to a child who later turns violent. Generally speaking, children who are loners who then turn aggressive and have access to guns are not a good mix.

Adam Lanza conducted his killing spree with weapons owned by his mother, who would take him to target practice, according to multiple reports.

David Abrams, clinic director at Clifford Beers, said there are services out there for families who can navigate the nonprofit network. A common problem however are teens over age 16 who refuse to attend treatment sessions or take medication.

He said it doesn?t appear that Lanza was getting treatment and that mass killings point to psychotic delusional behavior.

Involuntary commitment to a mental health treatment is possible when a person threatens to harm himself or others. Abrams said when they leave the hospital and told to follow up later, they often don?t comply. Continued...

?They fly under the radar. They are not in the system and we don?t have an eye on them,? Abrams said.

Source: http://nhregister.com/articles/2012/12/19/blotter/doc50d280c7171e3669145658.txt

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