One year ago, the unthinkable tragedy in Newtown inspired me to offer three steps to fix our mental health system as seen through the lens of my own family's struggle with serious mental illness. Since that time, a movement toward solutions has gained ground on three critical fronts: social, political and scientific.
From a policy perspective, the White House's Conference on Mental Health succeeded in sparking dialogue about reform and recovery across the country. In the fall came the long-awaited implementation of the Parity Act, ensuring health insurance companies cover brain-based treatment in the same manner as the rest of the body. In December the White House announced an allocation of $100 million in mental health funding, and a call on lawmakers to prioritize mental health care. Today, pending legislation has the potential for sweeping changes to our mental health system that -- while its details are debatable -- would be the most radical shift in 50 years toward making recovery and prevention possible.
On the social front, Chicago Bears wide receiver Brandon Marshall, the NBA's Royce White, and Silver Linings Playbook's author Matthew Quick and director David O. Russell bravely shared their stories, bringing serious mental illness out of the closet and into our dining room and social media discussions.
Anti-stigma campaigns led by Glenn Close, NAMI New York's #iwilllisten, Britain's Time to Change drove toward more productive and compassion-based dialogue, while Delaney Ruston's touching and enlightening documentary explored how schizophrenia is viewed and treated (or not) around the world.
On the neuroscience horizon, researchers are on the cusp of groundbreaking treatments for schizophrenia, bipolar and major depression; progressive community-based organizations are partnering with researchers to transform the lives of young people living with schizophrenia through cognitive behavioral therapy and empirically supported psychosocial rehabilitation interventions such as Open Dialogue; and the linking of science and technology is pushing the forefront of treatment for psychosis and depression.
Meanwhile, a groundswell of mind-body wellness initiatives are underway, supporting veterans returning home with PTSD; children exhibiting early signs of brain disorder; at-risk teens; incarcerated youth; and teachers.
In all, 2013 was the year that one horrific headline after the next caused us to wake up to the reality of a deep and woeful gap in how we detect, prevent, serve and view those among us living with some kind of mental illness.
And yet, waking up is not enough.
We must collectively take urgent action -- as the road ahead for people living with serious mental illness and their families is still a long one, riddled with obstacles on all fronts: social, scientific and political.
This is not a time to ask for more psych ward hospital beds. This is a time to demand transformational change.
It's time to envision a society where a multifaceted array of "locally based services responds early, expertly and effectively whenever we begin to struggle with our mental health." To infuse treatment of brain disorders -- whether it's a child exhibiting severe behavior challenges, a teen struggling with hearing voices or an adult who has been long haunted by depression -- with an expectation of recovery.
This is a time to trace backward the ugly chain of events leading to school shootings, homelessness, incarceration, and an increasing epidemic of suicide, and zero-in on the most opportune moment we have in the lifecycle of brain disease to impact lasting change.
Consider the following:
- 50 percent of chronic mental illness begins by age 14 -- 75 percent begins by age 24
- A several year delay between first symptoms and seeking treatment is common
- "Self-harm is now the leading cause of death for people 15 to 49, surpassing all cancers and heart disease"
- Less than half of those experiencing schizophrenia benefit from the prevailing treatment: antipsychotic medication
Solving for these crises has everything to do with understanding how to better detect and treat children and adolescents exhibiting the risk factors and signs of brain disorder. For all ages, it has to do with identifying the best evidence-based, patient and family centered, recovery-oriented treatment modalities available, and creating funding sources to infuse them into both primary health care and the fabric of every community. It means moving away from "one size fits all" therapeutic approaches and appreciating the circuitry of the brain, such as in Dr. Bruce Perry's Neurosequential Model of Therapeutics, which provides a framework for approaching any treatment through a primary viewpoint of cognitive functioning.
Further, radical change will demand a definition and standard of care that spans beyond the traditional, acknowledging our collective neurobiological-based needs for physical activity, nutrition, creative expression, healthy relationships, a sense of community and contribution thereto.
While policy change and funding must help pave the way forward, this task is outside the scope of one organization or government agency alone. Community organizers, advocates, policymakers, researchers, social workers, educators, clinicians, primary care providers, technology innovators, business leaders and families must join together to work toward these types of solutions.
If we get prevention-focused, whole person centered, community-based mental health care right, the need for emergency psychiatric beds, involuntary commitment, prisons serving as psych wards and the heavy reliance on (often necessary, but too often overprescribed) psychotropic drugs would be much muted.
That is the happier, safer, more equitable world my brother wants and deserves to live in. And so do I.
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