There will be more shooting rampages, like that which targeted Congresswoman Gabrielle Giffords in Tucson last weekend -- as long as it is easier to get a gun than mental health care. Our current epidemic of mass shootings is but a symptom of our nation's broken health care system. Poor access to medical care jeopardizes an individual's health. But when the mentally ill or the seriously distressed can't access care, we are all at risk.
As a psychiatrist, I remember when I once did everything in my power to keep a disturbed patient stable, and society safe. I'd see the patient every day, or hospitalize the patient for months, if necessary. Needless to say, this degree of attention is impossible today, given limited resources, and the fights my staff and I regularly undertake with insurance companies to get even routine care approved.
For decades, the American health care system has prioritized profits, often by excluding the sick. This travesty is now coming to roost, in the form of mass violence, such as the recent shootings in Tucson, at Virgina Tech, and in communities across the country, including my own. Medical care for our most disenfranchised citizens will never turn good profits -- yet basic health care for everyone, is necessary for the stability of society.
What does it mean that for kids today, the greatest threat of mass violence comes not from enemy powers, but from fellow disenfranchised citizens? As opposed to the duck and cover bomb drills of my own childhood, schoolchildren today do drills to prepare for shootings. Across the country, uniformed officers with weapons rush onto campuses to tackle imaginary shooters, while students run for cover. In Oxford, CT, helicopters and over 150 officers helped stage an elaborate shooting drill. At Scales Elementary School in Tennessee, little kids cried and wet their pants during a drill. In Dallas, police mistook a drill for an actual attack, and rushed onto campus like an episode of Keystone Cops. What have we come to?
Insurance companies have the ultimate say about how often I see a patient, what medications I prescribe, and if the patient can be hospitalized. In the past, I might have provided services free of charge, in the name of patient welfare, my own professional ethics, or for the sake of public safety. But physicians and hospitals who don't prioritize the bottom line are increasingly put out of business. Even St. Vincent Hospital in Manhattan, after 161 years of practicing good medicine but bad business, is bankrupt, gone. Meanwhile, health insurers are among the most profitable companies on Wall Street. It's a perverse distribution of the nation's precious medical dollars.
My own community's worst mass shooting occurred on August 18, 2005, when five people in Albuquerque were shot and murdered by a man who suffers from schizophrenia. For the prior three days, John Hyde sought help, but was turned away each time. His family called his psychiatrist repetitively, but HIPAA privacy laws prevented communications. On the day Hyde started shooting, he sought help from his insurance company.
Hyde was once kept stable for seven years by an old-fashioned psychiatrist who had personal relationships with patients, and who was available at all hours, like all doctors of another time. But when for-profit insurance companies took control of New Mexico's mental health dollars in 1998, Hyde's psychiatrist found himself paid less, while needing to spend just as much time haggling with insurance bureaucrats, as treating patients. In 1998, practicing the same devoted way he had for 22 years, Hyde's psychiatrist, Dr. Jay Feierman, closed his practice with $50,000 in debt.
After Hyde lost the long-term, committed care of his personal psychiatrist, Hyde fell into a system that operates in today's typical fashion. His care was divided between a psychologist for therapy, a psychiatrist for medications, an emergency room for problems after hours (which is most hours of the week), with insurance bureaucrats ultimately at the helm of each medical decision. With Dr. Feierman, at least Hyde knew who to call, if he felt unstable.
Effective treatments for serious mental illness only began with anti-psychotic medications created in the 1950's. An older, more primary function of psychiatry -- dating from the time of asylums -- has always been to keep society safe.
We as a society are only as stable as the least stable individual roaming our streets.
How many more tragedies need occur, before we conclude that our mental health care system no longer functions to keep us safe? When will we learn that everyone needs basic medical care, not just for humanitarian reasons, but for the safety of all of us?
Follow Dora Calott Wang, M.D. on Twitter: www.twitter.com/doracalottwang
It might interest you to know that in 2011, even non-profit mental health organizations such as Recovery International (which is not insurance-dependent and has offered donation-based self-help therapy for 75 years), are forced to eliminate staff and services due to lack of funding. This year RI finds itself struggling to maintain its Power to Change program for inmates, and its weekly meetings for anyone with a mental or emotional disturbance.
Bob Dey, one of the group leaders for PTC told me, "The biggest tragedy would be that this younger generation would be deprived of a self-help support system that is so badly needed." Recovery International focuses on Dr. Abraham Low's Self-Help Systems with amazing results. Are you aware of RI? And if so, have you ever attended a meeting? With your brilliant mind, I'd think you'd take to the RI self-help method like a duck to the proverbial water.
The percentage of administrative costs for healthcare in Taiwan and France is especially enlightening. Thank you for your comments, also.
Excellent article.
http://digg.com/news/politics/Rep_Walz_Video_MNNetroots_on_Mental_Healthcare_funding
I propose to legalize all drugs, and simultaneously, slap a huge "indulgence" tax on them. Add to them alcohol, tobacco, and maybe gambling. And guns. Dedicate every penny of the indulgence tax revenue to treating those who are addicted and wish to kick the habit, or to treat and/or incarcerate those who have committed crimes while under the influence. Some of the tax revenue could also supplement award settlements for victims of crime of those "under the influence".
At present, the purveyors of these "indulgences", are reaping untold profits while externalizing huge business costs onto society at large. The TRUE price of a gun, or a Vicodin, or a bottle of vodka, or a pack of Camels, ought to include making whole everyone hurt by these indulgences, whether they personally indulge in them or not.
President Obama is calling for all public agencies to do cost-benefit analyses of their work. Fine.
Let's us all do our own, and let's include ALL the costs currently externalized by business (legit and otherwise) onto the public----so their owners, investors, and CEO's can profit off our misery!
When mental illness is so rampant and indulgences so common that a member of Congress can't even speak to constituents without endangering her life, where are our priorities?
I appreciate your comments and know that your perspective on this issue is a unique and accurate one. My question would be what do you think it would take to change things? Huge questions, I know but my worry is that pieces like this get lost because they're a great take on the state of affairs but don't follow w/a solution.
My first job out of grad school, like most therapists, included working with CMI clients and it was both terribly frustrating and very rewarding work; I just couldn't pay my bills on that job. How can we hope to change our system if we don't put value (and by that I mean money) on the work? Love your thoughts on how things need to change.
And followed you on twitter, thanks for including the link.
Thanks for your thoughts and feedback, as a fellow HuffPo blogger. The easy answer is that we need to cut bureaucracy--it consumes 1/3 of health care dollars, a plain waste. Also, health insurance bureaucracy is usually aimed at blocking access to care. France spends about 5 percent of its dollars on administration, Taiwan less than 2 percent. And on almost all measures, their health care systems are superior. The U.S. simply needs to operate as efficiently as all other nations. Some European countries cut bureaucracy by eliminating health insurance--and putting those dollars toward health care.
While at my endocrinologists office, I mentioned I was concerned about a reoccurance of anemia and asked to be checked for that in my blood test. The nurse practioner declined and advised that "we can't go looking for things" because of the insurance restrictions, even though I had been severely anemic in the past. So, the means you have to report symptoms, and possibly be in later stages of a disease, before you can be checked of it.
I think I may have to start recording all of my doctors visits as protection for future damages so my family can collect after my death.
If attorneys find class action suits for one drug or one medical procedure to be profitable, they should find some interest in a class action suit against any insurance company that thwarts a patients right to care.
I am appalled that corporate America has come between my physicans and myself. I especially regret that you now get 15 minutes with your psychiatrist and an MSW to put the "bandaid" on, without getting to the root of your complaint. It's as if it's all cognitive therapy....teaching the "dog" (me) a new trick.
DR Norman Rosenthal MD psychiatry recommends it and is writing a book about it
couldnt find a current blog really relevant to this from Common Ground magazine [ greater Vancouver regional district ] : " new promising news for parkinson'Âs : a Saponin in Ginseng contains a stimulatinÂg factor for stem cell growth etc "
also Common ground says " a Euopean parlaiment law of 2004 will make many herbal and natural medicines including traditionaÂl chinese [[ of which ginseng is one]] and ayur vedic medicines illegal on april 1 2011
something for huffposters like Dora to do
couldnt find a current blog really relevant to this from Common Ground magazine [ greater Vancouver regional district ] : " new promising news for parkinson'Âs : a Saponin in Ginseng contains a stimulatinÂg factor for stem cell growth etc "
also Common ground says " a Euopean parlaiment law of 2004 will make many herbal and natural medicines including traditionaÂl chinese [[ of which ginseng is one]] and ayur vedic medicines illegal on april 1 2011
something for huffposters to do
Maharishi ayur veda etc all traditionaÂl medicine is way mor eimportant positive sustainablÂe and neccessry than drugs
drug companies are trying to kill the competitioÂn
We're not just a nation with some mentally ill people not getting treatment; we are a nation, collectively, that is mentally ill.