This week, David Katz M.D., director of the Prevention Research Center at Yale University School of Medicine and HuffPost blogger, asked for your most pressing health questions. Many of you responded with personal stories about dieting, chronic illness, and genetically-modified foods. Below, Dr. Katz responded to one such question. You can submit advice questions to Dr. Katz at any time, as often as you'd like, by emailing firstname.lastname@example.org, and your question may be featured in Dr. Katz's next blog post.
Dear Dr. Katz,
While we are considering changes to gun laws, shouldn't we also address mental health care issues that complicate the gun issues? I am forwarding my daughter-in-law's FB post, which is echoed by many other parents who are stymied by laws in their effort to both help their children and protect the public:
"The age a psychotic break usually happens is 18-24 years old. And families have no power at that point. We need to fix that. My daughter had hers a few weeks after her 18th birthday. She went missing, and I found out she was in Houston. She was very sick, a tiny, beautiful young girl with psychosis running around in Houston. And the cops would not help me. Finally I found her, and I was able to get her to a hospital. I was so relieved. But she decided she missed her cat at home and started yelling that she wanted to go. They would not keep her. I had no power to do anything else but take her home. Behind a lot of the mentally-ill are desperate families that would do anything to help, but they are disempowered. We are having people whose judgement is impaired make their own mental health decisions. Now that's crazy. It really does need to change. Thankfully, my girl is medicated and doing fine now. It's amazing what good health care can do. She is lucky. So am I. This is not true for most families, and I will never forget how it felt to be denied help like that during that trauma. When the shooter of Gabriel Giffords and others was on trial recently, it really got me that that guy's father was behind him sobbing during the sentencing. [In my opinion], that whole thing could have been prevented if his parents had been empowered to do something."
-- Ann Chapman, Corpus Christi, Texas
First, no matter what we do to address mental health in this country, we do, in my opinion, need dramatic changes to our gun control laws. I have opined on the topic before and will do so again. There is virtually no legitimate use for semi-automatic weapons with high capacity magazines; they are designed for carnage. And the epidemiology confirms how well they function in that regard.
But yes, absolutely, we need reforms to mental health care. From my perspective, the single most important reform would be respect. We need to recognize that mental health disorders are every bit as legitimate and deserving of effective, compassionate, state-of-the-art care as a heart attack, of skin infection, or meningitis.
As a culture, we seem to accept that bad things can happen to the hearts of good people -- and we should take good care of them when they do. But we fail to realize that bad things can happen to the vastly more complicated organ that resides in our head, too, and that it is no more -- and often less -- the fault of the victim than a heart attack! It's not just the health care system that needs to rethink mental illness; it's our culture.
That said, you raise an extremely challenging issue. I, too, have lived through the situation you describe. I was a medical student at the time, doing a rotation in Israel, and the 17-year-old daughter of a close family friend had a psychotic break, going on to be diagnosed with schizophrenia. The situation was just a bit easier, because at 17 she was a minor -- but it was still, in a word, a nightmare.
There may be no reliable way to make it otherwise. Once someone is overtly psychotic, they can, of course, be committed -- meaning incarcerated and treated against their will. At that point, a parent once again would have authority over a minor. The trouble is, like most misfortunes of health, mental health disorders come to us across a spectrum. In some cases, they are merely troubling, and do not rise to the level of renouncing personal autonomy. In some cases, they are so extreme as to be all but unmanageable. And there's a lot in between.
Until a determination has been made about what's going on, there is no basis in law to deal with the period of transition. What would such a law look like? It might be: a child becomes self-reliant at 18, unless they have a mental health disorder that precludes it... But such laws are already on the books. The problem is, you first need a professional to determine that in any given case, a mental health disorder does, indeed, preclude autonomy.
And there's the dilemma: As long as a young adult has autonomy, they can refuse the medical evaluation required to prove that they should not have that autonomy! A dreadful Catch 22, but there's no easy solution. There are, however, crisis response resources available -- and there usually are ways to "reel in" that out-of-control loved one, so they can get the care they need and deserve, in spite of their best efforts to refuse it.
There is, of course, much more to this topic -- but we'll leave it there for now. I think it best to unbundle the salient and worthy topic of mental health care, from the salient and worthy topic of gun control. Like a Venn diagram, there is an area of overlap, but largely these are independent public health priorities -- and neither is getting the full measure of attention it deserves.
For more by David Katz, M.D., click here.