Our Mental Health Problem

Although I disagree with much of what Donald Trump has said, as a psychiatrist, I believe there is validity in one of his recent statements. In response to being asked whether gun control measures could have been the key to the tragic shooting in Texas he stated, “mental health is your problem here.”

Whatever his motivations, the essence of the statement is a truth. To better understand, let us reframe the issue within an analogy: we do not consider the recent, tragic occurrence in New York in which a man mowed down innocent bystanders with a truck and primarily debate “motor vehicle control”. Instead, we understand the vehicle was wielded by a man intent upon killing due to a psychological acceptance of the ideology of a terrorist faction. I.e. we frame our discussion around a need to deal with “terrorism”, acknowledging the causative factor was rooted in the psychology of terrorism. We then discuss ways to mitigate the appeal, spread, and associated behaviors of this ideology. In addition, but not exclusively, we acknowledge the truck was the cause of death and discuss how to prevent someone from obtaining a vehicle for that purpose. So why do we continue to focus on “gun control” as the primary element of debate with each new instance of a shooting by a mentally disturbed individual?

I propose we do so because a debate around these shootings framed as “a mental health problem” means acknowledging and grappling with a vastly more complex and cross-partisan issue than “gun control”. In our country, the elements of this issue include, but are not limited to, 1) the stigma associated with mental health, 2) the lack of parity of mental health coverage vs. physical, and 3) the shortage of mental health professionals. All contribute to the 4) alarmingly low levels of preventive services, 5) exceedingly limited identification and early intervention/ treatment options, 6) lack of access to services even after an issue is identified, and 7) minimal integration of mental health services with other health and supportive services.

In addition, 8) it is true, and must be reinforced with education, most people with mental health issues will never be violent. But it is also true most guns held by civilians and most motor vehicles are not intentionally used to kill people. Yet, we should, and do, discuss how to change the requirements of access to these potentially dangerous objects to prevent morbidity and mortality. We should have similar discussions of how to prevent a mentally ill individual from becoming so ill they believe they must kill others and/ or themselves. Lastly, 9) mental illness produces considerable morbidity beyond that associated with violent episodes; a significant burden of distress, lost productivity, and cost, both economic and opportunistic, to the individual, the families and communities of those afflicted, and to society at large. This makes a discussion of the “mental health problem” even more compelling.

I am not saying “gun control” is not a worthy issue for discussion. I am saying we miss an opportunity with a sole and primary focus on “gun control” in the wake of the Texas massacre. At least for once, our president called it right. He, and we, would do well to acknowledge, discuss, and treat the “mental health problem” as the underlying cause of the all too visible symptom of our societal illness. If we do so, we have the potential to prevent more massacres. In addition, we could mitigate the numerous, terrible ways that mental illness affects us and create increased health, safety, productivity, and happiness for individuals and for our society. Yes, we have a “mental health problem” in Texas and across the country. How could this not be a worthwhile, if difficult, problem to focus upon?

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