Post-Newtown, mental health services considered

In the days following the shooting in Newtown that left 20 children and six staff members dead, speculation was rife over the 20-year-old gunman Adam Lanza’s mental health. Multiple news outlets reported that Lanza had been taking medication prior to the shooting and that his mother had been mulling over more intensive treatment for her son. Throughout the state, lawmakers and Connecticut citizens have been asking the same question: Had the state’s mental health system been stronger, could the events at Newtown have been prevented?

In the wake of the shooting, the Connecticut Legislature established the Bipartisan Task Force on Gun Violence Protection and Children’s Safety on Jan. 14, charged with the mission of patching up cracks in any laws through which Lanza may have slipped. The task force is divided into three caucuses: school security, gun safety and mental health, which will each propose a bill this legislative session. Though bills normally take the entirety of the five-month legislative session to discuss, pass through committee and come up for a vote, the task force is due to release its proposals by the end of this month.

Several mental health experts interviewed said that although they were glad to see an unusual spotlight shone on issues of mental health, they worried that producing legislation in reaction to a tragedy might produce regulations that were not well-thought-out.

Kate Mattias, executive director of the National Alliance on Mental Illness Connecticut Chapter, said that Lanza’s high profile leads the public to wrongly conclude that individuals with mental illnesses have a propensity toward violence. To the contrary, according to the National Institute for Mental Health, individuals with severe mental illness are no more violent than the average population when their symptoms are controlled.

“There is no connection between what went on in Newtown and people with mental illness. We do not have any sort of diagnosis for the young man,” Mattias said. “What we do know is that the mentally ill are much more likely to be victims than to be perpetrators of crime.”

MENTAL HEALTH SOLUTIONS

In order to keep the symptoms of mental illness under control, mental health experts agree that a comprehensive mental health care system must be in place. By many accounts, Connecticut’s system is one of the most progressive in the country. According to Mary Kate Mason, the spokeswoman for the Department of Mental Health and Addiction Services, or DMHAS, the state employs a “recovery model” of treatment. Rather than putting the mentally ill in institutions, she said, the department seeks to integrate them into communities and teach them independent living skills.

“They have lives that are very similar to folks who don’t have mental illness,” she said. “They go to school, they work, they live full, productive lives.”

Christine Limone, director of political advocacy for the Connecticut chapter of the National Association of Social Workers, said that once patients emerge from hospitals, the recovery model relies on three prongs of treatment. The first is adequate clinical care, including medication and regular therapy. The second is a system of supported housing complexes, where individuals live in their own apartments, but staff work in the building to assist dwellers in taking their medication and other daily tasks. The third is known as psychosocial treatment — programs that assist patients to reintegrate into their communities, for example helping patients find work or go back to school.

Limone said that the state faces a chronic shortage of supportive housing, leaving many patients with inadequate care once they leave the hospital. But, she added, the state tends to underestimate the need for psychosocial services funding, as well.

“Psychosocial rehabilitation is the most likely to be underfunded,” she said. “People understand that at base minimum you need meds and you need a doctor. But people underestimate the power of just having people there with you.”

DEBATING INVOLUNTARY COMMITMENT

Perhaps one of the most hotly contested issues surrounding the state’s mental health care system revolves around whether the state should institute an involuntary commitment law. Currently, Connecticut is one of six states across the country that lacks such a law, which would allow family members or service providers of a person with severe mental illness to force them to seek treatment. In Connecticut, a person can only face involuntary commitment if he or she is found unfit to stand for trial in court proceedings.

“People that are mentally ill don’t think like the rest of us,” said Howard Zonana, the director of the Psychiatry and Law Division at Yale Medical School. “So you can’t just rely on someone to say, ‘Oh yes, I’m mentally ill, and I need treatment.’”

Zonana said such a law would be more likely to pass after a tragedy such as Newtown, when the impetus to act is so strong. But he added that though involuntary commitment laws in other states have reduced arrests of those facing mental health challenges, they have not necessarily prevented all acts of extreme violence from these individuals.

Opponents of the law say that if Connecticut’s recovery model-based mental health care system was funded adequately enough to provide every person with adequate services, they would not reach a point where involuntary commitment would be necessary. According to William Sledge, a professor of psychiatry at Yale and the director of psychiatric services at Yale-New Haven Hospital, the potential of facing involuntary commitment might be enough to scare many in need away from the system.

“I’ve seen so many patients who — something like this has such a chilling impact on their ability to take advantage of the resources, it would have more disadvantages in turning people away from treatment,” he said.

State Rep. Terrie Wood, a Republican from Norwalk and a co-chair of the task force’s mental health caucus, said that some form of an involuntary commitment mandate would “most likely” not appear in the bill her committee will put forward this month. Such a proposal, she explained, is too complex to decide in a few short weeks.

“Some of the deeper issues should go through the regular legislative process, just because they need to be much more thoroughly vetted,” she said.

A QUESTION OF FUNDING

In December, Gov. Dannel Malloy included $7.7 million in cuts to DMHAS as a part of his deficit mitigation package to close the state’s shortfall this fiscal year. After the events at Newtown, though, most of these cuts have since been reversed, with Malloy including several line-item increases for DMHAS in his proposed biennial budget for the two fiscal years starting on July 1. According to Mason, proposed increases include funding for 100 new units of supportive housing and increases in funding for young adult services.

Despite its weaknesses, the state’s mental health care system is one of the nation’s strongest, according to Sledge. Sledge said that, though Connecticut lawmakers are conscious of its cost, they are largely cognizant of the importance of a robust mental health care system.

“Politicians in Connecticut are fairly sophisticated about mental health services,” he said. “It doesn’t mean it’s their favorite thing. But as far as legislators go, I would take them over any other state that I know of.”

Sledge added that, if there were any changes he could propose to the system, he would allocate more funding to clinical research on mental illness. He said that, though Malloy maintained the large majority of DMHAS funding in his proposed budget, he cut funding for education and research.

“If there’s anything Connecticut could pass, it would be an investment in the future,” he said. “Making sure there are adequate health care providers through education and training, and there is adequate investigation into the causes and treatment of mental illness.”

With such a strong track record, it is unclear which areas of the system the legislative task force can fix through rushed legislation. Wood suggested that any items included in the bill later this month would be fairly noncontroversial. She declined to discuss specific proposals, though she suggested that the caucus would delve into issues such as more widespread mental health training and linking services between DMHAS and the Department of Children and Families.

During this fiscal year, the appropriation for DMHAS totaled $693 million.

Comments