Experts give views on gun violence, mental health debate
By Susan Frick Carlman firstname.lastname@example.org January 26, 2013 4:56PM
A victim moved treated after a shooting on the Northern Illinois University campus Thursday, Feb. 14, 2008, in DeKalb. | AP File Photo~Northern Star, Jim Killan
Signs of trouble
While policy makers consider options for reducing gun violence through increased focus on the mentally ill, experts in human behavior say there are red flags to look for in a young person who may be struggling with a psychological disorder. Early intervention is critical, they say, to prevent the behaviors from escalating.
In young children, troubles may be expressed outwardly through defiance or other stubborn behavior inconsistent with their age, or frequent complaints about physical discomfort. Young kids also may cry often.
Adolescents may show they are struggling by isolating themselves in their rooms and generally withdrawing from social interaction.
A teen with mental illness also may shift to a new circle of friends, or show a greater inclination to become angry or verbal, or both.
Impaired school performance and substance abuse can be signs of emotional disturbances as well.
Updated: February 28, 2013 6:23AM
Part of an occasional series looking at how the national debate on gun laws and gun violence is playing out in local communities.
Although one in 17 Americans suffers from a serious and debilitating psychological condition, one in four has a diagnosable mental disorder, according to the National Institute of Mental Health. Of that 25 percent, three out of four begin to experience symptoms before age 24.
Yet officials say fewer than half of children with behavioral health challenges receive the diagnosis and treatment that can help prevent them from growing into troubled adults who one day may become violent.
“Most people who have been married, have had kids or have had a boss they can’t stand have had thoughts of committing violent acts,” said therapist Stephanie Willis, a Sun-Times Media columnist who runs a private group therapy practice with a location in Naperville. “It isn’t just the one in 17 who have a serious illness that could potentially be harmful, but it is the one in four people who have any diagnosable disorder.
“We have to understand what mental health issues are and recognize when we are not managing life mentally well.”
Willis is one of the local professionals who see promise in President Obama’s call for expanded access and more thorough identification of people who struggle with mental illness — particularly those who could be driven to violence by their disorders.
Obama last week outlined nearly two dozen measures intended to reduce the frequency of gun violence in the U.S. Authorities see potential benefit in the proposals that focus on the psychological state of those who use firearms.
Several of the young men who legally purchased guns and then committed mass shootings in the U.S. in recent years had histories of mental illness, including some of those responsible for the seven incidents last year that left a record 140 people dead or injured.
The young gunmen implicated in the deadly rampages in Tucson, Ariz., and Aurora, Colo., and on the Virginia Tech and Northern Illinois University campuses had behavior disorders documented in their pasts as well.
Reported to have exhibited symptoms of mental illness years before his shooting spree, 20-year-old Adam Lanza used his mother’s guns to fatally shoot her, 20 first-graders, six adults and finally himself in Newtown, Conn., last month — and brought discussion of gun control and mental illness back to the national table.
“This is something we’ve been asking for and crying for the last 20 years, because the mentally ill are housed in our county jails,” said Kendall County Sheriff Richard Randall.
The law enforcement community, which long has supported efforts to ban the public sale of assault weapons, is showing support for a piece of Obama’s gun violence package that would result in collecting more information about mentally ill people believed too volatile to own guns.
The state keeps some records on those individuals, but Hiram Grau, director of the Illinois State Police, said funding limitations have held up the transfer of that information into a federal database.
Support for the plan falls short of full consensus. St. Charles psychologist Peter Coe, who for 30 years worked with veterans experiencing post-traumatic stress disorder, suggested the idea could backfire. Coe emphasized the confidentiality of a therapist’s office, where people can safely voice fantasies arising from their anger, guilt and other feelings. A reporting requirement that goes much beyond existing rules for acting on people deemed an imminent threat could jeopardize that sense of security, he said.
“Lowering the bar on when mental health practitioners are required to report their clients to the police, and to inform authorities about the presence of weapons, would increase the risk of violent outbursts since they would leave the treatment that is lowering depression and turmoil,” Coe said.
Because it can be all but impossible to accurately pinpoint violent criminals before they have acted, Coe believes the proposals could risk overreaction, despite the tragedy that launched them.
“A nuanced and respectful view of mentally ill people is a fragile position to maintain and can be shaken in times of stress and fear,” he said.
Youth at risk
Among the pillars of the administration’s plan, some of which will require Congress to act, are new funding to expand prevention and intervention programs for young people; more open discussion of mental illness; and increased collaboration among school districts, police and mental health agencies to ensure help gets to those who need it.
According to the White House, 22 percent of teens age 14 to 17 have witnessed a shooting in their lifetimes. Studies have established links between exposure to community violence and children’s emotional health, including a significant increase in some kids’ risk of later developing mental disorders that contribute to them eventually committing violent crimes themselves.
To many of those in the behavioral health profession, prevention is key.
“That’s really important, because you can really change someone’s life if you intervene early enough for people at high risk,” said Diane McLaughlin, director of behavioral health at Presence Mercy Medical Center in Aurora.
The patterns of behavior that culminate in random violence are often established years earlier, said Naperville therapist Kimberly Groll, also a Sun-Times Media column writer.
“I have parents bringing their teens to me when they’re 17, or they’re 20 and they’re no longer in school,” said Groll, who often is told that the child’s behaviors took a turn long ago. “My question is, ‘Why wasn’t it addressed then?’”
She also usually inquires whether the child’s friends have changed, or she has become more verbal, or he is displaying more outward anger, such as punching walls or doors.
“Parents will say, ‘I’m constantly repairing this or repairing that,’ or ‘We’re afraid to say anything, because we don’t know what’s going to set him off,’” Groll said, noting that adults often have trouble admitting their children may be mentally ill.
“It’s just like the heroin issue. Nobody wants to talk about it, ‘My child would never be involved in heroin.’ And I think it’s the same thing with mental illness.
“I think what the biggest problem is, is the word ‘mental’ being put into it.”
Also problematic, Groll said, is the high cost of behavioral health treatment, which insurers don’t always cover comprehensively.
“That’s the biggest reason that parents stay away, I feel,” she said.
The National Alliance on Mental Illness, which has chapters in Kane, Kendall and Will counties, lauded the proposals. In a statement released after Obama’s Jan. 16 news conference, NAMI Executive Director Michael J. Fitzpatrick said the plan to boost mental health services reflects many of the suggestions his agency made in meetings with Vice President Joe Biden’s task force in the aftermath of the Connecticut school shootings.
“Out of tragedy, Americans today have an opportunity that probably comes only once in a generation,” Fitzpatrick said in a statement posted on the organization’s website. “The mental health care system has long been broken. The challenge is not to fix it, but to build it anew, focusing on early screening, diagnosis, treatment and prevention. The President’s plan takes important steps toward meeting that challenge.”
Assorted factors can keep families from seeking treatment for a troubled child, and young people from looking for help. The cost of services can be prohibitive, even for those with insurance coverage, if deductibles and co-pays are high. The expense especially hits home for those who are neither wealthy nor very poor.
Karen Beyer, executive director of the Ecker Center for Mental Health in Elgin, said the problem is not exclusive to Illinois.
“Access is being reduced. It’s been going on for several years now,” she said. “There are many people who don’t have Medicare, who don’t have Medicaid, and can’t afford to go out and get these services.”
Until a few years ago, Beyer said, mental health treatment was subsidized for many low-income households.
“Those subsidies have been dramatically, dramatically reduced,” she said, noting that coverage also has been sharply cut back. “In some cases there’s really almost nothing except emergency services.”
She is encouraged by recent policy shifts that require equal levels of coverage for physical and mental health treatments, and by provisions in the Obama administration’s health care overhaul that will extend Medicaid coverage to nearly 17 million more Americans.
“That has far, far-reaching implications in terms of people having access to care,” Beyer said. “And with the Affordable Care Act, most people have insurance now.”
One element that continues to stymie efforts to aid those with behavioral challenges is a lingering perception that mental illness is something shameful, rather than an illness.
“I think that the stigma of mental illness still affects people’s willingness to get help, as well as the availability of resources,” McLaughlin said.
Beyer also sees that at the Elgin center.
“It’s not simply a matter of money. There is, we have to admit, a real stigma attached to mental illness. Especially for young people, it’s very difficult sometimes to admit that, ‘Maybe I do have a mental health issue, and maybe I do need treatment.’”
McLaughlin appeared cautiously optimistic that Obama’s proposals to connect people with treatment may prove effective.
“If what he’s proposing increases access to mental health services as well as allows more services to be available,” she said, “that would mean people can get the help they need.”