shot dead in DC

[Lamplighter]

Originally Posted by sexobon

It seems women are more likely to murder their children just before they commit suicide.

...because only a man would try to figure out how to do it afterward.

[Perry Winkle]

Originally Posted by sexobon

Yes, yes of course, thank you for making all so doable. We argue for universal, unconditional support, elimination of poverty, and the end to all wars. Pie in the sky arguments are saving lives everyday dontcha know.

Don't patronize me. I never said unconditional support, elimination of poverty or the end to all wars.

I think it's better to set lofty goals and take baby steps toward them than to give up and dehumanize people. No "one big push" ever succeeds fully. No matter what you are going to have a painful period where you zero in on what's most effective.

A starting point would be a movement to stop mental illness stigma. We have bullying prevention and all sorts of other social initiatives. Generally not expensive.

Incarceration is what happens to a lot of mentally ill people who don't have access to social support. It's much cheaper to put someone in a hospital for a while, get them the drugs and therapy they need and then do whatever helps them reintegrate with society as safely as possible. You prevent a lot of negative externalities by helping those in need.

I think the problem most people have with this sort of suggestion is that it's addressing the cause not the symptom. Most people just can't fathom that. It's easier to use whatever quick fix is available after the problem becomes acute.

[Lamplighter]

Well said, PW

[sexobon]

Originally Posted by Perry Winkle

I think the problem most people have with this sort of suggestion is that it's addressing the cause not the symptom. Most people just can't fathom that. It's easier to use whatever quick fix is available after the problem becomes acute.

The problem is not with that sort of suggestion; but, that you would FIRST argue it:

Originally Posted by Perry Winkle

... I would first argue for universal, non-judgmental support. ...

The problem is already chronic. For serious issues there are often two solutions, a short term solution and a long term solution. In this context, Clod's argument supports both a short term solution of intervention which prioritizes saving children's lives and a long term solution of not stigmatizing those in need of mental health care to further that objective ... not the other way around ... one doesn't have to wait on a cure to address the symptoms.

Originally Posted by Perry Winkle

Don't patronize me. ...

As you wish, then get ye to a tanning booth or something. I'm sure your dermatologist will understand:

Originally Posted by Perry Winkle

... there will be no more clear thought on my part until Mayish.

Think that might have something to do with your perspectives?

[orthodoc]

Originally Posted by sexobon

Yes, yes of course, thank you for making all so doable. We argue for universal, unconditional support, elimination of poverty, and the end to all wars. Pie in the sky arguments are saving lives everyday dontcha know.

Treating mental illness as comparable to physical illness and refusing to stigmatize those who suffer from it are not pie in the sky concepts.

Crisis intervention is a stop-gap measure that does help defuse many situations, but not all. But it's the long term care that's lacking. In spite of legislation requiring insurance companies to cover mental illness, the majority of policies I've looked at in the past month offer NO coverage for 'behavioral health'. People with severe illness can't wait months for an appointment and then just see a mid-level. They will decompensate.

This is a huge problem on both sides of the border. The reality is that there's no care for the 3% of the population with psychotic disorders! and little to none for the 10-15% of mothers who suffer postpartum depression.

[xoxoxoBruce]

Treating mental illness as comparable to physical illness and refusing to stigmatize those who suffer from it are not pie in the sky concepts.

No but it is expensive, and the Muslim Kenyan in the White House is too busy redistributing wealth to bother.

[orthodoc]

It's far less expensive than treating lifestyle-induced chronic disease, and we don't balk at that. Although if we don't address that issue, we'll go bankrupt. Stay tuned for campaigns to promote healthy lifestyles that are similar to the very successful anti-smoking campaigns of the past couple of decades.

[sexobon]

Originally Posted by orthodoc

Treating mental illness as comparable to physical illness and refusing to stigmatize those who suffer from it are not pie in the sky concepts.

They are as a first priority; or, first method of approach as the issue currently exists. That's what my comment addressed.

ETA: Pass me a 64 oz. regular Coke.

[tw]

Originally Posted by orthodoc

Treating mental illness as comparable to physical illness and refusing to stigmatize those who suffer from it are not pie in the sky concepts.

Psychology was mostly a subjective art. Without tools to properly quantify a disorder and identify its causes, psychology remained something above blood letting. A subjective art.

Pet scanners and other recently developed tools are just beginning to turn psychology into more of a science. So how is any doctor to make a diagnosis supported by hard facts? That's the problem. Mental disorders are identified mostly by subjective observation.

Now, would a women suffering from post-partum depression always be obvious? Do symptoms come a go even within hours? How would one identify simple depression from potential acts of violence? Could the many who saw her days before recognize anything wrong if informed what to observe?

[xoxoxoBruce]

I think most of the people I meet are mentally ill, so how to we select which need help, as opposed to the ones that are self pitying attention whores?

Also, how do we help the ones that are so crazy they think they're fine? I sure as hell don't trust Dr Phil, and the courts have ruled you can't force institutionalize them unless they are a danger. There again, a judgment call unless they've harmed someone.

[orthodoc]

The advent of PET scanners has done a great deal to move our understanding from theory to observable, reproducible information, as has our understanding of neurotransmitters and neuroanatomy/neuropathology. It's true that psychiatric diagnoses remain clinical, but so do many 'physical' diagnoses, such as carpal tunnel syndrome (EMGs don't make the diagnosis; they just provide information regarding the extent of neural disruption), MS, and most of the degenerative neurological diseases. Many, many diseases are identified by direct observation.

Postpartum depression is a particularly malignant form of depression, with a higher prevalence of psychotic features than many other forms. Any woman who suffers from it needs aggressive treatment, support, and frequent assessment. The presence of any psychotic symptoms is a huge red flag indicating the need for immediate evaluation and probable admission.

Could others have noticed differences in the days leading up to the crisis? Possibly, if she had shared any delusions or hallucinations. Could they have gotten help for her? It's fairly unlikely. If she even had a policy that covered mental health, the criteria for admission are so stringent that unless she vocalized direct threats to herself or others she would not be admitted. Being psychotic on its own does not get you admitted. Even then, insurers will force discharge the moment the direct threat appears to have settled, even though the person is not stable.

[orthodoc]

Originally Posted by xoxoxoBruce

I think most of the people I meet are mentally ill, so how to we select which need help, as opposed to the ones that are self pitying attention whores?

Also, how do we help the ones that are so crazy they think they're fine? I sure as hell don't trust Dr Phil, and the courts have ruled you can't force institutionalize them unless they are a danger. There again, a judgment call unless they've harmed someone.

Self-pitying attention whores are just that. I'm talking about major mental illness, the kind that kills - major depression, schizophrenia, bipolar 1 disorder. Not the personality or anxiety disorders or the urbanites who can't decide what they think about anything until they see a therapist.

Psychotic people are completely immersed in their delusions or hallucinations. That IS their reality. They live in fear more often than not. If you hear your furniture whispering bad things about you at night and plotting to kill you, you act to try to prevent that and you live in fear, as the next place you stay has furniture that whispers about you, too. The danger comes when command hallucinations start, or delusions become so overwhelming or terrifying that the person acts on them.

Dr. Phil doesn't do psychiatry, he does family therapy.

[xoxoxoBruce]

OK, but the first group are more likely to demand attention, whereas the second are more likely to retreat and sequester, from what I've read/seen. Seems pretty hard to sort out, even if they agree to talk to a shrink.

[orthodoc]

The second group is definitely more fearful and resistant to treatment. But these things can be sorted by diagnosis. The first group should have access to care, because the anxious ones will function better with some treatment. But they could be treated by PCPs. The second group needs priority for specialty care. They're harder to reach and treat because they're seriously ill with a brain disorder that makes them distrust everything they encounter. But they should have the Elite Class pass to immediate specialty care whenever they present.

[xoxoxoBruce]

But how do you locate and treat them before they try to ram the White House gates, or gun down a classroom full of children?