A small, empowering act

Believe this shit? Look at what’s happening to our country, compare and contrast the following —
Bush’s Mental Health Madness by John Sorboro MD:

Soon after 32 innocent people were gunned down by a loner sociopath at Virginia Tech, GWB responded by announcing he was going to send clueless bureaucrats around the country to meet with an equally clueless band of educators, mental health experts and state and local officials in hopes they can tell him how to prevent violence by dangerously unstable people. After they are done perhaps they will meet with magicians nationwide in an effort to develop a plan to make the national debt disappear.

Almost immediately after the shootings folks everywhere began asking why and how such a thing could be prevented again as we always do after a school or workplace shooting. This is not a bad question to ask, it’s just not one that is easy at all to answer. The first responses were from the gun control advocates. “Just get all the guns out of people’s hands and this would never happen. In a perfect marshmallow world yes but not surprisingly, President Bush an avid supporter of 2nd amendment rights has stayed clear of any discussion of gun restrictions as a response to the Virginia Tech shootings.

Also not surprising given his tract record on mental health issues is his attempt to fall back on the myth of the usefulness of psychiatric practitioners as a tool for effectively screening and segregating those who will commit such crimes. (President Bush’s New Freedom Initiative calls for the screening of the entire US population. The fact that it can arguably be seen as little more than a customer fishing expedition for big pharma is another issue.)

At first glance it would appear as a completely sensible thing to do. What could be wrong with getting some expert opinions on how to identify those people who will commit violent acts before they actually commit them in an effort to intervene before someone gets hurt or killed? What reasonable person could be against such an approach? The problem with all of this is that your average person on the street is every bit as good at actually predicting such violent behavior as the best psychiatric expert.

Cho Seung-Hui is not someone who slipped through the psychiatric fence. On separate occasions he was involuntarily hospitalized, sent for psychological evaluation, and referred to the university counseling center. In December 2005, when the university obtained a temporary detention order against Cho, a magistrate referred him for a mental health evaluation that found “his insight and judgment are normal.” Some have seen this as a failure of psychiatry to respond in an appropriate and forceful way and that if Cho had been coerced into treatment and perhaps the taking of medication this would have never happened.

This failure is indeed a reflection of the failure of psychiatry to effectively deal with such an individual. Not because it did not in this particular instance but rather because it can never do so. Mental health interventions to determine future propensity for violence do not protect society because mental health professionals as a group have no particular capacity to make such determinations. Such determinations rely on the ability of the evaluator to know the state of mind of a detained individual, arbitrarily decide if his or hers expressed belief system is secondary to a mental illness and than predict how they will act based on it. There is no objective way of doing such a thing.

The English Royal College of Psychiatrists published a study in February 2007 on the science of risk assessment and the prediction of violent behaviors in those labeled as having Schizophrenia. The report estimated that for every homicide accurately predicted there would be over 3300 false positive reports. I wonder if President Bush would support 3300 involuntary detentions in order to protect one individual. I suspect if he were presented with such odds he would see it as an unacceptable cost of our civil liberties as most people would.

And you’d be wrong, bud, this just in:

The Department of Labor (DOL) has published proposed changes in form EFA 6-53, the health questionnaire used for enrollment in the Job Corps program. The changes expand the questions to ask about the applicant’s mental health treatment and whether the applicant has ever had certain specific mental health-related conditions.

The stated purpose of the proposed changes is “to determine whether an otherwise eligible applicant offered enrollment may pose a direct threat to self or others.” The proposed questions are of little if any value in assessing whether an applicant poses a direct threat. Rather, in addition to potentially inhibiting access to treatment, such broad mental health inquiries amplify the stigma faced by people with mental disabilities and perpetuate the public’s misperception that such individuals are violent.

The Department of Labor is accepting written comments on the proposed changes. These comments must be received by June 4th.

The Bazelon Center has drafted a model letter with the key points, which you can use.

Agencies count the individual comments received, even if they repeat comments in other letters. The more public comments highlighting the problems the Department of Labor receives, the more likely it is that the discriminatory questions will be thrown out.

It is critical that the Department of Labor hear from you.

Email Barbara Grove, RN, at:
grove.barbara@dol.gov.

I don’t know if sending letters can help a cause or not. I do it to get me stronger after feeling I’ve been kicked in the face, reason enough.