Connecticut Tragedy: A reasonable vehicle for addressing mental health needs in young people?

Recent media coverage, sensationalistic and omnipresent as it is (and, by the way – has anyone noticed the correlation between frequency of school shootings and this type of media coverage?) has raised numerous issues about the relationship between the tragic story in Connecticut and youth mental health.  Largely the story line has gone something like this: oh my gosh, this young man had a psychiatric diagnosis; his mental illness likely made him act this way; why can’t our society do a better job of identifying youth who are likely to have this kind of negative impact; we need to fix our mental health services.

Have we ever wondered where that kind of story line takes us?  Does it take us to a rational and evidence based understanding of mental health and mental disorders?  Does it take us to a place where we can logically develop mental health care that meets the needs of young people and their families?  Does it provide reliable information about what a mental illness is and how a mental illness may or may not lead to specific behaviors and outcomes? OR – does this kind of knee-jerk reporting maybe increase the stigma associated with mental illness, lead to inaccurate understanding of what a mental disorder is and how that relates to specific kinds of behaviors and in both the long and short run, do a disservice to all those who are living with a mental disorder, their families and those who work to help them get well and stay well?

We know that easily accessible, responsive and best quality mental health care is not readily available for most young people who need it. We know that most young people with mild to moderate or non-complex mental disorders can be appropriately and effectively treated in primary care (click here to check out the child and youth mental health components.) We also know that it is the tiny minority of young people with a mental disorder who require intensive and high acuity mental health care.  And, we know that is only a tiny minority of those who may have a mental disorder of the type that leads to the tragedy recently played out in Sandy Hook.  So why is this event even considered to be the poster child for mental health reform?

I think we need to have many adult conversations that this tragic incident forces us to consider.  The most obvious one is that of: how to best deal with the killing capacity of the final common pathway – automatic/semi-automatic weapons and handguns.  The Dunblane school shootings in Scotland led to popular protest that led to changes in gun related legislation that has been associated with a substantial decrease in deaths of young people from shootings.  This is a no-brainer – or maybe this is the problem.

We also need to fix the mess that is mental health services for young people – everywhere.  Just because we live in Canada does not mean that we are doing what needs to be done – on the contrary.  But we don’t need to have a tragedy to address this reality, we need commitment from all of us and political will.

-Stan

Stimulant medications and automaton kids: Sociobable or substantive concern?

It is fashionable in some domains of public discourse to denigrate psychostimulant medications and their therapeutic impact on young people living with ADHD.  In particular, it is not uncommon to find armchair philosophers, scientologists or even research naïve journalists happily spouting off about the way that psychostimulants turn young people into robots, take away their feelings and generally make them less than human.

These medications are, in the mouths of those espousing such opinions, at best dehumanizing and perhaps worse. 

They are supposed to take away the mind and the soul of those to whom they have been prescribed. They are supposed to make young people less authentic as individuals and are supposed to block their ability to make critical considerations about their ability to function, on or off the medications.  In short, they are a challenge to authenticity and damage moral agency.

An interesting aspect of this pontificating has been the strength by which these opinions are held, interestingly enough not supported by data addressing authenticity or moral agency. This certainly does not mean it is unimportant, only that it needs empirical evidence to either support or refute the opinion. This would therefore classify it as an informed opinion, not simply an opinion.

So, what does the data show us? Click here to view an interesting article recently published by the British Medical Journal. Interestingly, the author asked what young people’s experiences and considerations were. Further interesting, the conclusion states: “drawing on a study involving over 150 families in two countries, I show that children are able to report threats to authenticity related to stimulant drug treatments, but the majority of children are not concerned with such threats. On balance, children report that stimulant drugs improve their capacity for moral agency, and that they associate this capacity with an ability to meet normative expectations.” In other words, children treated with these medications appreciate their therapeutic value while at the same time preferring not to be taking them and not liking the side effects.

Wow. We would expect the same response from young people taking insulin or medications that treat heart problems or cancer. Interesting however, is the observation that armchair philosophers, scientologists, sociobabblers and others do not set their vitriolic sights on those other types of medication treatments. Maybe treatments for traditional “physical” conditions are okay, but treatments for traditional “mental” conditions are not. Maybe there is a gross misunderstanding that mental actually means brain and brains can get sick, just like the pancreas or the heart. We seem to miss out on the data, i.e. the facts that speak to this exact reasoning which can shed some light to the notion that the difference should not exist.

In my opinion, this is either a lack of knowledge writ large or a familiarity with knowledge submerged in prejudice.  It is hard to know which would be worse, but the stigma that this vitriol contributes to is real.

-Stan