Sunday, January 16, 2011

Arizona Aftermath: With Eyes Wide Open

For caregivers of people with schizophrenia and other mental illness, the shootings in Tucson last week were just another reminder of how bad things can get. We know little of Jared Loughner and less about his parents, who lived with him. We do know this: Nearly three million Americans have schizophrenia, and surveys vary in what their actual rate of violence is.

The May 2009 issue of the Journal of the American Medical Association reports the latest I could find: The increased risk for violent crime associated with schizophrenia is largely due to the subgroup of patients who are substance abusers. People who had schizophrenia and substance abuse problems were four times as likely as the general population to have a violent-crime conviction.

Whatever problems there are usually happen at home.  A 1986 NAMI study found that 38 percent of families reported that their ill relative had been assaultive or destructive in the home at least once. How often the police were called, the study does not say.

Let's be honest here. A lot of people with schizophrenia who are not in treatment are self-medicating and have substance abuse problems.  Getting help for them is terribly difficult, even when you are trying very hard, because our mental health system is broken.

We also know that Pima Community College told Jared Loughner's parents in September that he could not return to school until he had a letter from a psychologist stating that he posed no danger. The New York Times reported Friday: "No record of Mr. Loughner seeking or receiving mental health care has surfaced."

That really doesn't mean that his parents did nothing because of the waiting lists involved in getting psychiatric help.  For example, when my son's psychiatrist suddenly closed his practice, the waiting list to see the psychiatrist at the community mental health center was eight months long. We were able to get medicine only by going to a psychiatrist who does not accept insurance of any kind.  For some, that's no option. The list to get a psychiatric evaluation may be just as long in Tucson.

Nonetheless, I feel strongly about three things. 
1.  When you are asked by an outsider ... a school, a workplace ... to get your loved one a psychiatric evaluation, move heaven and earth to do so. Go to a NAMI or Mental Health America support group to find out the tricks for getting it done in your area.

2. Become the Gladys Kravitz of your family. Snoop. Set up a Google alert in the person's name. Search YouTube. Search periodically for alcohol, for drugs, for weapons, for bizarre writing.

3. Fight to change the privacy laws to require colleges and universities to notify parents about troubling behavior by young adults. Schizophrenia and serious bipolar issues often begin in the late teens and early 20s. I continue to believe that the Virginia Tech shooting would not have happened if someone had called Cho Seung-Hui's parents to tell them how he was acting. Because Virginia Tech had Cho institutionalized briefly, it's clear that his parents had some idea that he was sick. And they seemed like responsible people in the aftermath.

That said, I feel very sorry for Jared Loughner's parents. Parents of 22-year-olds who are acting oddly often think it is a phase or a drug issue. And it's hard for a person developing paranoid schizophrenia to tell parents and others what is happening to them because ... surprise ... they are paranoid. Still, violence is not a common symptom.  The person getting ill is much more likely to hurt himself than to hurt anyone else. We need an accessible system of care. And we need it now.

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