Sunday, July 29, 2012

Warning: Crisis Ahead

The phone calls came pouring into mental advocacy hotline, psychiatrist offices and community mental health centers in recent days.  The question was often the same: "I've got a son with paranoid schizophrenia. What are the warning signs that he might become violent?"

In response, NAMI wrote a blog that many have called the most reasonable answer to the question yet published. Responding to the tragedy in Colorado, NAMI says:

No. 1: You can't diagnose mental illness by watching someone on TV. Even if they look really, really mentally ill.

No. 2: The likelihood of violence from someone with mental illness is low. A U.S. Surgeon General report called the contribution of mental illness to violence in the United States "exceptionally small."

No. 3: Sometimes the mentally ill do commit violence, and sometimes it's because the mental health system has failed.We don't know what happened to James Holmes and his family. In my talks with families, I've seen that the smarter the person, the better they are able to hide the development of schizophrenia. They know exactly what the illness is, and they don't want it. An open letter to the Holmes family from other mother who is trying to help her son against all odds was printed in the Pittsburgh Post-Gazette. It's heartbreaking. 

And she's right. This needs to prompt a discussion on what we are doing nationally to help the mentally ill.  But that should have happened when Gabby Giffords got shot, when Virginia Tech happened and so on.

So far, even David Brooks, who I respect enormously, is going for a "If you see something, say something" approach to preventing violence.  So what are you looking for? Other than cartons of bullets arriving on the UPS truck? Violence from someone with paranoid schizophrenia tends to happen early in the illness (which usually strikes around 20), to those who have substance abuse issues, had violent tendencies before they got sick and/or are descending into psychosis.

Signs of psychosis are:
  • Serious drop in academic or job performance
  • Trouble concentrating or thinking clearly
  • Writings that reflect disorganized thinking, paranoia or just plain crazy thoughts
  • Spending a lot of time alone
  • Decline in personal hygiene
  • Unusual suspiciousness or uneasiness with other people
  • Unusual decline in talking to you and turning away from friends
  • Having no feelings at all
  • Intense anxiety and fear
  • Bizarre outgoing voice mail messages (This evidently happened with James Holmes and it's happened to others I know.)
Next time: Planning for a Mental Health Crisis




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