In Psychiatric Illness, Families Must Be Our First Responders

These are real and remediable problems.

While I think mental health professionals and legal authorities could say many smart things about what can be done to correct the ways we miss opportunities to do more (and earlier), I sincerely, and with all due respect, suggest they (we) are not the ones to tell us all what needs to be done. It is families who are the true experts, the people who have learned all too well from experience what they need to help their loved one get help. It would also be a good idea to invite the opinions of those people with mental illness, who are well into their recovery, about how we can do better in engaging people with serious mental illness in the treatments that will keep others from losing ground, or from acts of aggression that blight their lives and ours.

There is a great and inescapable tension that exists between those advocates and experts who represent patient civil rights and those who call for more involuntary control of people with mental illnesses. But the pendulum has swung hugely since the 1960s, when commitment to a mental hospital was far too readily exercised (and little treatment offered once admitted). The former group is passionate about privacy and self-determination and deploys lawyers to defend patient rights for freedom and choice in psychiatric units throughout this country. The latter group, no less passionate, call for increasing involuntary hospitalization for people with serious mental illness, including outpatient commitment and requiring that patients take medications they refuse. Neither group has it all right nor is all wrong about what may be the best course for our country (and for mental health services and the law) to take. After Newtown, however, we are pressed to ask, and answer, is it our children or our rules?

So, as the tide of ideas carries on in the wake of Newtown, my suggestion is that we be sure to ask those who are first to notice, most determined to help, and whose ongoing love and support will be essential to whatever the professionals (like me) have to offer: the families who have member with a serious mental illness. Some have called this approach user driven design.

More money for treatment, while always welcome, is imprecise, if unlikely. We already spend a great deal of money poorly for mental health care. Let's start by formally inviting families with members who have a serious mental illness to the "invitation-only" policy and planning meetings that dedicated public officials will call to see how future mental health disasters can be averted -- including those that take the lives of one person at a time, not just the ones that wind up the focus of national attention.

I am sure that families, represented by exceptional organizations like the National Alliance on Mental Illness and other established family advocacy groups, can help medical, mental health, social service, and legal and law enforcement professionals more responsively change many of the encrusted and ineffective practices that exist today. Let's involves these families in engineering the most effective systems for involving their early warnings, using their leverage with their loved ones, and capitalizing on their ongoing support of the treatments that, if delivered early and consistently, will reduce the risks for tragic events.

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Lloyd Sederer, M.D., is medical director of the New York State Office of Mental Health and adjunct professor at the Columbia University Mailman School of Public Health. His book, The Family Guide to Mental Health Care, will be published in early 2013.

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