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Be an advocate for the mentally ill: The case for editorials.

HE'S MY HERO, my son John, a young man in the prime of life who struggles daily against an illness science only half understands.

A powerful anti-psychotic drug, a mood stabilizer, and an anti-depressant allow him to enjoy watching the Indianapolis Colts; to take part in a new rehabilitation program at a center, a clubhouse known as the Carriage House; and to be the best-darned uncle two little girls ever had.

He is also one of those naturally caring people who reaches out to others who suffer from some handicap or another with empathy and whatever help seems needed.

Long before John had a diagnosis of mental illness, even before he was a teenager, I wrote editorials that urged the community to invest more in services. In May, during Mental Health Month, I always urge readers to support the work of the Mental Health Association.

I write editorials calling on the community to lay aside the stigma that imposes a social ostracism on top of the brain chemistry and emotional problems a person afflicted with this illness must live with. As a former theological student, I bring some academic background in psychology and counseling to such writing.

But John's illness took me inside the system. It took me into the world of fragmented, underfunded, and inadequate services. It took me into the lives of the family members who themselves are heroes because they must cope with a loved one's erratic, sometimes explosive, and occasionally suicidal behavior. In its own way, madness is infectious, testing the character and resources of anyone in its path.

Inside this world, my writing on mental illness surely is more sensitive and knowledgeable. It is also more urgent, as I see good people, the mentally ill and their loved ones, living on the edge.

Because mental illness is so prevalent, striking an estimated one family in five, and because Rosalyn Carter, Tipper Gore, and other prominent Americans have taken up the cause, I'm sure other editorial writers have had occasion to write editorials and columns about mental health issues.

But I believe our profession has a special opportunity, and even an obligation, to be advocates for the mentally ill.

No other illness is so prevalent yet so isolating. I guess you have to be in the system to appreciate how much alone the patient and family can feel. Most of the family members I know wouldn't think of discussing this with their neighbors. Often within the family, denial that a loved one has a mental illness becomes a routine part of the relationships. A mother can't talk to her husband about the son's illness. If the loved one commits suicide, almost always the result of depression, the stigma descends like a plague upon the household. Survivors have related to me of the ostracism a daughter's or wife's suicide has brought upon them from people who were once their best friends.

Here's where editorial writers come in. We can call attention to those afflicted with a mental illness. We can help distinguish this from other brain disorders such as retardation and Parkinson's disease. We can disabuse people of the notion that the mentally ill suffer from a weak moral character or would "act normal" if they'd just stop feeling sorry for themselves.

In a more practical vein, we can educate the public about some of the newer drugs that have brought so many sufferers almost literally back to life. We can draw attention to the gaps in services, the injustice of inadequate insurance coverage, and the need to create job opportunities for those able to work.

My own writing on the issue has taken various directions. During debates over insurance parity legislation in Indiana, I did a great deal of research, which mostly showed that the cost estimates by businesses and insurance companies were exaggerated. I also condensed arguments in favor of the legislation in a way that could be easily lifted out and used by the advocacy groups to make their case to lawmakers. I'm proud of this small part I played in seeing that Indiana now has one of the strongest mental health parity laws in the country.

On another front, I unsettled a lot of people who work in the mental health system in my city when I wrote a Sunday commentary objecting to the fact that two different agencies were handling 72-hour emergency commitments of the mentally ill. It's a classic turf battle. But the competition, which often benefits the consumer in other areas, does disservice to the mentally ill.

The community mental health center dispatches a mobile crisis team, and since the team's inception, it has reduced the number of such hospitalizations, often associated in the research with poor outcomes. But the local mental health association has been handling these commitments for many years. The director refused to relinquish her monopoly on the commitments. Her role has been to orchestrate the commitment over the phone, without a mental health professional ever actually seeing the person.

At this writing, the city has been examining alternatives to coordinate the services of both agencies and to improve the training of police officers, often the first persons to confront a mentally ill person who has become psychotic.

Beyond the police, those who make the ultimate judgments in criminal justice, such as prosecutors, judges, and defense attorneys, also can benefit from training in mental illness.

As you know, many people caught up in the system have severe mental problems, often compounded by alcohol or drug abuse. One case brought the problem home powerfully to me.

In July 1997, a young man, Joe Corcoran, shot and killed four other young men, including his brother and a sister's fiance, on the grounds that he thought they were talking about him.

As I followed the case, I discovered that principal players, including the judge, had a poor grasp of mental illness generally. They seemed to appreciate only vaguely how this illness might severely diminish one's capacity to form criminal intent or to act rationally under stress.

To compound the difficulty at getting to the truth and, then, to deal justly with Joe, psychiatrists and psychologists offered conflicting opinions as to his competence and his diagnosis. Unfortunately, the judge ended up discounting much of the expert testimony and gave this very sick young man the death penalty.

I have since learned that this often-futile battle of experts throughout Indiana has the effect of nullifying state statutes meant to protect persons who are gravely disabled.

What's more, I found Indiana law permits anyone with a medical license to be counted as an expert on competency in a criminal case. There are no standards as to the type of examination or the length of the exam. Nor is there any peer review to assure the defendant has been adequately diagnosed.

I'm told no other state has rigorous standards of competency exams, either. Under such circumstances, I can't imagine how the truly mentally ill are protected or, for that matter, the community protected. The disposition of many cases is made virtually in a psychiatric fog.

As these shortcomings in the criminal justice system pertaining to the mentally ill dawned on me, I proposed that Indiana-Purdue University, Fort Wayne, create a center for the study of mental illness. I understand if the proposal becomes reality, it would be the country's first for educating the community. The idea is to give the lawyers and others in the system, as well as other professionals, a special, short-term course on mental illness.

IPFW's chancellor and several department heads have been working on the proposal since last fall, and it enjoys the support of the mental health center, advocates, and judges.

Another gap I've found is the lack of a consumer's guide to mental health services. I occasionally attend a family support group -- a local affiliate of the 250,000-member strong National Alliance for the Mentally Ill. I've heard so often at those meetings family members tell of their frustration at not knowing where to turn or being directed to one agency, only to learn that the agency doesn't, say, deal with children or offer direct services or take Medicaid patients.

I brought this up in an editorial, and several NAMI members offered to invest the time and energy to assemble such a consumer's guide. I believe that our broader perspective on community services helps editorial writers spot such needs. When it's complete, such a guide will be of enormous benefit to many families. And imagine. The proposal I made was merely one paragraph in a longer editorial about the need for mental health services!

I would be remiss if I failed to mention Leo Morris. He's the editorial page editor of the competing newspaper in Fort Wayne, The News-Sentinel, and an NCEW member. Leo has written with sensitivity and passion on behalf of the mentally ill. Whereas mine is the liberal paper, his is the conservative voice in Fort Wayne. We rarely agree editorially. But both of us opposed the death penalty for the mentally ill Joe Corcoran.

In my own writing, I try to avoid using the technical terms unless they're widely known. I also avoid pretending I know the real causes of mental illness. At national conferences, I've heard too many "mays" and "maybes" and "we believe nows" from distinguished researchers to discuss causes with anything approximating certainty. My advice is to approach the subject with humility and you can't go far wrong. Not everyone does.

Be forewarned that plenty of experts in this field can be as dogmatic as you can imagine. Some, such as Dr. H. Fuller Torrey, seem to have little use for counseling the seriously mentally ill. Others -- Dr. Peter Breggin is an example -- have no use for drug therapy. Arguments on both sides, however, are worth considering carefully.

If you haven't written much about mental illness, you can get lots of reliable information from the Websites of the National Alliance for the Mentally Ill at www.nami.org, the National Mental Health Association at www.nmha.org, and the National Institute of Mental Health at www.nimh.nih.gov.

For even more specialized help, the national associations of the psychiatrists and psychologists will refer you to experts, giving you a variety of opinions. Also, every type of the illness, bi-polar, schizophrenia, anxiety disorder, obsessive-compulsive disorder, and depression, has its own national support group.

A national consumers' organization often takes a different and interesting tack. A fascinating and important debate is whether to force the mentally ill on the streets into treatment. Dr. Torrey speaks for the "yes" side of the debate, while, predictably, the ACLU represents the most vocal "no" side.

In selling editorial writing to an applicant, I'll often tell them that yes, it's a fun job, and the hours and pay aren't bad. But the best part of it is the chance to make a difference in the lives of ordinary people. That's certainly what I've found to be the story writing about mental illness.

When a mentally ill person or family member sees me at some meeting and gives me a big hug of thanks for some editorial, I know I'm learning what it means to make a difference. Especially when the hug is from my son.

NCEW member Larry Hayes is a columnist and former editorial page editor of The Journal Gazette in Fort Wayne, Ind.
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Author:HAYES, LARRY
Publication:The Masthead
Geographic Code:1USA
Date:Mar 22, 2000
Words:1899
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