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September 19, 2013

The Navy Yard shooter, and when pleas for mental health care are discounted

With Navy reservist Aaron Alexis, we're hearing yet another story about someone who was "hearing voices" and slipped into homicidal depression before opening fire in a public place and killing a lot of people.

It's very troubling news on a number of levels, including when you have someone in your family who struggles daily with a mental illness.

First of all, it's irksome to see mental illness gain extensive media coverage over someone like Alexis, who presumably spiraled into psychosis before he got ahold of a firearm, headed to his workplace and went on a violent rampage. On Monday, Alexis brought a shotgun into the Washington Navy Shipyard, where he was working with a company subcontracted to upgrade computers at the base. He opened fire and killed 12 people.

As disturbing as Alexis' acts were, they were an anomaly. Most people with a mental illness--even if they don't get proper diagnosis or treatment and even if they go off their meds--do not turn violent. The Institute of Medicine reported in 2006 that "the contribution of people with mental illnesses to overall rates of violence is small," while the American Psychiatric Association said that the vast majority of people who are violent do not suffer from mental illness.

What's also concerning is  evidence that Alexis wasn't receiving proper treatment for his increasing symptoms. In early August he told police in Newport, Rhode Island that he was hearing voices and feeling vibrations sent through his hotel-room walls. But the Washington Post also cites federal officials as saying that Alexis subsequently sought treatment for insomnia in Veterans Administration emergency rooms but told doctors he was not depressed and was not thinking of harming others.

If Alexis downplayed his symptoms with emergency room doctors,  it could be because people in mental distress often have difficulty being upfront about their symptoms. Sometimes, they are having trouble making sense of the voices or agitation. Or, they don't know how to communicate what they experiencing. Or, they are afraid of the stigma that comes from a diagnosis.

And, sometimes, the illness stops them from saying too much, especially if they are paranoid and fear being victimized. But it's also entirely possible that physicians who took his history weren't listening or asking the right questions.

There are a lot of reasons the system fails and people don't get the help they need. Sometimes it's because the patients aren't willing or able to seek help, but sometimes the system itself fails. 

In my family, we've recently been dealing with some fall-out from a psychiatrist who hasn't inspired confidence, or incompetent pharmacists, or both.

Last spring, my husband's beloved psychiatrist died, which is another circumstance that can cause a patient to become unstable. 

My husband, who has schizo-affective disorder, had excellent rapport with this psychiatrist. He felt like the psychiatrist was a good listener and was willing to be partners in the treatment. My husband trusted this psychiatrist's expertise, especially in handling the constant dance he had to do with adjusting his medications in response to his changeable symptoms.

After this doctor's unfortunate and premature death, my husband started seeing a new psychiatrist. This new psychiatrist has not entirely agreed with my husband's previous treatment regimen. In my husband's most recent appointment, the psychiatrist didn't communicate his reasons for adjusting medication levels.

My husband is willing to work with this new doctor, but is wary about making changes, since he feels like he has been taking medication that works for him. 

 In August, for some reason, my husband couldn't get his prescriptions filled in a timely way. He'd go to the pharmacy, and his refills for several medications hadn't been filled. His psychiatrist's office told one story, that they had faxed a refill authorization to the pharmacy. The pharmacy said something else, to the effect that they hadn't received faxes.
My husband started to get his medication piecemeal, with the exception of his anti-depressant. So, he was forced to go off his anti-depressant, which is widely known to be dangerous. He ended up going without his anti-depressant for nearly three weeks, despite bugging his psychiatrist's office and the pharmacy daily.
 
My husband's mood plummeted, and he became irritable and anxious.  It was hard for him to get out of bed in the morning.

Finally, he got his anti-depressant, and took a dose right away. The next day, he looked and felt much brighter, alert and energetic. The difference a day makes--in his case, it was dramatic. The lesson, while painful for my husband, was instructive. We always knew his anti-depressant was important but figured the anti-psychotics and mood stabilizers were most crucial. Now we know better.

The lesson was instructive in a more global way, as well.  My husband's treatment regimen temporarily collapsed, either because of an unresponsive or inattentive psychiatrist, or because of a communications snafu between the psychiatrist's office and the pharmacy. 

I hear that such treatment breakdowns are fairly common in the mental health world, and now my husband is dealing with a doctor he's not sure he trusts.

Is our system for dealing with mental illness broken? It certainly doesn't work as well as it should, for a number of reasons.

1 comment:

Heather Von St. James said...

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