As a firm believer in gun control laws and restrictions on violent video games, I am in favor of an in-depth conversation on legislative reform. However, as I read multiple reports on the passing of this new law, I began to question whether this legislative act will actually remedy gun violence. I pondered whether the confiscation of weapons from an individual deemed mentally impaired could lead to more problems than expected.

Severe, untreated mental illness is a complex phenomenon, and dealing with it can be quite a challenge. I have identified three issues that should prompt further consideration before such gun laws are implemented in other states.

1. Negative response by individuals unaware of the extent of their illness. Most people are unfamiliar with the behavioral characteristics, including rule resistance, that individuals with severe, untreated mental illness exhibit. Their behavior can present as extremely rigid and being asked to follow the simplest rule can provoke outbursts.

Past incidents of law enforcement coming in contact with individuals with severe untreated mental illness have resulted in tragedy.

Many individuals with untreated mental illness do not see the necessity of seeking treatment, and many will not think they are ill enough to have their weapons taken away. Confiscating the weapons of people unaware of their own mental impairment could lead to a tug-of-war between the individual and law enforcement, resulting in bloodshed.

2. Negative response due to reduced autonomy. Confiscating weapons feels to many individuals like an attack on their autonomy. When a person feels as if their freedom is being curtailed, the resulting behavior is often negative. Some people will verbally or physically challenge authority; some may be willing to die for their “freedom.” Confiscating weapons from an individual who feels this way will not be a positive experience.

3. Lack of mental health education for law enforcement personnel. The work of men and women in law enforcement requires great courage and stamina. They live dangerous lives. Many, however, are unaware of mental health issues and how they may affect the compliance of individuals they encounter. If law enforcement personnel are to become more involved in the mental health field by having to confiscate weapons from severely impaired individuals, they should be required to engage in continuing education about mental health.

When therapists are trained to work with the severely mentally ill, they are taught to identify patterns of behavior that might signal agitation or violent outbursts from clients. For the most part, experience, education, and intuition come together in such cases. Mental health professionals are also trained to calm emotionally intense situations. Unfortunately this is not the type of training law enforcement personnel receive.

Neglecting the True Problem

Citizens are understandably horrified by the recent cascade of violence in our communities and society appears desperate to find a remedy. The problem with some of the proposed laws is that rather than address mental health issues, they neglect them. It is important to learn better ways to approach people with severe mental illness when weapons must be retrieved.

Because reporting the potential for violence among clients is more art than science and requires personal judgment, it is very risky for a therapist to step out on a limb and report a client. It not only reduces trust in the therapist-client relationship, but labels the client as well. Innocent clients who might never engage in violence may be labeled “potentially violent.”

We need a frank discussion that focuses on how to safely confiscate weapons from an individual with a severe, untreated mental illness. Society will not be made safer by simply sending in law enforcement professionals to retrieve guns. What is required is knowledge about how to calmly and wisely approach those who have the potential to kill.

Gun photo available from Shutterstock

At Western Psychiatric Institute and Clinic (WPIC) in Pittsburgh, Penn. — one of the state’s best psychiatric hospitals — a shooting spree left two dead and seven injured.

WPIC helps educate future psychiatrists, psychologists, and masters-level mental health therapists. Medical doctors of other specialties, including surgeons, anesthesiologists and radiologists, and other health care professionals also receive training there. It is an institution where education, science, and practice merge together.

I remember the day I spoke to my mother about potential danger at mental health hospitals and the possibility of violent occurrences becoming my reality as a therapist providing treatment to various populations. Her eyes said it all; I could see the terror across her face. Many — primarily professors, professional speakers, and coworkers — reassured me that such incidents were rare because most institutions were highly secure and provided their employees with emergency protocols and trainings. WPIC trains their employees on issues relating to mental health policies, emergencies, and “unusual occurrences” — that is, patient violence.

Unfortunately, the reality of such occurrences often is discounted by more mentally stable “consumers” of mental health treatment, society in general, advocacy groups, specialty groups, and even mental health professionals themselves. It is true, according to the Treatment Advocacy Center (2012), however, that “there are approximately 1,000 homicides – among the estimated 20,000 total homicides in the U.S. – committed each year by people with untreated schizophrenia and bipolar disorder.”

What increases the probability of violence (perhaps even in institutional and clinical settings) is when individuals with severe mental illness are untreated or overlooked by a society wholly uninformed about the signs and symptoms of severe and untreated mental illness. In fact, the National Institute of Mental Health (2010) estimates that “7.7 million Americans suffer from schizophrenia and bipolar disorder – approximately 3.3 percent of the U.S. population when combined. Of these, approximately 40 percent of the individuals with schizophrenia and 51 percent of those with bipolar disorder are untreated in any given year.”

Tragedies in and around some mental health institutions are a reality. We must be willing to accept the reality that there are individuals who suffer from severe mental illness or untreated mental illness — along with substance abuse — and often cannot control their impulses and their thought processes, which often provides the conditions necessary for such tragedies as what happened in Pittsburgh.

The gunman was 30-year-old John Shick, whose first victims were a receptionist and security guard. His other victims included an engaged 25-year old male therapist, a unit clerk, and psychiatrist.

While the topic of violence among individuals suffering from mental illness is quite controversial, it is a conversation that deserves fervent attention, mature conversation, and unbiased interpretation of statistics of previous acts of violence committed by individuals untreated or improperly treated by the mental health system. Progress can only happen once we lay aside our feelings and objectively look at the facts. The Treatment Advocacy Center provides statistics from the Department of Justice:

• of spouses killed by spouse – 12.3 percent of defendants had a history of untreated mental illness

• of children killed by parent – 15.8 percent of defendants had a history of untreated mental illness
• of parents killed by children – 25.1 percent of defendants had a history of untreated mental illness
• of siblings killed by sibling – 17.3 percent of defendants had a history of untreated mental illness

These statistics do not represent those with severe mental illness who are appropriately treated. They reflect only incidents where a severe mental illness was untreated. Although we have yet to access the full details of the shooting in Pennsylvania, it is important that we consider what actually happened, how we can prevent such incidents from occurring in the future, and what policies (state and federal) need to be adjusted, changed, or implemented to protect innocent bystanders and workers in mental health settings.

Implementing new policies or adjusting current policies (e.g., gun laws, assisted outpatient treatment laws, etc.) can help us prevent tragedies. For example, WPIC sits almost directly in the middle of the University Of Pittsburgh School Of Medicine, the university itself, and other large institutions. If, hypothetically speaking, the gunman would have escaped from the institution, he could have taken many, many more lives of bystanders who were commuting from one institution or university to another in the area.

I often refer to Oakland, a microcosm of Pittsburgh, as a “small community.” It is filled with various apartment complexes, halls, schools, hospitals, mental health clinics, churches, playgrounds and parks, and businesses. The area is very highly populated. As a result, this shooting spree could have been a much greater tragedy if the university hadn’t reacted as promptly as they did. I’m sure many families are grateful for its dedication and expertise. Nevertheless, this incident brings to the table a fresh discussion about institutional policies and state and federal laws.

What can we do to prevent future occurrences? A few ideas may initiate greater discussion:

1. Assure increased security presence in ALL mental health settings. The reality is that some mental health clinics, primarily community outpatient centers, do not always include strict security. At WPIC, security was not present during the time the gunman entered the building. There are other settings where security is completely nonexistent. This must change.

2. Extensive training in emergency protocols. It is extremely important that mental health professionals and other staff receive appropriate training in order to respond to and be aware of emergency situations involving patient aggression and violence. This includes police and other law enforcement officials learning about mental illness and the typical behavior of individuals with severe, untreated mental health problems.
3. Community education. Education about mental health problems, behaviors of those untreated, the legal rights of the mentally ill and their families, and how to protect our society from unfortunate circumstances such as violence or aggression is a significant component of proper advocacy of the severely mentally ill and their loved ones.
4. Advances in state assisted outpatient treatment laws. Assisted Outpatient Treatment (AOT) is a court-ordered treatment (including medication) that is available in 44 states. It is often utilized with individuals who have a history of medication noncompliance and noncompliance with mental health treatment. AOT is for individuals with severe mental illnesses who require strict maintenance. Learn more about AOT here.

It is presently unknown whether the gunman had an untreated mental illness, but many of his neighbors, friends, and acquaintances stated that he was acting very bizarrely days before the shooting spree. The signs were there, the treatment was not. According to University of Pittsburgh police Chief Tim Delany, “three of the Pitt officers ‘engaged in gunfire’ with him… This is what we prepare for and hope it never happens. It happened. I don’t want to think about what could have happened with all those people in there.”

We need our citizens to get involved and become more knowledgeable about state laws and the consequences of untreated mental illness. We need our police officers to continue their trainings and to continue to be the great protectors they have strived to become. We need our mental health professionals to embrace reality and strive to educate others on the potential of violence and aggression that sometimes lies directly before us all. In turn, we protect the severely mentally ill from losing their lives.

Our attention to tragic realities will keep us protected from future tragedies that might involve loved ones. I encourage you to get involved, to become knowledgeable, and to effect change wherever and whenever you can. Our future depends on it.

For more information on state mental health laws, visit http://www.treatmentadvocacycenter.org/legal-resources.

For more information on getting involved in your state, visit http://www.treatmentadvocacycenter.org/solution/getting-involved.

Sweet, innocent babies die every day from a preventable disease in an indigenous country. That number could be considered huge by some, or perhaps quite small, depending on your perspective. If you are referring to population size, however, that is the size of a small city. In regard to time, 30,000 seconds is actually only a little over eight hours. Or 30,000 children could be like 30 large elementary schools disappearing from the face of the earth on Monday … and again on Tuesday … and so on.

What’s stealing the future from so many children? It’s not always some mysterious plague or natural disaster — we’re usually talking about far more common things like malaria, diarrhea, measles and unclean water.

What’s unconscionable is that nearly every one of those deaths could be prevented for as little as $1 (or more) per child. Even more, this epidemic can be properly contained or prevented by loving individuals who care for the lives and future of these children who need us.

Yes, we have issues in our own cities (and country) that monopolize our time, psychological and emotional energy, and the news, such as the rising cost of housing, local politics, job loss, mental health disparities, poverty and homelessness here at home, child abuse and neglect, rape, natural disasters and the like. But we rarely hear about something as devastating as tens of thousands of children dying each day due to extreme suffering as we go about our daily lives.

Unfortunately, we forget these children exist and may not be reminded of this reality until the holiday season rolls around, a time when Christians are strongly reminded of the birth of Jesus and the beauty of spreading the love of God. While this is a wonderful endeavor, we should also be reminded to show love to these children and lend a helping hand throughout the year.

It’s time we started demanding more of ourselves regularly and begin feeling responsible for our neighbor. I would like to urge readers of this article to educate themselves beyond the issues within our own borders. Become culturally astute! While we are lending a helping hand to our neighbor right here at home, let’s expand our charitableness to those outside our nation. Find out what’s going on in the rest of the world and then take a step to do something about it.

To stay updated on international information related to psychology try http://www.internationalpsychology.net/home/. Another good place to start might be compassion.com/youcan.

There are also practical ways (e.g., random acts of kindness, donating clothing, books, or money; helping out at local food banks, hospitals, or shelters; having compassion on the needy, that is, reminding ourselves that we are never above poverty or homelessness because it can happen to the best of us; etc.) and even inexpensive ways (e.g., volunteering or internship and continuing education about the issues various cultures face) we can all get involved in the fight against poverty and inequality.

If you are interested in missionary work with children visit Samaritan’s Purse or the Hands and Feet Project.

30,000… What comes to mind when you hear that number now?

May love continually inspire you to reach beyond the holiday and toward a hurting child in need.
Paz y amor (peace and love)

Reference

Compassion. (2010). Releasing children from poverty: Child advocacy. Retrieved November 28, 2010, from http://www.compassion.com/child-advocacy/default.htm.

I became increasingly weak and tired of the perpetual striving for achievement in a very competitive field. I also became so weary that each waking moment was like pulling an elephant with a thin rope. My days were not filled with excitement anymore, but rather a sense of trepidation. I began to ask myself: Who am I? Who am I becoming? What is my ultimate purpose in life, in my profession, in my world? When will I ever have time to find out?

I pulled back and decided to do some introspection of my own life and life in general. I reserved specific times of the week solely for the incorporation of existential and spiritual elements into my life. I was then faced with the realities and the rawness of humanness. Through this I became familiar with myself; I developed a relationship with the essence of my being.

Life repeatedly brings us face to face with the fundamental realities of our existence, whether that includes feelings of alienation and loneliness, fear of death and taking responsibility for the aspects of life over which we have control, or our search for meaning and the fear of being meaningless. Individuals are constantly seeking material wealth, success and prosperity, comfort and security, joy in being alive, health and satisfaction, and a place in society as well as expertise. While these things have their place in the healthy and overall development of the self, we cannot exclude the very essence of our spiritual selves and existential concerns.

I assumed psychology would introduce me to greater aspects of myself, but it actually distanced me from my innermost character because I had to constantly be in the mindset of the helper, the thinker, the miracle worker, the scientist and the fortress. Was I wrong? Was I holding unhealthy and defeatist perceptions?

Of course I was. Mental health professionals are only human and they too struggle with many personal and professional trials and tribulations. But the pressure and mounting reality of becoming a crutch and an earpiece to various lives can eventually usurp one’s passion to help. I was headed that route until I chose a different one. Additionally, with the hustle and bustle of everyday life, various daily commitments, occupational endeavors and academic obligations, it is no wonder we are rarely — if ever — in touch with our true selves.

But the very nature of life’s uncertainty (if we pay attention) can bring us close to authenticity, the capacity for self-awareness, and connectedness with spiritual and nonspiritual elements of life. As author Gerald Corey (2009) states “…we strive toward a meaningful life by recognizing our freedom and by making a commitment to choose in the face of uncertainty” (p. 91).

The first step for me in becoming acquainted with the self was to discard and readjust old values. Hard work, nonstop dedication, and various obligations are often praised in society, but they depleted me of my courage and strength to be. A balance of these things in one’s life is more appropriate.

The second step was for me to actively create two worlds: one for material reality (i.e., everyday life) and the other for nonmaterial reality (i.e., spirituality).

The third step was to stay true to myself and embrace the rewards of individuation (the act of becoming separate).

The fourth and final step — which is the stage I presume I will forever remain in — is learning to become further rooted in being, in existing, in operating in the power of becoming the architect of my world. The ultimate goal is to become cemented in your true self; to become so familiar with you that you perhaps can become a catalyst to someone else’s search for true meaning. (Logotherapist Viktor Frankl is an example. After being released following years in a concentration camp, he contributed to the “meaningless” lives of his clients.)

Having an existential mindset can help develop insight and responsibility. Insight and responsibility, in turn, can lead to willingness to take action to make desired changes. The waves of humanness and spirituality can bring not only ripples of internal and external familiarity, but also all that life has to offer. As long as you stay connected to the depths of truth you will always find authenticity.

May you someday discover the essential elements of your true being!

Paz y amor! (translation: peace and love)

References

Corey, G. (2005). Theories and techniques of counseling and psychotherapy. (7th ed.). Brooks/Cole-Thomson Learning: Belmont, CA.

If it were not for the service of the Kennedys and for their endless dedication to equality for mental and physical disabilities, Congress would not have passed the Mental Health Parity Act of 2008. The bill requires insurers to cover any mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in the same manner they do health conditions. Individuals who struggle with substance abuse are also included. At the time of the Act’s passing, Speaker Nancy Pelosi said, “Illness of the brain must be treated just like illness anywhere else in the body.”

The Kennedys are the epitome of both the elegance and of the suffering that plagues human existence. If it were not for supporters of psychology’s battle against mental health inequality such as Sen. Patrick Kennedy (who himself suffers from depression and substance dependence) the Mental Health Parity Act would likely not have passed. To show adoration for one who fervently reached out to society, who tirelessly sought advancement, and took our needs to Congress to rid us of the bind of politics, we must carry on the legacy of the Kennedy era.

May the late Sen. Kennedy’s spirit remain in a little of each of us and may he always be an example for future change. If you would like to contribute to helping the cause that Sen. Kennedy worked much of his later career on, please visit the following websites:

• For more information on the 2008 Mental Health Parity: House Approves Bill on Mental Health Parity (NYT)
• A new vision for American health care from the American Psychological Association
• Psychology’s role in health care reform from the American Psychological Association
• Consider writing a letter to President Obama to support comprehensive legislation that will include an extension of the 5% Medicare psychology payment restoration and fully integrate psychologists and psychological services into the delivery system: http://capwiz.com/apapractice/mail/?id=3181&lvl=F&chamber=P
• Go to APA Practice Organization and type in your zip code on the upper right hand side into the search engine called “Legislative action center.”

As Gandhi once said, “Be the change you wish to see in the world!” And may Sen. Kennedy rest in peace knowing the good work he helped champion in his decades of service to our nation.