The recent school shooting in Newtown, Conn., as with similar tragedies, has spurred conversations on gun control, school safety and mental illness.
And while it has not been confirmed that the shooter, who took his own life, had been diagnosed with a mental illness, the link between illness and violence is often made, many times incorrectly. Such tragedies turn a spotlight on mental disorders that are plagued by stigma and a mental health system that is short on funds.
Mental illness can be mild or all-consuming, and the label covers a multitude of disorders, from depression to post-traumatic stress disorder to schizophrenia.
About 45.9 million American adults – 1 out of 5 – were affected by mental illness in 2010, according to the Alliance for Health Reform, a nonpartisan, not-for-profit health policy education group. About 11.1 million adults reported an unmet need for mental health care, and those who are persistently unemployed are four times as likely as those with jobs to report symptoms of severe mental illness.
Despite public perception, mental illness alone is not predictive of a risk of violence, said Mark Binkley, general council and deputy director of administrative services for the S.C. Department of Mental Health. In fact, he said, those with a serious mental illness are 50 times as likely to be the victim of violence and not the perpetrator.
Binkley said many people blame reform that occurred in the 1970s for the incorrect perception. At the time, there were a high number of people being involuntarily committed according to the current standard, which was simply the need for treatment. The reform changed that standard, adding that the person also must present a danger to themselves or others, he said, which linked a level of dangerousness to the mentally ill.
While many people need treatment, there are various reasons they either don’t seek it or don’t receive a proper diagnosis.
Most people who know they need treatment report they don’t get it because of the cost, according to the Alliance for Health Reform. Much of the nation’s mental health treatment also is given by family doctors, who are not mental health specialists and who are usually giving care as a secondary treatment.
Barb Maier, executive director of NAMI Grand Strand, the local affiliate of the National Alliance on Mental Illness, said a place people most often turn is to clergy members, many of whom are not educated about mental illness, and the stigma of a disorder keeps many from reaching out at all.
“The research is there, and it’s treatable, but people can’t quite believe that it really is a physical illness,” Maier said. “They still secretly think it’s due to poor character or bad parenting.”
NAMI aids family members of adults and children with mental illness. It holds meetings, support groups and free classes, and shepherds people through the process for acquiring treatment, which Maier said takes work when going through the state system.
“It helps a lot if you have a lot of money if you have a mental illness,” Maier said. “There’s plenty of private practitioners for the worried wealthy – too many of them.”
Locally, the Waccamaw Center for Mental Health is one of 17 state-owned, mental health care centers. It serves the largest of the state’s geographic areas – a total of 2,901 square miles in Horry, Georgetown and Williamsburg counties. About 7,000 individuals receive services from the center each year, about half of them children.
The center offers outpatient services from physicians, licensed counselors, social workers and clinical counselors, said Ethel Bellamy, executive director of the center since early November. She said the center offers individual and family group therapy; home-based services, such as family preservation; and TLC, an intensive program for adults. The center also offers care coordinator services to link clients with other community-based services.
Those who are in need of treatment but refuse it are referred to a private facility if there’s an ability to pay, Bellamy said. If they are indigent, they are referred to the G. Werber Bryan Psychiatric Hospital in Columbia.
South Carolina has suffered four straight years of reductions in state appropriations for the Mental Health Department, which has lowered funding by $88 million, almost 40 percent, Binkley said. The agency received almost $18 million more in state funds for fiscal year 2012-13, and Gov. Nikki Haley’s 2013-14 budget, unveiled Thursday, supports another increase in mental health funding, but Binkley said it is difficult relying on one-time funding for the biggest part of the debarment's budget, and they need continuous funding.
Bellamy said the Waccamaw Center has felt the impact of tighter budgets and has not filled many vacancies when they’ve occurred. She said even though they are operating with less staff than in the past, they have not cut back on services and have not cut any programs.
While the center is not-for-profit, insurance and first-party payers represent the largest portion of the center’s budget, and it must be able to bill for services in order to continue to serve residents of the area. Bellamy said state funding is the smallest part of the pie, and distribution is contingent on a formula, although there are opportunities to request additional funding. According to the center’s 2011 management report, Georgetown and Williamsburg counties also provide some funding, though most emergencies occur in Horry County, which does not support the center through funding.
Statewide, a concern is the long wait times in emergency rooms for those in crisis, Binkley said, and they are studying the problem county by county. He said while state inpatient beds have been cut, the problem has been compounded by cutbacks at community hospitals, which also have cut their psychiatric units and options to house the uninsured.
The state is fortunate to have an award-winning telepsychiatry program in 20 smaller emergency rooms that don’t always have access to a psychiatrist, Binkley said, as well as strong connections to research institutions such as the Medical University of South Carolina and the University of South Carolina School of Medicine. It allows a psychiatrist to be available for a video consultation 20 hours a day, seven days a week, and research shows it cuts the length of a patient’s stay almost by half, he said. Last year, $500,000 was appropriated for the program, and Haley supports bringing that to $1 million.
“That’s the wave of the future for all of public health,” said Binkley, who said they are talking to nine more ERs about the program.
Binkley said 72 schools have lost mental health intervention services over the past six years as a result of losing 78 counselors due to the budget reductions. Still, he said more than 12,000 children and adolescents received services in school settings. He said some school-based services shrank in part because of district funding, which suffered during recession and caused some districts to drop out of the program. With more funding, he said the state’s Mental Health department would like to put money back into the program to expand with more schools and counselors.
Bellamy said the Waccamaw Center, like many of the community health care centers, are experiencing a challenge as far as retaining psychiatrists. She said much of that is due to the state’s salary structure, and the doctors are taking other employment avenues throughout the state and the country for better compensation.
“The pay scale is making it more difficult to recruit and retain them,” Bellamy said. “Nonetheless, what we are recognizing is an increased request for services in our three counties. We have been able to respond, but it is challenging, and we haven’t turned anyone away.”
Binkley said the state is beginning to see the impact of the Newtown shooting and has had quite a few parents calling with concerns about their children’s behavior and questions about treatment.
“This was a horrible tragedy, but we don’t think the attention arising from Connecticut is a bad thing,” Binkley said. “To the extent this raises awareness for help for families, that’s a positive thing.”