The Daily Item, Sunbury, PA

October 8, 2013

Geisinger doctor: Mental illness stigma must end

By Robert Stoneback
The Danville News

— DANVILLE — Mental illness has been in the news a lot recently, with a shooting spree and car chase both occurring in Washington, D.C., committed by those with alleged illnesses.

However, these tragedies underscore a deeper problem, according to a Geisinger physician. The mentally ill are often stigmatized for the actions of a psychotic few who are frequently unable to get the treatment they need.

“The likelihood of someone with mental illnesses being involved in the perpetration of a crime is no greater than the rest of the general population,” said Dr. Stephen Paolucci, chief medical officer for Geisinger-Bloomsburg Hospital and chair of Geisinger Health System’s psychiatry division.

This week is National Mental Health Awareness Week, Paolucci said, and these illnesses affect more people than one might expect. If broader examples of mental illness, such as substance abuse, anxiety attacks and depression, are included then 20 to 25 percent of the population has had some experience with a mental illness.

Of these, about only one to two percent actually turn into “psychotic” cases, where a person’s ability to comprehend reality is impaired. “When it reaches this point these people cannot interact with their environment enough to seek help,” Paolucci said.

Two recent crimes in Washington, D.C., have many of the qualities of psychotic breaks, such as delusions and hallucinations, he said. Last month, Aaron Alexis killed 12 people in the Washington, D.C., naval yard before ending his own life. Just last week, Miriam Carey was shot and killed by Washington, D.C., police after running her car into a White House barrier and then fleeing from law enforcement.

Family members later described Carey as claiming the President was spying on her and as suffering from postpartum depression. Alexis said he was hearing voices in his head and being controlled by low frequency radio waves.

Psychotic breaks usually emerge after a person has already experienced considerable mental and emotional trauma in their life, such as depression. “When people become psychotic, it’s generally an indication that things have gone from bad to worse,” Paolucci said.

Unfortunately, the ability of the country’s mental health system to help these people is somewhat limited. Safeguards are purposefully put in place to make it hard to commit someone against their will, and while that protects a citizen’s liberties it also makes it difficult to get help for truly troubled people like Alexis and Carey, Paolucci said. Based on what he knows of their cases, Alexis and Carey could only have been committed if either survived their crime since neither made threats to harm someone ahead of time.

Under America’s mental health laws, a person can only be committed if they threatened to harm themselves or others and acted toward causing that harm. Even then, a person can only be committed for a limited time.

“It’s a net that’s supposed to keep people from the edge of the cliff, but there’s a long walk to that cliff,” Paolucci said. “When you’re trying to stop people at the edge of the cliff, you’re sometimes there a second too late. … And then there’s nothing you can do.”

“To fix this problem, we need to maximize all the other services to prevent people from even getting to that point,” he said. “If we were doing a better job, less people would need to be committed, but as we know mental health resources are frequently underfunded and there are not enough of them out and about to provide for what we see are the needs of the patient.”

Geisinger has expanded mental health services into the primary care setting, where patients can request a short depression screening test. Mental health professionals have also been embedded at primary care centers in order to offer consultation and assume responsibilities for patients.

These steps allow for psychiatric intervention to occur at earlier stages of an illness, which also cuts down on the resources a mentally ill person would need later. People with a mental health problem use about five times the amount of health services as other patients, Paolucci said.

There needs to be less of a stigma associated with asking for help with mental issues, especially since they are much more common than people think, Paolucci said. “Unfortunately the ones who make the news are extreme cases,” which just stigmatizes the mentally ill even more, he said.

And while people are quick to criticize the mentally ill, he hasn’t seen many who want to assist them. “I haven’t seen people more ready to hand out money for better services” following tragedies, he said.

Email questions or comments to rstoneback@thedanvillenews.com.