B4Stage4

For the past several months, I've been traveling around the country for Mental Health America.

I have been delivering two messages.  The first is that it was a mistake to use a "danger to self or others" standard as a trigger to treatment for people with serious mental illnesses.  Because this has made mental illnesses the only chronic diseases we wait until Stage 4 to treat, and then often only through incarceration.

The second is that if we are to treat people with mental illnesses the same way we treat people with other chronic conditions, we have to act before Stage 4.  We have to start with prevention and then invest in early identification and intervention.  We have to integrate health, behavioral health, and other services.  And we have to give people an opportunity to recover at all stages in the disease process.

May is Mental Health Month. Since 1949, it has been a signature program of Mental Health America, formerly known as the National Mental Health Association.

This year's theme is B4Stage4.  It succinctly gets the message across that we need to turn our attention upstream if we're going to prevent tragic outcomes, and if we're going to change the trajectories of people's lives for the better.

By May 1, more than 3,500 organizations had downloaded MHA's materials to share with others - and many more have downloaded them since.  That's no surprise.  We've had millions of social media impressions with #B4Stage4, and advocates around the country are rallying to its simple and straightforward message.

Mental Health Month materials are available free of charge here, and help explain the importance of B4Stage4 thinking - and action.  They are available in English and Spanish, and there are videos and infographics that go along with them.

It's no secret why this matters to me.  I've had too many all-too-personal experiences with Stage 4 thinking.  It has cost a lot of people like my son Tim the opportunity to lead happy and productive lives.

And we can do a whole lot better than we have in the past - if we're willing to try.

Order a copy of Paul's book, Losing Tim, from your local or online bookstore or directly from Mental Health America.  Read more of Paul's occasional blogs at the MHA website, at Health Affairs, or at Psychology Today.

The Best and Worst States for Your Mental Health, 2015

Where our nation's mental health is concerned, disparity, not parity, rules.

Mental Health America released a new report today.  It's entitled Parity or Disparity: The State of Mental Health in America, 2015.  The report offers the first cumulative ranking of mental health status and access to services for all fifty states and the District of Columbia.

Source:  Data from www.mhascreening.org

The report includes measures of mental health status and access for adults and children, drawn from national databases that are regularly updated.  Altogether, they paint a very interesting picture of how states measure up to one another in protecting the mental health of their people.

The best states for your mental health?  Massachusetts leads the list, followed by Vermont, Maine, North Dakota, and Delaware.  Rounding out the top ten are Minnesota, Maryland, New Jersey, South Dakota, and Nebraska.

There are traditionally liberal and traditionally conservative states in the top ten, so what does that tell us?  Two things at least.  First, neither party has a monopoly on mental health policy, and so political compromise and consensus are more than possible when everyone works together.  Second, treating investments in mental health as a priority matters.

How about the bottom ten?

Idaho, Arkansas, Montana, Oklahoma, and New Mexico are in the next-to-last group of five.  And the bottom five are Louisiana, Washington, Nevada, Mississippi, and - last of all - Arizona.  As it turns out, no single region dominates the bottom ten.  And there's room for improvement most anywhere.

What's the best way to reduce the disparities among the states?  A concerted effort to invest in early identification and intervention would be a start.

Why are mental health conditions the only chronic conditions we wait until Stage 4 to treat, and then often only through incarceration? By that late stage, treatment is expensive and recovery is difficult to achieve - just as it is with Stage 4 cancer or Stage 4 heart disease.

When half of mental illnesses manifest by age fourteen, why do we wait ten years - until the diseases have robbed people of schooling and jobs, broken apart families, cost people insurance and housing - before we step in?

The problem is that too many policy makers are trapped in Stage 4 thinking.  They wait too long for crises to occur, and then respond inadequately when they do.

We could change this way of thinking, and change the trajectories of people's lives.  And - whether you think your state should have been ranked higher or lower - this report can help us do this.

To read the full report, click here.

For more information, email me at pgionfriddo@mentalhealthamerica.net.

In the Aftermath of the Marysville Shooting

I was sitting at my desk at Mental Health America when the news broke on Friday afternoon that a fifteen year old student at Marysville-Pilchuck High School in Washington had opened fire in the school cafeteria, killing at least one other student before taking his own life as well.

Another fourteen year old who was shot died over the weekend, bringing the death toll to three – all young teenagers.

It is hard to know what to make of these kinds of tragedies, because we don’t really understand them.  

The shooter, Jaylen Fryberg, was said to be popular and well-liked.  The victims – two of whom remain in critical condition – were his family and friends.  Some form of bullying may have been involved, but no one had any reason to believe that when he walked into school on Friday he intended anyone harm.

In recent years, shootings – whether or not they are related to a mental illness in the shooter (and most frequently they are not) – have shone a bright light on how poorly we handle mental health concerns in our country.

Half of all mental illnesses manifest by the age of fourteen – roughly the age of Jaylen Fryberg and his friends on the day that they were shot.  And yet, it typically takes ten years from the time symptoms first manifest to the time we get an accurate diagnosis and treatment.

We can - and should - do much better than that.

Suppose for the moment – and we do not know this today – that Jaylen Fryberg’s actions were the result of an undiagnosed mental health concern.  Were there other signs of such a concern present in the days, weeks, and years leading up to the Friday he died? 

In hindsight, some people think so.  A week before he died, he wrote on Twitter that “I know it seems like I‘m sweating it off, but I’m not.  And I won’t ever be able to.”

It’s hard to say what that implies, but it hints that there’s really only one course of action to prevent tragedies like this one – early identification and early intervention before crises occur.

At Mental Health America, we believe strongly that we need to intervene long before people die as a result of their mental health condition or someone else’s.  We need to think of mental health concerns in the same way we do other chronic conditions.  We need to screen early and often and – when we detect concerns – we need to stop waiting until they reach Stage 4 to do something about them.

Our screening tools – at www.mhascreening.org – are available online to anyone who is concerned about whether they, a family member, or a friend has a mental health problem.  More than 150,000 screenings have been completed since the beginning of May, and a thousand more are completed every day.

And they tell us something extraordinary - while as many as two-thirds of those who screen have an early mental health that warrants attention from professionals, two-thirds of those indicate that they have never before been diagnosed with a mental health condition.  

There are things we can do to prevent both crises and tragedies related to mental illnesses and to promote recovery  – and both state and federal legislators ought to start paying a lot more attention to these, and a little less attention to what we do to or with people after they reach the late stages of a disease process.

Because by then, it is often too late to make much of a difference.

This week, the children and young adults of Marysville are starting down a new path, leading lives that will be affected by the trauma they all experienced last Friday.  So the question we must ask ourselves is this:  Will we act on their behalf today, or will we wait ten years, until some of them are in crisis, before we do?

Only time will tell.

A version of this blog was also published by Mental Health America as its "Chiming In" blog for 10/27/14.  For more information on mental health issues in America and Mental Health America's #B4Stage4 efforts, visit MHA at www.mentalhealthamerica.net.

The Missing Mental Health Element in the Ferguson Story

By now, everyone has heard the news from Ferguson, Missouri.  An unarmed 18 year old named Michael Brown was shot and killed by a police officer.  Michael Brown was black.

Some of the events surrounding the shooting are in dispute.  But what isn’t in dispute is that for the past two weeks, a community has been torn apart by race – a community that until recently was best known for its proximity to St. Louis and its designation as a Playful City, USA.

Picture credit: Health Affairs

Media reports since the August 9^th shooting have focused almost entirely on one angle – race relations. 

We’ve heard about unrest in the city, the National Guard, police in riot gear, and danger in the streets.  We’ve heard about the District Attorney’s ties to law enforcement, and concerns that a too-white Grand Jury may be racially motivated not to indict the police officer involved in the deadly shooting.

But the media have been strangely silent about a different angle – this community is experiencing an ongoing trauma.  And where are the mental health services it so desperately needs?

Make no mistake about this.  Race matters.

I have written in the past about people such as Anna Brown, Miriam Carey, and Allen Daniel Hicks, Sr., a mother, a dental hygienist, and a coach.  None survived encounters with the police during times of crisis.  

And we know they are not the only ones.

But what these people had in common was that the final crises they experienced were in part medical. In some respects, that makes them more sympathetic than Michael Brown.  In others, unfortunately, it allowed media to dismiss what happened to them as aberrations brought on in part by their medical emergencies and suspicion of mental illness (an assumption that proved to be fatally incorrect in all three cases).

So the message frames in those stories quickly dissolved.

But when we’ve got a community at “unrest,” the story frame lives on. 

But let’s read between the lines.  This isn’t just a community at unrest, this is a community in distress.

And it is time we did something about that.

I have posted a version of this blog on Mental Health America’s web site, which you can find here.  In that blog, you’ll find several resources to help communities in distress, ranging from local MHA affiliates to national helplines, to tools and training aimed at helping communities recover from tragedies.

You’ll also find a call to action to join our #B4Stage4campaign, which launches in September, at Mental Health America.  You will hear much more about this campaign in the coming months.  It is designed to move our attention around mental health to where it belongs – on prevention, early identification of concerns, and early intervention. 

And it is designed to get public officials and the media to recognize that managing distress comes first and prevents violence, and to demand that they put resources into families and communities before mental illnesses progress to “Stage 4,” when “danger to self or others” is the only standard we have – a standard that leads too frequently to incarceration or tragedies like these.

Finally, you’ll find mental health screening tools and other resources you can use for yourself or with family and friends, especially if you – like me – keep imagining what your life would be like if your child were the victim here, or if your community was the one falling apart.