May 4, 2010

LKL Web Exclusive: Rosalynn Carter on the Mental Health Crisis

Posted: 05:00 PM ET

Former First Lady Rosalynn Carter is the author of Within Our Reach: Ending the Mental Health Crisis, published on May 1 by RODALE Books.

My interest in mental health began in 1966, when Jimmy first ran for governor. Many Georgians were desperate and asked what my husband would do to help their mentally ill family member. Some years earlier, an exposé revealed horrors in our big Central State Hospital–thousands of patients packed into the mental institution, often for life, with few services and only 48 doctors. In 1963, Congress had passed legislation calling for closing the large state hospitals and building community mental health centers all across the country. This sounded positive. People would find help close to home.

But while campaigning, I discovered that patients were being moved from institutions before services were available in their communities. At 4:30 one morning, I stood at the entrance to a cotton mill, waiting for people to get off work. A stooped, older woman emerged alone. She looked weary, and her clothes and hair were matted with lint. “Good morning,” I said, “I hope you’ll get some sleep.”

“I hope I can,” she said, explaining her daughter had a mental illness. She and her husband struggled to care for her. “I work all night while he stays with her, and he works during the day when I’m home.”

She was exhausted. What would she find when she got home? Would her daughter be awake? Would she get any rest? I watched as she trudged away.  This woman haunted me all that day, and I was compelled to try to help. When I first got involved, little was understood about the causes of mental illnesses, the relationship between brain development and the environment, or the most effective treatments. The world has changed since then. Functional brain scans track disorders in real time, scientists chart genetic markers, insights are emerging into the interactions between biology and the environment, and individualized medications hold promise for those who might have seemed hopeless three decades ago. Yet, despite these breakthroughs, in some ways we have hardly moved forward.

What are the consequences of our inaction? Our mental health system is still in crisis. Prisons and jails have replaced the old mental institutions.   There are huge gaps in care for children and the elderly and a serious shortage of mental health professionals. People with serious and persistent disorders lack adequate community supports. Stigma remains our biggest obstacle and holds back progress in this field.

One in four adults struggles with a mental illness, yet we treat this large proportion of our population like second-class citizens undeserving of our help, resources, and understanding.  This hidden minority among us endures pervasive discrimination. More often than not, their suffering and that of their loved ones goes unnoticed, and that hurts all of us.

May is Mental Health Month. With today’s expertise, we can change lives forever by moving forward into an era of understanding, care, and acceptance. Recovery is a real possibility. Let us all find the political will to finally end the mental health crisis. Our dream of a day when stigma no longer exists, when services are available to all, and when every individual can look forward to a fulfilling future is within our reach.

Filed under: Health • LKL Web Exclusive

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Matt   May 3rd, 2010 3:08 pm ET

There will never be an "end" to the crisis that IS mental illness in the first place. Reform the system, possibly, but stop people from becoming schizophrenic, for example – never.

MartyK   May 3rd, 2010 4:23 pm ET

The best way to celebrate Mental Health month would be an awareness campaign against pyshciatric/pharma fraud. That people have problems is a certainty. The bigger problem is that the entire mental health landscape is dominated by a profession (psychiatry) that has openly stated they have no idea of how to diagnose or cure mental illness and BigPharma that makes new psych drug addicts daily. But boy is it profitable...

Dodie   May 3rd, 2010 4:35 pm ET

The plight of deinstitutionalization, the mental health phenomena.

Rosalynn Carter certainly has her facts correct. After the closing of psychiatric hospitals and institutions, prisons and jails started filling up with people who suffer from a mental illness (MI). Currently 80% of the homeless in California are afflicted with a mental illness. There is a huge shortage of mental health professionals and social workers for the children and elderly.

Deinstitutionalization started in 1955 with a new antipsychotic medication, chlorpromazine or commonly referred to as Thorazine and the formation of the National Institutes of Mental Health (NIMH). Most individuals who were deinstitutionalized from the nation's public psychiatric hospitals/institutions were severely mentally ill (around 50 and 60 percent diagnosed with schizophrenia) and varied according to state.

Early 1960s Psychiatrist Thomas Szasz's book, The Myth of Mental Illness, and Sociologist Erving Goffman's book, Asylums both deny the presence of schizophrenia or bi-polar (manic/depressive) disorder.

1963 President John F. Kennedy's passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act provides the first federal money for developing a network of community based mental health services also accelerated the trend toward deinstitutionalization

1960s With the introduction of Medicare and Medicaid, the federal government assumed an increasing share of responsibility for the costs of mental health care. That trend continued into the 1970s with the implementation of the Supplemental Security Income program (SSI) in 1974.

In the 1960s-1970s, State governments aided in the acceleration of deinstitutionalization by championing the need for comprehensive community mental health care, though this ideal was never fully realized.

1979 National Alliance for the Mentally Ill (NAMI) was founded which is an alliance for the mentally ill. All in support of deinstitutionalization.

1986 the National Alliance for Research on Schizophrenia and Depression an organization to help afflicted individuals who have severe (MI).
1990s A new generation, of antipsychotic medications, was introduced. These drugs prove to be more effective in treating schizophrenia and Bi-polar disorder which have fewer side effects. Haldol (Haloperidol) Mellaril (Thioridazine) and Stelazine (Trifluoperazine) were the most popular.
1992 A survey of American jails reports that 7.2 percent of inmates are overtly and seriously (MI).

Today with the onset of a new generation of antipsychotic medications, Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Aripiprazole (Abilify). Paliperidone (Invega), the trend is to keep individuals out of institutions.

The concept of deinstitutionalization would be an excellent choice if there was enough community support. Unfortunately for many, these individuals were released from the hospitals/institutions without housing; thus, currently live in cardboard boxes under freeway passes, etc.

Another issue which has not been addressed… the function of the brain and how it operates differently with someone Dx (MI) than a ‘normal’ (whatever that is) individual. MI is not just a factor of neurotransmitter imbalance. We humans are more complex than just a cause-effect analysis. Even to this day, professionals really do not fully understand the full ramifications of schizophrenia. If they did, the dis-ease would be either completely under control or cured!

I stand up with full admiration and applaud anyone inflicted with this disease and continue to survive in today’s world!

Meg   May 3rd, 2010 4:39 pm ET

They can shuttle people off to another planet but help the majority of people with mental illness ....doubtful.....there is still too much of a stigma attached to that label. Many people state the mentally ill are just weak,don't try to improve. If you have ever known a person who suffers from that'll realize there's noone on earth that would ever request thhat affliction!!!!

Jessie from Auckland, NZ   May 3rd, 2010 5:06 pm ET

@Dodie May 3rd, 2010 4:35 pm ET

Well said.

The same thing has happened in our country (Illumanitis). What's that saying.........."IF IT AIN'T BROKE DON'T FIX IT!" Are these community-based facilities (Deinstitutionalization) working I wonder?.........

In my opinion, I think there could be genetics involved in this as well. Passed down through families to a certain extent. There has been research too in support of this if I can remember. Could it be in what you eat, chemical inbalances in the brain, environment.......etc., etc.........There are a lot of factors that come into play. Are you born with it or can it even be put down to demon possession of sorts?........

God bless Lady Rosalynn Carter and for her support in this. Need more people like her in the world. Also God bless the people who work in this field of work as it is not easy to deal with.

Joe G. (Illinois)   May 3rd, 2010 5:13 pm ET

Having a conscience is not a mental disease.

Having morals is not a mental disease.

Having integrity is not a mental disease.

But billions of dollars get spent each year to chemically lobotomize them

Dodie   May 3rd, 2010 5:19 pm ET

@Jessie from Auckland, NZ

You are correct! They have traced the genetic involvement with the neurotransmitter imbalance. It has always been the nature vs nurture condition. Children born with the genetic predisposition may not necessarily incur the dis-ease. Environment stressors are most often the trigger for many cases. I have seen onset of this illness as late as 58 years of age when it was thought no one would have onset after 40 years of age.

Very good insight and comments, Jessie! Thank You!

Dodie   May 3rd, 2010 5:27 pm ET

@Joe G. (Illinois)

I agree with you in that we have a tendency in this country to over mediate for whatever reason. However, we also have individuals suffering from audio and visual hallucinations, or delusions which create danger, stress and major complications for their survival and life. This group of people are NOT dangerous to others, just to themselves! Often the voices will tell them to walk across the freeway, etc. Medications do have their place and I have seen it help many people.

jill c.   May 3rd, 2010 8:07 pm ET

Thank you for shedding some light on this topic!

Donald L Allen   May 4th, 2010 2:25 am ET

Donald L Allen say I,M not Black if I need to be black I reckon I want get no help from you right I thought you may Be pardes well no hard filing But you get the hen right see you

K   May 4th, 2010 5:30 am ET

I don't think the stigma will ever go away. I just hope a way to function and perform in this life is found so that some quality of life can be enjoyed. This is a tough spot to be in. However, for society's sake, it has to be addressed. I look at people with Asberger's syndrome and autism and can't help but wonder how people can ignore this problem as anything but real.

MT   May 4th, 2010 8:27 am ET

Wake up people. Big pharma can no longer rule your lives. With recent twin studies it is found that yes-something triggers illness' like these. The same organisms are implicated in mental illness, MS, Autism, Alzheimers, ALS, and the list goes on and on. And you sit there and let them get away with letting them take your lives little by little-saying 4 weeks of antibiotics will kill anything.per the IDSA/CDC for the sake of big pharma who has invested billions in drugs to treat every known syndrome and symptoms they can cause-from restless leg to arterial vasculitis. And now they are doing brain surgeries for MS arterial blockages on thousands with a test that is estimated to be only 30% accurate for borrelia and in the presence of borrelia any other test may be rendered neg for other organisms because of its stealth ability. Not to mention other countries who are starting the new malaria vaccine and the new HIV vaccines without testing these immunocompromised people. The public can no longer turn their heads-it is in every back yard now/.

Smith in Oregon   May 4th, 2010 6:58 pm ET

Sounds like the entire Bush Family could really use copys of this book. I always thought highly of Rosalynn Carter and I hope her new book is a best seller and continued success.

Theresa   May 5th, 2010 3:30 am ET

Why would you say the Bush family could use this book? Just because you don't like former Pres. George W. Bush.......doesn't mean he's mentally ill! Yes, I certainly think he was not a good president but that didn't mean he's mentally ill. I saw an interview with Laura Bush & her daughters onOprah yesterday. I found it interesting. All 3 seem like very personable people . They seem like a very close knit family. It must've hurt when they heard all the negatinve press about a husband that is well loved as well as a father that is well loved. The Bush sisters appear to be very interesting,well adjusted , intelligent young women. Laura Bush was asked about the accident where she (I think she went thro' a stop sign..she was the driver) was the cause of an accident when a very good friend was killed. She said she has carried the guilt with her everyday. She seems as if she is very proud of those daughters!

Psychiatrist   May 5th, 2010 10:10 am ET

reading some of the comments ,reminds me of the middle-ages nonscientific perpective on scinece, that undermines the advances in treating mental illness.
These brain disorders are real and patients suffer from them for a long time. Its not fair to the patient to delay the treatment and we should do more to decrease the stigma.
Its time for a psychiatry renaissance and to respect advances in neurobiology .
We should mobiize all the resources based on currnet scientific data to relive our patients from suffering.
we should realize that there is a red line in freedome of speech and if some one is preaching a concept that prevents patiens from getting treatment and is going to hurt our fellow citizens,should be help liable in the court of law.

Stacy Lee   May 5th, 2010 10:41 am ET

From experience, having a child with high functioning autism, I believe that the educational system discriminates against children with the "label" of autism. It has been a heart tugging nightmare to negotiate with our son's school to allow him to receive a higher education. It feels as if we are dealing with the maufia. A school can do and say what ever they want to keep a child that has autism in a autism class. It is absolutely gut wrenching to be told by a school official that "Your child is not high functioning", especially coming from a person that is not qualified to make that decision. Fortunately, we sought out a psychologist that diagnosed our child with "High Functioning Autism",that was a wonderful moment. From one parent to another, Always consider seeking out independent evaluations of your child different from the school's. These evals have helped get our child a much needed reading program,hopfully even more. The sad truth is that we have spent 1000's$ on specialists to get a reading program, that the school should have already been using with our child a year ago,at least. Exactly one year ago, we as parents,begun a battle with our son's school to advance our son into a higher class that is "Strongly prefered over further delays" and "The potential benefits to our son are substancial",stated by our specialist, and that we as parents already knew. This has been the hardest goal to accomplish for our son. Especially since the school system has went out of their way to underestimate our son's abilities, and use hypothesis's and autism characteristics against our son to keep him from an appropriate education that he rightfully deserves and needs. Our son has came along way, advancing beyond our expectations,we as parents have no choice but to stand up for our son and others to rid the unfair discrimination within the educational system. The quality of these children's lives and futures depend on it.

Bill   May 5th, 2010 12:14 pm ET

I think what is needed to advance acceptance of the mentally ill and to promote their cure and treatment is bringing their plight to a public forum on a regular basis. I think a TV show running on a regular basis, hosted either by a mental health professional or by someone like Rosalyn Carter who could then have mental health professionals and people suffering from mental illnesses on the show would greatly expand the public knowledge of what mental illness is and what it ISN"T.
I think that this knowledge would help decrease the stigma against people with mental illness and help people who do have a mental illness yet aren't seeing a professional for treatment, discover that there may be help out there and learn how to go about getting it.

debra pierce   May 5th, 2010 11:19 pm ET

Im dealing with that right now but on the other side .The ederley have no rights what so ever. Ihave 4 siblings trying to get my mother deemed incompitant even though shes been evaluated 4 times AND PASSED . The system is now helping them to abuse her. You have to go through the district attorneys office to file a claim . They (MY SISTERS) hired the assistant district att. So we cant even get in to see him .My mother asked for a mediator with a social workers back ground . she got my fathers gaurdian ilitem . she had her dr. to give her a shot before going she was so out of it she told them to cancel he told her to be quiet she didnt even make sense she was so out of it.Our lawyer was suppose to take depositions from them . the ass. district att. let them make out there own .Our lawyer was suppose to do derogitories assistant district attorney and the gaurdian illitem did them . our attorney tells us to get a gun or move out of state because she is not going to get a fair trial.Last time we went he told us her daughters paid the district attorney alot of money to abuse her, and people wonder whats wrong with our country.

C. Louise Sellaro   May 15th, 2010 1:59 pm ET

The case of educating children with autism appears to replicate the situation that impacts that of children I have been working with who live in an ecomomically disadvantaged segment of society that is part of a fairly large city. These .llittle ones do not fare well on the assessmenrt tests used to assess their educational level achieved at certain points during public school years.

I have been voluntarity working with children in this school system since 2003. In general, they were not doing well on these tests but have improved over time when they have been tutored in reading and math. Their attitude has been negative, and their self-assessment associated with academic achievement reflects this. But they are excited when they disscover that they can actually read a story out loud to their peers and lead a discussion about what they have read.

This indicates that increased interpersonal interaction is important to the educational affect. It suggests that additional time spent with the young ones during their early education years can reap much benefit.

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