NH Republican HQ after being vandalized in October 2013 (Image courtesy of AP)

Could Obamacare Reduce Violent Tragedies?

Why Inadequate and Unaffordable Healthcare Is The Biggest Danger In America — Part 1

…I Am the One Who Knocks

Pundits and politicians enjoy exciting the voting public by touting the idea that legislation around healthcare reform is somehow “dangerous”. Dangerous for you, dangerous for your family, dangerous to small business owners, and dangerous to your health. While I can agree that poorly written (and often exploitative) legislation certainly is a problem, I’d argue that the reality is far more grim. The danger is already here, and it’s been staring us directly in the face since World War II: a growing population without access to adequate and affordable healthcare.

The World Health Organization estimates that the economic costs of untreated mental illness in the United States costs taxpayers more than $100 billion each year. This number is derived based on costs incurred by unemployment, unnecessary disability, substance abuse, homelessness, inappropriate incarceration, suicide, and more.

There are two important things that I need to address before I begin, in order to avoid perpetuating stigmas and confusing the point of this article:

First, I want to be clear that those suffering from mental illness are not more likely to commit crime, violent or otherwise, than any other portion of the population. They are, however, at the highest risk of becoming victims of these types of crimes.

Second, I’m painting a picture with extremely broad and generalized strokes. When I refer to the “mentally ill” I am encompassing everything from chronic depression, to bi-polar disorder, to addiction, to schizophrenia, and beyond. Mental illnesses are often extremely complex, and the severity and success of treatment can vary rather heavily. At their best, they are extremely treatable, and at their worst they are needlessly fatal — in some cases to both the sufferer and to others.

Statistically, due in part to the nature of the disease as well as the stigma that continues to surround those who suffer, the mentally ill are the population least likely to seek treatment, even though in many cases their illness is extremely treatable. They are also the population most likely to be unable to afford proper care. This stems largely from: 1) The likelihood that those with the most severe cases are unemployed and/or homeless, and 2) That the type and length of treatment oftentimes makes it extremely cost prohibitive.

According to the National Alliance on Mental Illness, between 70 and 90 percent of individuals with a serious mental illness have significant reduction of symptoms and greatly improved quality of life with a combination of medication and psychosocial treatment.

It should then be easy to deduce why we, as a society, need to work hard to reduce healthcare costs and strive for some sort of universal healthcare system — not only here in the United States, but globally. We have an entire population of people, many with treatable conditions, who aren’t receiving adequate (or in some cases, any) treatment. The repercussions for choosing not to treat them are staggering on both a fiscal and social level, yet we continue to exclude them from the talking points when it comes to discussions for and against pieces of legislation like the Affordable Care Act. Why is this?

The First Rule Of Mental Illness Is: You Don’t Talk About Mental Illness

While I don’t think any of the reasons are particularly good, I would speculate that there are several factors at play, the largest of which is that we don’t talk about mental illness because we don’t understand it. I think the average person probably still thinks that being a drug addict is a “life choice” and not an illness. A lot of people probably still tell someone suffering from chronic depression to “snap out of it” or “cheer up”. So we need to talk about it, as scary as it is sometimes, in order to make sure the general populous is aware that no one wants to throw their life away to drugs and alcohol any more than someone wishes they had cancer.

Another reason may simply be that it’s a complex issue, and we don’t address it because there isn’t a single “feel good” solution. It’s really easy to take up a cause like the fight against breast cancer, for instance. We can all agree that it’s a problem, and it’s tragic, so we just sort of raise awareness and money to combat it, and then we can all feel good about what we did to help. And we should. But mental illness isn’t quite so simple. Every case is unique, there are many different treatment options, and not everyone agrees on what the best approach to solve the problem is. However, the reality is that it isn’t just going to go away, especially if we let the enormity of the problem overwhelm us into complacency.

To put the danger of this complacency into perspective, allow me to give an example using everyone’s favorite Sunday past-time: football. The National Football League has been under fire for years for encouraging dangerous play, and not doing enough to protect its players from head trauma.These traumas have left players combatting all kinds of different mental and physical conditions later in life, many of which leave them debilitated. Still, even after ten current and former players have taken their own lives in the past three years alone, the NFL has done little to correct the problem. Not only has the sport done almost nothing to raise awareness and provide treatment to its most valuable asset — the players — it has gone so far as to fine those that have tried.

During an October 10th game, Chicago Bears wide receiver Brandon Marshall decided to take a stand. Throughout the month of October, the NFL had partnered with the American Cancer Society for a campaign to raise awareness and funding for the fight against breast cancer. As part of that partnership, the players wore pink cleats; the color we use on ribbons to denote breast cancer awareness. However, Marshall didn’t take the field wearing pink that day. Instead, he donned lime green cleats, showing solidarity with sufferers of mental illness (of which he is one) during Mental Illness Awareness Week. The NFL’s response? They fined Marshall $10,500 for a “uniform violation” which he then matched to charity. At least your players have class, NFL.

Now I’m not against breast cancer awareness. I’m not some kind of monster — I think breasts are pretty great. But if your sport is dominated by men and has a predominantly male viewership, and breast cancer is statistically 100 time less likely to occur in men, would it hurt you to perhaps also recognize a cause far less funded and spoken about which is most certainly leading directly to the death of your own players?

I Grew Up Playing Doom and Mortal Kombat, and I Still Turned Out (Mostly) Okay

I’d like to switch gears for a moment and talk about mass shootings. Not the most uplifting topic in the world, but an important one to address nonetheless. Every time a young person goes on a shooting spree at a school, we’re all very quick to try and find something or someone to blame. In fact, we react that way to most tragic events. But, I find the discussions around school shootings to be amongst the most infuriating, and here’s why: we never make any real strides to address the problem. We talk about gun control and bullying. We blame the parents, or video games, or Marilyn Manson. But we almost never talk about the illness this person was obviously suffering from when they made the choice to unload a firearm on their classmates, and that has to change.

The Office of the Surgeon General reports that an estimated 10 percent of children and adolescents in the United States suffer from serious emotional and mental disorders that cause significant functional impairment in their day-to-day lives at home, in school, and in interactions with their peers

It takes an extremely ill individual to open fire on a school of young children. No amount of Call of Duty has ever inspired a completely healthy person to gun down a bunch of people. Listening to Antichrist Superstar on repeat has never caused a rational human being to build an arsenal of bombs, and plant them all around their school as booby traps. These are just excuses that we use to try and rationalize tragedies which occur on a such a horrific level that they become incomprehensible. We fall, and blame every branch we hit on the way down, when in reality we need to examine why we fell in the first place. The only thing that causes someone to act out in such irrational ways is severe mental illness. Period. What brought on the illness is a completely different story, and often a complex story to try and unweave. However, if we look at it from the most basic and rational level — which is that the tragedy was caused by someone who suffered from an untreated mental condition — then we can begin to take action.

Look, we’ll never outlaw all the guns. I’d love it if we did, but I know that’s not realistic. And even if we did, those with severe illness and absolute intent on committing horrific crime would probably still find a way to obtain them. Maybe not so frequently, but we can’t even pass legislation that’s completely sensible around gun control, so let’s focus less on guns in the interest of progress.

We also shouldn’t push to censor music or video games. That’s a really dangerous thing to start doing. You start infringing on the right to creative expression and the freedom of speech. I, for one, would argue that we should censor even less than we already do. When we start looking for scapegoats the real problem gets lost in the noise. What we truly need is less legislation and taxpayer dollars used to try and restrict the sale of violent video games, and more legislation that will provide treatment options and programs for the kids who are at risk or already suffering from mental illness.

And Why Do We Fall, Bruce? So That We Can Learn To Pick Ourselves Up

So what can we do? A lot actually, as it turns out. For starters, we can continue to work on reforming our healthcare system in order to make mental health services affordable and available. We can fight harder to remove the associated stigmas that only serve to bring on an unwarranted sense of hopelessness, and erect social barriers to treatment and recovery. We can encourage legislation that allows doctors the discretion to treat their patients, and require those released from psychiatric holds back into our school systems to be monitored and held accountable for their continued treatment.

We can also raise awareness, starting at a much younger age, and encourage understanding and tolerance for those suffering from mental illness in our schools and neighborhoods. No one should have to be ashamed of any illness, let alone one which affects so many people. Stop treating the mentally ill any differently than you would a diabetic or a cancer patient, because mental illness isn’t any different than those diseases. It’s mostly treatable, but when left untreated can be fatal, and it affects all of us — not just the sufferer of the disease.

Right now, the country’s largest provider of mental health services is the prison system. We aren’t treating people, we’re incarcerating them. Obviously, something needs to change. A Department of Health and Human Services report showed that the Affordable Care Act will provide first-time mental health services for over 32 million Americans, so we have the potential to make tremendous progress. The question is: can we raise awareness and remove the stigma, encouraging the untreated to seek help? It’s a gargantuan task, no doubt — but it is our responsibility to try.

If I’ve learned anything from my time spent researching this topic and trying to become an advocate of sorts, it’s that this issue is extremely complex. The true danger is our complacency, and our seeming unwillingness to begin addressing a problem until we feel, on both sides of the issue, that we can solve it one-hundred percent of the way. That’s simply unrealistic. Does the Affordable Care Act solve all of our problems? Of course it doesn’t. But while the people on one side of the issue are at least getting the hard work ahead started, the people on the other side are trying to stop it dead in its tracks. We know the current system is broken, so how about instead of fighting to do nothing, we instead fight to make our solution the best it can be? Don’t we owe that to each other?

For further information on mental health awareness, treatment options, and what you can help, please visit the National Alliance on Mental Illness website at nami.org.