Over on Pete Earley's blog, he gives the text of a speech by DJ Jaffe, a mental illness advocate. Mr. Jaffe contends that those with serious mental illnesses constitute 4.2.% of the population and those people can be differentiated from the rest of the population, including the 20% of the population in any given year who have DSM diagnoses which are "mainly minor illnesses like anxiety." Jaffe would like to see those with real mental illnesses, who aren't the worried well, moved to the front of the line for services.
I've ranted before about how I still don't know who those mentally ill people are -- I did a poll on this on Shrink Rap and got results from 696 people and wrote about the results Here and Here. I've been in private practice for over 20 years, and have worked at 4 different community mental health centers, including a stint volunteering at HealthCare for the Homeless. Many of the people I see spend most of their lives doing very well, and for Catlover who commented on the post on The Violent Mentally Ill, I'll add that when they are well, they are indistinguishable from everyone else: they go to work, they care for their children and parents, they are doctors, lawyers, teachers, the heads of companies, and they do amazing volunteer work and give generously to charities. And when they are sick, they suffer, can't get out of bed, miss work, stop eating, and feel suicidal. Some of these very well people hear voices, have delusions, and shut down. Some of the mentally healthiest people I know are also some of the sickest people I know -- it simply depends on what slice in time you catch them, and the sick part can be a very brief, but life changing, slice. Many people I see have been hospitalized at some point, have attempted suicide, or have needed 4 or 5 medications at a time in order to be well.
But Mr. Jaffe is right: there are some people who are chronically ill, who never get well, and who aren't going to work and contributing to society. They cycle from the jail to the hospital to the street, and very frequently (as in almost always) this population includes people with substance abuse disorders. Does it matter? If someone cycles from the jail to the street and back again and they have a substance abuse problem which contributes, do they deserve less help than the person who also has a mental illness? What if they have a personality disorder that destroys their ability to function, have relationships, hold a job, maintain housing, and live in a meaningful way in society? And if you're in the midst of a terrifying panic attack, who decides if your problem is "mild?" I don't like the Us/Them split with the idea that there is a clear divide. We're all people, we all hurt sometimes, and some of us need more help than others : diagnosis is not the thing that determines that. Nearly 40,000 people a year die from suicide; they aren't all obviously ill and sometimes we are left to be totally shocked. 400 physicians a year (the equivalent of an entire medical school) commit suicide and they probably weren't falling in Jaffe's listing of the severely mentally ill who cycle through jails and hospitals. When people commit suicide, or school shootings for that matter, there were often subtle signs, but most of these people weren't in that 4.2% and weren't the obvious severely mentally ill.
If you're suffering, you're suffering, and we need better services, available more readily, for everyone. The teenager who kills himself because he is distraught over a break up is just as dead as the man with chronic schizophrenia who dies on the street. We need more and better treatments for substance abuse, and we need more and better treatments for those mental illnesses that are resistant to the medications that are available now. We need more ACT teams, more housing (because it's hard to get your medicines if you have no address to get your check and no shelf to put them on), more peer support, more transportation. Offering help to those who suffer but don't have severe, chronic, and persistent mental illness should not be equated with stealing services from those most in need.
[This weather calls more for a snowy owl theme, I think. --Clink]