In case you missed it, the billboard above, sponsored by designer Kenneth Cole, has been the source of a lot of angst. Presumably, Mr. Cole meant to point out that people with difficulties have trouble accessing mental health care ( ~so true), but instead the message blames people with mental illness for gun violence. It's both wrong and stigmatizing, and the American Psychiatric Association understandably asked to have the billboard taken down and started a #GiveStigmaTheBoot campaign.
I want to point out an inconsistency in the APA's endorsements. Representative Tim Murphy has proposed an overhaul of our national mental health services from the top down. Many of Murphy's proposals in his Helping Families in Mental Health Crisis Act are admirable and have the potential to decrease repetition of oversight, and hopefully to change the way psychiatric services are delivered to those who need them most. However, the bill was put forth in response to the Newtown tragedy where a disturbed young man killed 27 people, including 20 young children. Murphy repeatedly says that something needs to be done about our nation's mental health services before more such tragedies occur, and that this is his promise to the parents of the children who died at the hands of a disturbed gunman.
Murphy's bill creates incentives for court ordering patients to outpatient treatment, also called Assisted Outpatient Treatment or AOT -- a measure that has been used in some states for people with psychotic disorders who are repeatedly hospitalized for noncompliance with treatment. Outpatient commitment is a tough one -- it may help some people to get help, but it also infringes on a person's right to determine their own medical care, a civil right we all value.
In an article in Behavioral Healthcare on September 4, 2015, "Murphy touts mental health bill on Cleveland visit," Julie Miller writes about Murphy's support of the controversial outpatient commitment bill. Miller writes:
He believes that if the perpetrators of violent tragedies like Sandy Hook Elementary School and the Aurora, Colo., movie theater had assisted outpatient treatment, the tragedies wouldn’t have occurred. To those who oppose AOT on the basis of personal freedom, he says, “Go talk to the moms from Sandy Hook and tell them that.”
Personally, I'm at a loss here. From what I've read in a variety of sources: the media, the report of the Connecticut Department of the Child Advocate, and live-streamed testimony from the Aurora hearings, neither of those shooters had ever had a single psychiatric inpatient commitment and neither had a history of violence. No one knew these young men had planned these atrocities. The graduate student in Colorado was going voluntarily to treatment, he stopped when he left school and his eligibility for services ended. If his psychiatrist knew he was dangerous, there are laws in place that would have permitted his commitment. Both young men were diagnosed with anxiety disorders, not psychotic disorders, prior to their shocking crimes. Simply put, they weren't candidates for Outpatient Commitment, and by making the assertion that outpatient commitment can prevent mass murders, the implication is that the government could knock on your door to see if you are harboring a loner young man who plays videogames and behaves oddly. These aren't the people who get captured by Outpatient Commitment orders.
Yes, we need better mental health access and more comprehensive services. But we need them to help people live better lives and suffer less. Everything about Murphy's Bill as a promise to the parents of the children of Newtown --- that better mental health services will prevent mass murder -- is stigmatizing. And yet the APA has no campaign against this stigmatizing bill, in fact, the APA wholeheartedly endorses this form of stigma.