My Sojourn through Bipolar Illness – What to give up to fight stigma?

Do you feel uncomfortable when there is a news announcement of a violent crime committed by some one who is mentally unstable or mentally ill?  How can we address this stigma such that those of us who live with a mental health diagnosis largely lawfully are not readily lumped together with those people who are committing heinous acts due to their instability?

What might the typical mental health or substance use patient have to give up if there were to develop a Paranoia Hotline, a Paranormal  Institute or a Cohort Model is some level of privacy? (Please see prior posts for a discussion of these concepts.)  It is a “no brainer” to me that weapons do not belong in the hands of the mentally ill even when they are in recovery. 

I also believe we as a society should allow therapists and doctors to report clients who may be showing signs of being a danger to others. This is very tricky territory, but it seems to me that the person providing mental health care should be able to report findings to some larger group whose mission is to follow-up and investigate and intervene if the concerns raised by the therapist show that a patient is a threat to others.     At a minimum in my opinion, such notice from a therapist should ensure the patient goes on a weapon do-not-sell list.

In the past ten plus years the number of school or mass shootings in the US has sky-rocketed with the age of impacted schoolchildren often getting younger and younger.  I feel it is the responsibility of people with mental health diagnoses who know how dangerous paranoia can be and how quickly it can develop into an unsafe situation to speak up in favor of controlling and denying access to guns and other weapons for the mentally ill.  I also think the dialogue about what a therapist can reveal about his or her patient warrants more attention.  If a patient is clearly a danger to others, this fact should be communicated to a third party in charge of reconciling the account.    As people who strive day in and day out to be safe when there is often unsafety lingering around in the shadows, people with mental health diagnoses need to speak out as a group to ensure that lawmakers make weapons inaccessible to the mentally ill and provide societal intervention and/or follow-up for people who seem to be a danger to others.

It is only when we start to differentiate people who are a threat to others from people experiencing mental health symptoms but are no danger to others are we able to begin to address the stigma associated with mental illness.  The public needs to know that it is a small percentage of people with mental illness who are actually a danger to others so that we who are living with the impacts of mental illness are not lumped into that category of “danger to others”  and receive all the stigma that goes with that. These people who are a danger to others need early intervention from healthcare providers and first responders so that they do not act on these impulses to extend dangers to others.

My Sojourn through Bipolar Illness – Stigma

I have often felt that the stigma associated with bipolar illness is as big if not bigger (twice as big) as dealing with the illness itself.  Every time there is a school shooting or a gun incident or a drug cartel development that involves an unstable person with mood issues, all parties with a behavioral health diagnosis suffer.  The emphasis in society rarely is on developing preventive care for people with behavioral care diagnoses.  Admitting such people to jails appears to be more of the status quo in the years following the closing of many State-run facilities.  Undoubtedly, there has been a cost savings with the closing of hospitals across the United States but the flip side of this is that many people with behavioral health diagnoses end up in jail or homeless on the streets.  Too often people may encounter the fact that there are no beds available when they go to be evaluated for admission to a behavioral health facility.

While I am not an expert in addiction issues at all, I feel that the opiod epidemic of the last several years is evidence of the fact that our behavioral health and addiction facilities are lacking in funding and in expertise while the world is lacking in understanding and compassion.  The stigma associated with having an addiction or an addiction-based personality is a huge factor I believe in addressing this crisis.  What is evident now more than ever is that addiction issues (and behavioral health issues) do not discriminate based on race or socioeconomic stature or religion or any other factors.

I have encountered stigma in the workplace, during the job interview process, in the neighborhood, in the world of health insurance, and just about in every facet of society.  I have often heard of the comparison of behavioral health issues to diabetes.  Would you think less of a person who takes insulin daily? Probably not.  But would you think less of a person taking psychotropic drugs?   Today, the typical answer to this question is probably so.  Would you think less of a person who has exited the opiod epidemic and is actively addressing addiction tendencies?  Hopefully the answer is we are learning to be proud of that person for reaching out and for getting help with a problem that is real across all sectors of American society.

The stigma issue at least in behavioral health tends to feed on itself.  Because the stigma is high with regard to behavioral health diagnoses, I find it hard to share my diagnosis and my daily troubles with others.  This need for secrecy or keeping the diagnosis story a secret in turn creates undertones of distrust or lack of trust and/or continuing questions.  If I share my story with person x, will he or she keep that story confidential or not?  What will be the fallout if my diagnosis is shared in the neighborhood or in the workplace or at my daughter’s school?  These are serious questions regarding a very serious topic.

Mostly I have found that people outside my family circle are not at all aware of or supportive of mental illness concerns.  The education that they receive typically comes through the news where the typical story involves a young teen or twenty-something who is disturbed at home, who may have sought psychiatric care or may not have, and who decides to engage in some sort of heinous premeditated shooting rampage.  Unfortunately these stories of misunderstood teens and young people on a death rampage have become more of a norm in our society in the last ten to fifteen years than anyone would care to admit.

To me there are very clear steps that society should be taking to counter-act these potentially preventable heinous acts of violence. 

These include:

1) Background checks for the purchase of guns and other weapons such that people with a history of mental illness may not purchase or own a gun or weapon under any circumstances.  This includes background checks for all types of gun sales and gun ownership.

2) Some form of alert that can be provided by a mental health worker if a particular patient is in distress and appears to be a danger to himself and others, particularly to others.  Right now, most privacy laws do not allow for that disclosure given doctor-patient confidentiality laws.

3) A clearer understanding for Crisis Intervention workers and teams including training in mental health issues.  First Responders need to be armed with a greater understanding of when a crisis event is a dangerous event for others versus when a crisis event creates danger for only the patient and the patient’s life.

4) Funding and payment to Crisis Intervention workers for this training.

5) Funding and training to mental health workers to help distinguish patients who pose a threat to society as compared to patients who are experiencing a threat to themselves.    

6) Additional early intervention work for teens in inner city environments with behavioral health concerns to get them off the streets and out of association with gangs and gang behaviors with the end game being to treat these kids for psychiatric issues before they get a criminal record and are incarcerated. 

This requires that we look at the cost-benefit of treating at-risk teens for behavioral health concerns versus the current pattern of enabling criminal activity among teens by not providing the behavioral health care that they need until after they are in jails.  In my opinion, society needs to accept the cost of working with at-risk teens on behavioral health issues so as to avoid the huge cost of incarcerating a large and growing sub-population of mentally disturbed people with a history of criminal behavior in our inner cities and towns.    

If we are going to progress past the stigma of mental illness diagnoses, it may be necessary to give up some of our freedoms.  If we are going to differentiate between a mental health event that endangers the patient versus a mental health event that endangers community or society, we people with behavioral health diagnoses need to be willing to give up some of our freedom.  To me giving up freedom is agreeing to sign off on background checks for guns and other weapons as well as amending doctor-patient confidentiality laws if there is clear evidence or behavioral propensity of a danger involving the greater community.  Clearly if we are going to expect care-givers and first-responders to bear the responsibility of determining if the event scope is patient-only versus community-reaching, we will need to provide topnotch education to both mental healthcare providers and First Responders.  Both groups need to be well-versed in signs that distinguish when the patient is a threat to self but more importantly a threat to others.   Both care-givers and first-responders need to be armed with an understanding of how these two scenarios differ and how they are the same with the end goal being the care for human life – the life of a disturbed teen but also the lives of those in community with this teen.

My Sojourn through Bipolar Illness – Imprinting

What I took away from this first break experience during my Senior winter at Ivy College is that being mentally ill meant I was first a criminal and second a person. I know that first responders were doing their jobs to watch out for the safety of all those who were boarding the plane and/or in the airport. But that experience told me: “You are a criminal. You were trying to bomb the plane. You are guilty of anything and everything until proven innocent. You need to be handcuffed. You do not have the right to have fears much less to express them. You do not have the right to have perceptions that are not 100 percent clear. You are a danger to others around you and you need to be locked up.”

My first episode imprinted me for the rest of my life. For years, I would try to escape the label of criminal that had been imposed on me by circumstance and happenstance. But try as I might, I still felt like I was a criminal every time I had a subsequent break-through episode no matter how big or how small.

In hindsight, things could have unfolded quite differently. I could have reported to the school clinic that I was having anxiety about traveling to Chicago and had been having some trouble sleeping. I could have gone into the clinic for a routine evaluation and perhaps been put on lithium or some other drug for bipolar. But sadly, that is not the way my first episode and subsequent diagnosis of bipolar went. I remember to this day looking at those pictures on the wall in the police station and thinking they must be looking for me as “most wanted.” Being mentally ill simply meant I was a criminal.

I will talk later on about stigma and first responders — including the importance of training first responders how to recognize the signs if a person is a danger to him or herself or whether the person is also a danger to those around him or her. But that discussion about stigma and first responder training is for another day.