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Institutionalization back on the table?

Keene Sentinel - 8/31/2019

Aug. 31--On the heels of President Donald Trump floating the idea of bringing back old-school psychiatric institutions to combat gun violence, a local mental health agency and other area advocates are speaking out.

Before and during his Aug. 15 rally in Manchester, when referencing the recent massacres in El Paso, Texas, and Dayton, Ohio, the president said building more institutions for people with mental illness would be a better way of preventing mass shootings than implementing broader gun control measures.

"We will be taking mentally deranged and dangerous people off the streets so we won't have to worry so much about that," he told the crowd at the SNHU Arena.

Trump also called for more asylums after the Parkland, Fla., shooting in 2018, but now the rhetoric has progressed to potential policy changes.

The White House has also been mulling a proposal to use artificial intelligence to identify potential mass shooters -- using data from devices such as Apple Watch, Amazon Echo, Google Home and Fitbit -- modeled after the Pentagon's early intervention anti-terrorism program, the Defense Advanced Research Projects Agency, according to an Aug. 22Washington Post report.

Trump's comments have fueled a broader discussion about the state of mental health care in the United States, along with concerns about a lack of empirical evidence backing up his claims; due process; and reinforcing the stigma of mental illness.

'Just scapegoating'

Gun control has long been a fraught topic that people have intertwined with mental health in response to some of the more horrific mass shootings, such as the 2012 murders of students and staff at Sandy Hook Elementary School.

But Trump's insistence that mental illness -- experienced by one in five Americans -- and gun violence are correlated has frustrated local mental health providers, who cite data indicating people with these diagnoses are largely nonviolent.

Monadnock Peer Support's Executive Director Peter Starkey even released a statement on the center's behalf recently to dispute the president's remarks.

"The comment is really flawed because it draws [on] a long-standing misconception that mental health equals gun violence," Starkey said. "When you draw a direct line between mental health and gun violence, you are just scapegoating."

Mental illness, though long suspected as a primary cause of mass shootings, is attributable to only about three percent of violent crimes, according to the American Psychiatric Association.

Additional research published by the APA found that problems with self-esteem and perceived social rejection are common characteristics among people who commit mass shootings.

"There is the sort of common person, or reasonable person, who might say, 'Anybody that goes out and shoots x-number of people, there's something wrong with them,' " said Ken Norton, the executive director of the New Hampshire chapter of the National Alliance on Mental Illness (NAMI) in Concord. "But, you know, there's a difference between bad and evil, and mental illness. And I think that's what we need to be clear about here."

People with mental health disorders are also more likely to be victims of violent crime than perpetrators, said Louis Josephson, president and CEO of the Brattleboro Retreat.

"The fact is, people with mental illness are 11 times more likely to be a victim of violence," Josephson said, a statistic that's echoed on the U.S. Department of Health and Human Services' mental health page.

But rather than dealing with the gun problem, Starkey said, those in power shift the blame to easy targets.

"When we are struggling with a violent gun problem, and we blame mental health, they know these people can't fight back," Starkey said. "So these people who are depressed every single day now have this image of being a threat. They are struggling and can't defend themselves."

Nevertheless, Trump's comments have elicited a nostalgia for psychiatric institutions and reignited calls from Republicans to act on mental health rather than firearms.

This month, Fox News aired several segments on the subject during its primetime opinion lineup of Tucker Carlson, Sean Hannity and Laura Ingraham.

The Republican governors of Texas and Ohio -- Greg Abbott and Mike DeWine -- have blamed mental illness for the recent shootings in their states, but stopped short of calling for the return of asylums.

A 'very high bar'

While early advocates in the American mental hygiene movement like Clifford Beers sounded the alarm bell on psychiatric institutions as early as 1908 with the book "A Mind That Found Itself" -- an autobiographical account of abuse Beers suffered while institutionalized for what would now be considered schizophrenia -- the deinstitutionalization movement began in earnest in the 1960s.

Through the 1970s and '80s, a series of lawsuits and court decisions catalyzed a shift from large institutions to a more community-based approach, with New Hampshire'sLaconia State School -- formerly known as the N.H. School for Feeble-Minded Children -- closing in 1991.

That shift, according to Trump and some local Republicans, has been a source of homelessness and violence.

"We've gone -- I mean across the country -- all the facilities have been closed with the intent of integrating, and all it's done is create a terrible situation of homelessness, and then you have some who act out and do something violent, because they're not getting the care," Marilyn Huston, chairwoman of the Cheshire County Republican Committee, said, adding that there should be an increase in both short- and long-term care facilities for people with mental illness.

Ann Savastano, a Keene Republican who rode with Huston on a chartered bus to and from Trump's Manchester rally, reacted to the president's remarks when interviewed by The Sentinel afterward.

"I think it depends on, really, how humane it is," Savastano, of Keene, said of Trump's proposal to bring back asylums. "If it's just, you know, cities and states letting people out because they don't want the expense of it, I think that needs to be looked at, because it's clear that if it can be done humanely and responsibly -- and that would be the key thing -- and not as it was done sort of haphazardly and deplorably ... back in the '50s and '60s, it would be an excellent idea."

But Gary Barnes, executive director of Maps Counseling Services in Keene, refutes the idea that institutionalization would reduce gun violence, explaining that the ability to predict violence is slim.

"Unless someone already has a long history of being violent, we have no idea who is going to become violent and who's not," Barnes said. "You would just end up institutionalizing thousands, if not millions, to try and prevent something that is very rare."

Josephson, along with Barnes and Starkey, said he couldn't think of a circumstance that would warrant someone being institutionalized indefinitely. At the Brattleboro Retreat, he said most inpatient treatment is done within a week's time, even for chronic mental illnesses like schizophrenia.

"[Inpatient care] is absolutely valuable, just like you would have a medical crisis and be in an ICU for a little bit," he said. "But people aren't here for months and weeks and weeks at a time. We stabilize people, and we look at their medications, and then they are back to work, family, community."

Josephson also noted it's a "very high bar" to be admitted into a mental health facility. The person needs to be a serious danger to themselves or others, or must be so distraught they can no longer take care of themselves.

Most commonly, he said the retreat's inpatient unit treats people with depression, anxiety disorders, bipolar disorder and schizophrenia.

But the idea of isolating people only exacerbates their mental illness, according to Starkey. Stripping people of their every day connections is dangerous, he said, which is why community-based services are imperative.

"Our focus must be on keeping individuals with mental health in the communities of their choice, while developing more robust options of support that build relationships, strengthen community and provide opportunities for advocacy," Starkey said in the agency's statement. "We must not return to the failed practices of the past."

Statewide strides

At the state level, Norton said he thinks Granite Staters are far more nuanced than people in other parts of the country when discussing mental health. Resources remain an issue, he said, with bed shortages for short-term hospitalization and Cheshire Medical Center closing its psychiatric wing in 2016, but progress is being made.

NAMI NH "felt that the president's comments did not reflect the will or the beliefs of the people of the state of New Hampshire," Norton said. "I think our Legislature and our governor, right now -- bipartisan -- it's been very clear in terms of the steps that they took to move forward."

Gov. Chris Sununu, in a statement issued Aug. 9 as he vetoed three gun-control bills, said: "Our focus as a nation must be on addressing the root causes of hate and violence. Here in New Hampshire, we have taken multiple steps to address our mental health needs and to build a more welcoming and tolerant state. "

Norton cited the Granite State's 10-year mental health plan released this past January, which set goals for improving community-based service providers.

Norton, along with state Rep. Joe Schapiro, D-Keene, a retired social worker, said even more help could come after Sununu signed Senate Bill 11 into law in May. The bill provides funding for designated receiving facility (DRF) beds to ease the burden on hospitals housing patients in psychological crises awaiting treatment.

However, Schapiro said there remains a broader lack of funding, and the uncertainty amid the state budget impasse only makes matters worse.

"I think it's a real problem in our country that mental health services are not funded adequately, and it's specifically a big problem in New Hampshire, because there are so many competing needs for funds with public education, infrastructure -- and mental health funding is just one of those things," Schapiro said.

Norton added that it's frustrating for advocates when some politicians are willing to discuss mental health only after mass shootings.

"I think it's really disingenuous when politicians, after these shootings, make this connection with people with mental illness," Norton said. "And I'm talking outside of New Hampshire. Because if they really believed that, why haven't they invested in a strong mental health system for our country?"

Jake Lahut can be reached at 352-1234, extension 1435, or Follow him on Twitter at @JakeLahut.

Olivia Belanger can be reached at 352-1234, extension 9234, or Follow her on Twitter @OBelangerKS.


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