Continuing Progress on Mental Health Bulls

Editorial: Time for parity for mental health coverage

by The Grand Rapids Press Editorial Board

Sunday September 28, 2008, 3:00 AM

WHY IT MATTERS

Mental illness can be just as terrible and even deadly as physical illness, but isn't treated that way by some insurers.

Diseases of the mind aren't always as visible or obvious as those of the body. But depression, schizophrenia and other serious ailments can be just as debilitating and deadly as diabetes and heart disease. Still, mental illness is too frequently treated differently by health insurance companies.

Last week, the U.S. House of Representatives passed a bill that will improve insurance coverage for people with mental illness. The bill caps more than a decade of debate on the question, and marks an important step forward in addressing diseases that are increasingly treatable and beatable, provided they receive proper attention and care.

The legislation mandates mental health parity, making it illegal for insurance companies to set lower limits on treatments than are set for physical ailments. The bill prohibits higher co-pays for mental health treatment, too. And it requires equal treatment for substance abuse, provided that it is offered by a medical plan.

Those provisions would end restrictions in many insurance plans that can force people with long-term illnesses such as bipolar disorder or anorexia to pay for their own treatment or forgo treatment altogether because they can't afford the cost.

A mental health parity bill has already passed the Senate by a vote of 93 to 2. The House legislation passed by a vote of 376 to 47.

The two versions need to be reconciled. President Bush has expressed support.

Nearly every member of Michigan's congressional delegation -- Democrat and Republican -- voted for the measure. The sole exception was Rep. Peter Hoekstra, R-Holland.

The bill could raise costs. Any hike in insurance premiums is difficult, especially given the skyrocketing price of health care generally. However, the Congressional Budget Office projected that an earlier version of the parity bill would increase premiums for group insurance rates by only four tenths of one percent.

Untreated and under-treated mental illness carries costs of its own, from worker absenteeism to family break-up. Building a better system of healing and prevention for mental illness will decrease those expenses to individuals and society.

The bill contains safeguards for small business, exempting those with fewer than 50 employees. The legislation does not mandate that mental health coverage be made available by businesses that don't currently offer health coverage. And it does not specify which mental illnesses should be covered, allowing health plans discretion to deal with more controversial and questionable diagnoses. If coverage is rejected, the bill requires a health plan to explain why.

In all, the measure strikes the right balance between costs and the health care needs of ordinary people. Those who suffer from mental illness -- estimates are as many as one in four adults in the United States -- know those conditions can leave them alone and adrift. Congress and the president can throw them a lifeline by completing and signing this important legislation.

Much needed Legislation

We should be involved with our senators and congressmen to see that legislation gets passed.

Mental-Health Bill on Tap

By JANE ZHANG

Congress is on the verge of clearing legislation to require most employers and health insurers to put mental-health on par with physical illnesses.

That includes coverage for hospital stays and doctor visits, as well as co-payments and deductibles. Plans that offer out-of-network coverage for physical problems will have to add equivalent mental coverage.

But the legislation doesn't specify what disorders must be covered. Kathleen Mahieu, who heads behavioral health consulting at benefit-consulting firm Hewitt Associates LLC, said there is consensus that major problems such as serious depression, schizophrenia and substance abuse should be covered, but employers differ whether to cover autism, attention deficit disorder and some others. If coverage is rejected, the legislation requires the health plan to explain why.

Still, patient advocates welcomed the changes. "This is the biggest step we've ever taken in terms of integration of mental illness into the larger health care system," said Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness.

Over the last 15 years, both the House and Senate had passed different versions of the bill, only to see them founder. This time, the bill has support of business and insurance groups. On Tuesday, the House passed a standalone bill and the Senate attached the same language to a tax measure. Now, the two chambers must reach agreement on how to pay the $3.4 billion cost over 10 years before lawmakers leave town.

The legislation doesn't require insurance plans sold to individuals, employers with fewer than 50 workers, or those that don't provide any health coverage, to offer mental health coverage.

It applies to about 150 million people: 82 million in federally regulated plans funded by employers, 31 million in state-regulated plans and 36 million children and adults covered by managed-care Medicaid programs, the federal-state health insurance for the poor, a Senate aide said.

The legislation ends such common restrictions as 30-day hospital stays or 30 visits to a mental health professional if the plan doesn't similarly curb treatment for physical problems, Ms. Mahieu said. Reimbursement rates for doctor visits or hospital stays must equal the percentage paid for physical illnesses.

About one in four employers told a Hewitt survey they already offer mental health parity, but it's unclear whether their plans would meet the bill's requirements. President Bush has signaled support; the legislation would be put into practice nationwide by January 2010 if it becomes law.

That will make a big difference for people like Loretta Geyer, a 51-year-old social worker in Euclid, Ohio. She said she spent $4,619 out-of-pocket on medical care last year, mostly to treat her bipolar disorder. To save money, she said she often waits to get treatment until her condition worsens.

Her therapist doesn't accept insurance coverage, and Ms. Geyer, who sees her often once a week, pays out-of-pocket and then seeks reimbursement from her insurer, which pays her for 40% of the first 10 visits a year after a $300 deductible.

Employees might find an increase in premiums or deductibles because of the legislation. A survey by the American Benefits Council, an industry group, found 39% of large employers said they will charge employees higher premiums, while one in four also said they would change benefits or adjust total compensation, including slowing down wage increases. One in 10 said they will do both.

Death of a Genius

This book you will find in my book list on this blog. What a good looking young man and mind that succumbed to his chronic depression. Time Magazine gave him a fabulous write up worth reading as well.

David Foster Wallace: The Death of a Genius

By Lev Grossman Thursday, Sep. 18, 2008

David Foster Wallace

Suzy Allman / The New York Times / Redux

What would you write if you could write absolutely anything? This is the question that, as a reader, one imagined David Foster Wallace facing. Whereas ordinary authors resorted to the standard tricks of the trade--write what you know, look deep into your soul, whatever--Wallace seemed to have no earthly constraints. He knew everything and could look into anybody's soul he wanted to. Any writer in America would have killed for his talent, but the man to whom it belonged killed himself. On Sept. 12, Wallace's wife discovered his body at their home in Claremont, Calif. He had hanged himself. He was 46.

He was David Foster Wallace only on the page. His first agent suggested that he use his middle name, to distinguish him from another David Wallace, and it stuck. Born in 1962 and raised in Illinois, he was a competitive junior tennis player--at 14 he was ranked 17th in the Midwest. He studied philosophy at Amherst College and then Harvard, and when he was only 24, he published his first novel, The Broom of the System. In 1996 he vaulted into the upper ranks of the literary world with Infinite Jest, his 1,079-page (and 388-footnote) meta-epic of tennis, drug addiction, art, terrorism and loneliness set in a future when each year is known by the name of its corporate sponsor (e.g., the Year of the Trial-Size Dove Bar). Infinite Jest was the quintessence of 1990s literary maximalism, and it became instant required reading. Enough with those '80s party-boy writers! Here was a novelist with the industrial-strength intellectual chops to theorize even our resolutely anti-intellectual age. Wallace became a reluctant literary pinup, with his stubbly outsize chin and his shoulder-length hair. He was America's No. 1 literary seed, at the top of a hierarchy that was, one suspects, largely meaningless to him.

Reading it now, with the burden of hindsight, one sees that Infinite Jest is ominously infested with suicides, including that of the hero's father, who cooks his own head in a microwave. But back then, Wallace seemed invulnerable. How could a man who had put such crowds of people on the page--Wallace's ear for dialogue was unmatched in contemporary fiction--truly be lonely? Once you've gone inside the mind of a critically burned toddler, as Wallace did in his short story "Incarnations of Burned Children," what horrors can't you face? When he accepted a professorship of creative writing at Pomona College in 2002 and then got married in 2004, one imagined that his relentlessly generative genius might finally be undergoing some domestic mellowing.

Now we have some idea what it was that he couldn't face. Since his death, Wallace's family has stated that he was chronically depressed. He had been taking medication for his condition for 20 years and had occasionally been hospitalized. "Everything had been tried," his father said, "and he just couldn't stand it anymore."

What was "it"? In Infinite Jest Wallace wrote--in a passage that now reads like a lucid cell-phone call from the pilot of a crashing 747--that clinical depression is "lonely on a level that cannot be conveyed ... Everything is part of the problem, and there is no solution. It is a hell for one." What Wallace suffered was both agonizing and indescribable, even by him. And that last may have been what made it unbearable. Like Hamlet--who gave Infinite Jest its title--he had that within which passeth show. Even if he could have written on and on, an infinite number of words, it would never have been enough.

Oneofthose days

This was one of those days. My bipolar student has not been sleeping for about 1.5 weeks. I know this is a red flag with the mentally ill. His mother is a nurse and has been working nights, single mom, I am sure she makes more money on nights. But in the meantime, my student, I will call him Dane, is staying up all night worried about her not being there. So today was the day, today was the day that he could not handle it anymore, restless, would not sit in his seat, then started the running. When he is on edge he starts running around the school; mother was called, etc. What is sad for me is that I know what he faces and his mother faces in the future. The principal has already started documenting his behavior and is starting the process for him to go to a "behavior" school. Of course his intelligence level is extremely high, but the regular ed. teachers just want him out of their class. He is a great student, as long as he gets his sleep and takes his medicine, (heard that before?) I was saddened by seeing another instance of the mentally ill not being able to live in the "real" world. If the mentally ill can't "act" like the rest of the world, then they are asked to go somewhere else. I have been asking the teachers to have patience, they just don't understand just how much patience is required for the mentally ill. I want Dane to stay at the school in his neighborhood with his friends, but unfortunately his actions will ensure that he will be forced to go some where else. very sad. I just hope that we don't read about Dane committing suicide in the future, I won't have any regrets that I did all I could to help this child and I hope the other teachers don't read about Dane in the papers one day and wonder if they did all they could for this child.

To change the subject, this article is talking about me as well. I did write the book, I did tell the family's best kept secret, and I, even after all those years, changed the names of the family. When I started writing the story about our mother, my brothers thought it was "kinda" cute. Then when I got the book published, they both called to say "You did change our names didn't you?" So I will tell you that we are guilty of giving in to the stigma, and are still doing it. If you asked my brothers now about their mother, they would be hesitant to admit that she was as ill as she was. Some of us can admit that our loved ones are severely ill, some can't. I really have a hard time believing that I am actually working with students who are bipolar as I said when my mother died that I never wanted to work with that "disorder"again ever in my life. Now I am getting paid to do just that; go figure.

Mothers’ stories of mental illness

by Wendy Elliott/The Advertiser
View all articles from Wendy Elliott/The Advertiser
Article online since September 18th 2008, 10:14
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Mothers’ stories of mental illness

BY WENDY ELLIOTT

Kings County Register

Marty is a grandmother several times over, but she feels as if the umbilical cord is still attached to her own son, Adam.

“Sometimes, he’s like a four-year-old who wants to go out and play on the highway.

“He’s a threat to himself.”

Marty’s tears flow as she describes life with a paranoid schizophrenic. She wipes them away with her hand, though, and keeps talking.

Although he always acted out, at the age of 17, Adam began behaving erratically.

“He’d burn himself with cigarettes. He wouldn’t go to school. He did really weird things.”

Adam became a skilled tradesman, but “every time there was a crisis, he’d lose it.”

This strong and handsome man, now in his early 30s, has lost a wife, two children, a home and every job he’s ever had.

“He doesn’t see what you and I see. He hears voices in his head.”

Mental health professionals have told Adam his illness was all in his head, Marty says, suggesting he take Tylenol.

“He’d sit babbling in front of the doctor. He wouldn’t help him. In fact, he left him and walked out the door. Those that are ill need help.”

She terms adult protection services useless: “‘Go and stay with your mother,’ they’d say.” And, Marty adds, community services treat the mentally ill as capable of work. They’re not.

She blames a healthcare system that doesn’t help the mentally ill.

“They do not want to deal with it – financially.”

Marty says her son was only diagnosed four years ago. He spent a month in the hospital, “was totally drugged and then told to go work in the woods. He could hardly lift a chain saw.”

He tried suicide. He’s slept in clothing bins and eaten out of dumpsters. Since sick people are ill, they act strange, often getting evicted. Adam has slept in a tent and frozen while trying to pick apples. Local police know him well: they chase him out of public places if he is behaving erratically but, sometimes, his mother says, officers have given him money.

“Sometimes, he’ll lose it and break things. I’ve lost 50 TVs while he looked for microchips.”

While some families get burned out trying to help - “they had to let them go or lose their minds,” Marty has made her son’s improvement a mission.

“There isn’t anything I won’t do for that child. He’s living on the edge of society like he’s transparent. When I look at my son, I see the loving, sharing, compassionate person he is. He’d give away his shirt to help someone else.

“He can be very angry and frustrated,” she notes. When he’s on his meds, he’s 100 per cent better. “He still can’t concentrate, but he wants to work. I’ve got a piece of him back.”

Marty has been to court twice to try to access treatment for Adam. With the involuntary treatment law, she encountered a warm-hearted judge.

“I sat there, read my letter and cried. I told him, he’s not an adult, he’s my child and he’s going to do something to hurt someone.”

Adam has been criminalized because of his illness on an assault charge.

This judge ordered him treated and he spent two weeks at Valley Regional Hospital. The result, Marty terms, was a miracle.

“It’s a blessing. I see his blue eyes and there’s life there. He’s a grown man, but it’s like the first day of school.”

Looking back, Marty says, “this has been hell.”

No pill for disease, stigma and lack of support

Pat, whose son, Jack, also has schizophrenia; says he was diagnosed when he was about 23 - he is now 37.

“It has been a long road for our family, and that illness has coloured all of our lives. It is just the saddest thing to see what happens to a young person with this disease.”

Pat says support he receives from any mental health professionals is minimal and credits monthly visits with his psychiatrist for keeping him out of hospital.

“The medication that these patients need to take is no magic pill: it enables them to function somewhat normally. Believe me, I pray for a magic pill.”

Stigma is a big problem. As a culture, Pat believes, we punish the ill and vulnerable.

“As it is now, he has not made any new friends since he became ill. Understandably, people are sometimes frightened or put off by his demeanour.”

Jack, who holds down a job in a restaurant kitchen, has social contact with his siblings and parents.

“It must be a very lonely existence for him.He is one of the fortunate ones: he can hold a job and maintain an adult living arrangement.”

(Editor’s note: all the names in this article have been changed to protect families from the stigma of mental illness.)

Exciting Research

This is interesting in that one of the reasons why we don't have more information on BPD is because we have not been able to successfully do testing with laboratory mice. I know that a lot of medical problems have been solved or helped dramatically by the research done in the lab. We have always known that BPD is a chemical im-balance so we will hope for a cure not just the ability to contain and maintain this disorder.

Bipolar Disorder: Manic Mouse Made With One Gene Missing

ScienceDaily — Bipolar Disorder (BPD or manic-depressive illness) is one of the most serious of all mental disorders, affecting millions of individuals worldwide. Affected individuals alternate between states of deep depression and mania. While depression is characterized by persistent and long-term sadness or despair, mania is a mental state characterized by great excitement, flight of ideas, a decreased need for sleep, and, sometimes, uncontrollable behavior, hallucinations, or delusions. BPD likely arises from the complex interaction of multiple genes and environmental factors. Unlike some brain diseases, no single gene has been implicated in BPD.

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A major limitation to progress in research and treatment has been the lack of an appropriate animal model for BPD. This work was developed to create such a model based on a genetically engineered defect in the GluR6 gene. The glutamate receptor 6 (GluR6 or GRIK2, one of the kainate receptors) gene resides in a genetic linkage region (6q21) associated with BPD. Kainate receptors respond to the neurotransmitter glutamate, and recent research in mood disorders suggests that the glutamatergic system may play a role in causing mood disorders.

Until now, the role of GluR6 in regulating the mood swings of BPD has been unknown. Furthermore, the gene encoding the GluR6 receptor has recently been linked to treatment emergent suicidal ideation with antidepressants in a pharmacogenetic study. Notably, individuals with bipolar disorder are most susceptible to antidepressant-induced dysphoric states. In this study, mice of several strains were used to investigate this issue. Mice who were missing the GluR6 gene were compared with control mice.

The mice underwent a series of tests designed to approximate the symptoms of mania. The researchers found that mice that were missing the GluR6 gene exhibited many of these symptoms. They were more active in multiple tests and super-responsive to amphetamine, which is used in animal models to approximate hyperactivity. These mice also exhibited less anxious or more risk-taking type behavior and less despair-type behavior. They also tended to be more aggressive.

Notably, BPD is most often treated with a class of medications known as mood stabilizers; lithium is perhaps the best known of these medications. The researchers found that chronic treatment with lithium reduced hyperactivity, aggressive displays, and some risk-taking type behavior in mice missing the GluR6 gene. When biochemical tests were conducted, they also suggested that GluR6 may play a unique role in regulating some of the symptoms of mania. This new animal of mania permits researchers to better understand bipolar disorder and to screen for new treatments that if successful in the animal model can then be translated to the clinic.

Familiar Story

This is the same story that is being lived by a lot of families all across America. Our loved ones need help before they commit a heinous crime. They need help before they retreat into a delusional nightmare and are un-treatable. Please see that this situation is real. We do need new commitment laws, but our mentally ill loved ones, the severe ones, need to have medicine administered before they reach the "involuntary commitment" level of mental illness. They deserve a better life and so do the community and families that are affected by their mental illness. I have lived this story and I am sure a lot of you have as well. There is nothing more frustrating than trying to get your mentally ill loved one help or trying to get them to accept the help that is being offered them. They have all of the right of refusal until they actually hurt themselves or someone else, then their behavior becomes a police concern. That is the whole problem. This mother calls her son's illness the intruder, we called my mother's the monster. My dad would announce that the "monster has reared it's ugly head again" when she would go into her manic, delusional person. I feel her pain.

A 'gravely disabled' mental health care system

State's broken process wastes money, chances, lives

By CAROL SMITH
P-I REPORTER

Liz Browning nudged open the unlocked door of her son's Capitol Hill apartment and recoiled at the floor blanketed with garbage -- drifts of unopened bills, mounds of cigarette butts, rotting food and feces.

"Hello ... hello?" Her voice captured on a video taken in March sounds strained, wishing her 22-year-old son into view, and at the same time terrified of what she might find. "We brought you some food. ..."

She was startled, as her son Marc loomed into the frame -- tall, baby-faced handsome but disheveled, his long dark hair hanging in his face, a cigarette hole in the crotch of his drooping pants. He muttered to himself, and glared at the camera.

Browning felt sick from the stench. She forced herself to keep talking, trying to reach some part of him that remembered who he was before: Marc -- the funny, sweet-natured scion of a prominent Seattle family and descendant of legendary firearm inventor John M. Browning; Marc -- the boy who once played Michael Darling in a Seattle Intiman Theatre production of "Peter Pan." That Marc had disappeared.

Mental illness is an insidious form of identity theft, erasing one future and replacing it with another.

But the state's mental health care system abets the crime. The Brownings, like thousands of other Washington families dealing with mental illness, are snared in a Kafkaesque system that won't help people with serious symptoms until they are in imminent danger of harming themselves or others, or gravely disabled -- standards so high they exclude many who desperately need help.

But this strategy ends up costing the public more money, and puts citizens at greater risk, a scenario tragically highlighted in this state by a string of high-profile slayings by people who had severe mental illness but could not be treated despite signs that they needed help.

How the state treats -- or fails to treat -- its mentally ill is in the headlines again after Tuesday's bloody shooting spree, which left six dead. The family of Isaac Zamora -- the man arrested in the Skagit County killings -- has said the state didn't deal with his mental illness to help him and to protect the public.

It's not for lack of spending money that the state has failed. A Seattle P-I analysis found that the state spends at least $1.8 billion a year directly and indirectly dealing with mental illness, or its aftermath. Of that money, $530 million is spent directly on mental health care. The rest -- $7 out of every $10 -- goes toward prisons, police, homeless shelters and other social services that deal with the consequences of lack of treatment and preventive care.

This approach keeps people cycling through the streets, courts and jails. Beyond that, it squanders opportunities to intervene early on when there may be a better chance for successful treatment and recovery.

Ultimately, it wastes minds and costs lives.

The intruder

Liz Browning took in the bunker of her son's illness. An upright vacuum lay toppled on a table. Shaving cream blotted part of the bathroom mirror, and glass from a broken window littered the floor. Electronic devices -- a television, an iPhone and a computer -- all smashed. It appeared that a frantic intruder had trashed the place.

Marc insisted to his parents that there were people shadowing him -- people who vandalized his property and spoke to him in "voices you don't want to hear."

	Dan DeLong / P-I
Liz Browning wipes away a tear after visiting her son Marc at Western State Hospital.

But Marc's connection to reality had been spotty and fading for months. He started to lose himself in pieces. Strangers called his parents to tell them they'd found Marc's phone buried in their yard. Other strangers found his wallet in the street. Occasionally he would show up on the veranda of his family's gracious Capitol Hill home, ranting through the door until, feeling trapped, his mother called 911.

Now Browning stared into the face of the intruder. The invader had taken up residence in Marc's mind. The invader's name was schizophrenia.

A few months earlier, Marc had called for help. "I love you a lot," he began in a voice message left on his parents' phone: "If I could ask for one thing -- if you could find me a good hospital ... I just can't do it ... I'm not thinking right -- everything is just going poorly for me. If I could just feel better, look to the future ... I feel so lost."

Over the next three days, Browning and her son went to three hospitals -- the University of Washington Medical Center, Harborview Medical Center and Swedish Medical Center -- none of which would or could accept Marc because he wasn't sick enough.

"You almost hope they are really, really bad," Browning said. "And that's just so wrong."

Do not pass go

Hospitalizing someone for mental illness has morphed from a medical decision into a legal issue, said Dr. Peter Roy-Byrne, chief of psychiatry at Harborview. "It's like if someone came into the ER with chest pain or cardiac arrhythmia, and we had to tell them, until they have a heart attack or need a heart transplant, we can't do anything."

Then when patients are sick enough to go to the hospital, they are often more difficult to treat. Or patients get stabilized just enough to be sent back to the community, where, without sufficient services and follow up, they fall apart again. In what becomes a malevolent sort of social Monopoly game, the players are constantly forfeiting their gains to start over -- or go to jail.

For families, it's a grim game with stakes that are too high. There's a complex web of reasons for their frustrations.

Washington is one of the few states where neither families nor their doctors can decide that someone needs to be committed involuntarily for care. The only people who can make that petition are county-designated mental health professionals -- government workers, who are not typically psychiatrists or clinical psychologists.

There are 28 such workers to handle crisis calls from a county with a population of 1.8 million, a ratio that frustrates many clinicians who say that between the laws and the decision-making process, they are frequently unable to provide care, or are forced to release people when they are still in a precarious mental state.

Strict application of only the most severe criteria for commitment, coupled with a critical shortage of psychiatric hospital beds, prevents many people from being hospitalized when they might most benefit from it. Group housing with supervised treatment, scarce to begin with, is disappearing, limiting options for people facing hospital discharge. Although community outpatient mental health programs exist, the majority of patients who end up in them eventually vanish from treatment.

Nearly two-thirds of people who used public mental health services at least once never returned, according to the state's Institute for Public Policy Research, which recently looked at compliance levels. In the lexicon of mental health workers, they are known as "leavers."

"We wouldn't let an Alzheimer's patient leave the hospital to go sit on a sidewalk grate and rot," Roy-Byrne said. "But we do that all the time for people who are mentally ill."

Jails as 'psych wards'

Between January, when he asked for help, and March, when the police finally put him into restraints and hauled him to West Seattle Psychiatric Hospital, Marc's prognosis darkened.

By then, whatever inclination he might initially have had to help himself had been subsumed by illness. On his admission, Marc told social workers he wanted to "get a restraining order against the police because they won't leave me alone."

According to hospital notes, he didn't seem aware of why he had been brought in. He was angry, his mood unstable, and he denied being sick. He refused antipsychotic medication, and the hospital by law couldn't force injections without an additional court order. Within days, Marc was out of control, attacking staff members during an altercation over his smoking privileges. Several orderlies had to forcibly restrain and sedate him.

Then they called the police.

On April 24, Browning waited behind a glass enclosure while her son, wearing an orange jailhouse jumpsuit, was led into the courtroom. He seemed oblivious to the seriousness of the occasion, or even why he was there.

Marc stared around the courtroom, and glimpsed his mother behind the glass. The judge dismissed the charges and ordered him to Western State Hospital to be re-evaluated for civil commitment. When the judge asked him if he had anything to say to the court, he said: "Why is my mother crying?"

Psychotic break

After the hearing, Browning stood on a street corner outside the jail still shaking with frustration. She had been operating on adrenalin for months as her attempts to get treatment for Marc verged into theater of the absurd. At every turn, either the law, or the disease, blocked her attempts to intervene.

On this day, her shoulders hunched forward, and fatigue pressed its thumbs under her eyes. Behind her, the giant image of a man somersaulting down a wall in perpetual freefall decorated the side of a county parking structure, an apt, if unintended, metaphor.

It felt, she said, like they were back where they started, only worse off. Now instead of a treatment plan, her son had a jail record.

"It's like I don't even know him anymore," she said.

Marc, the youngest of three children, was an unassuming, well-adjusted, happy kid growing up, said family and friends.

"He was a sensitive and sweet with a natural charm and kindness," said his older sister, Ann.

		Photo Courtesy Of Liz Browning
	Marc Browning, shown at age 2 in 1988. Growing up, Marc was a well-adjusted, happy kid.

Though he was smart, school was hard for him, and he drifted with little ambition, said one of his elementary school teachers.

In eighth grade, his parents sent him to a small private school for boys with dyslexia, but his problems continued. A year later, a school psychiatrist diagnosed him with bipolar disorder.

During his junior year in high school, he was hospitalized for depression and suicide risk. Though he graduated and started college at Eastern Washington University, he dropped out in January 2005 -- the middle of his freshman year -- to go live with his older brother in Las Vegas.

One night, Marc began tearing apart the attic in the house he shared with his brother, looking for cameras he was convinced were tracking him. He accused his brother of controlling his thoughts. His parents persuaded him to go voluntarily to a hospital in Las Vegas for a week, then flew him back to Seattle.

But at home, his mental health continued to deteriorate, and in June 2005, a court committed him to a private psychiatric hospital. This time, Marc was uncooperative and tried to escape. The hospital wouldn't take him back.

So his parents did.

Marc's behavior grew increasingly erratic and frightening. He withdrew to his room for days at a time. Once, he slammed a chair through a window. His mother began locking herself into her own room at night, fearful of what he might do next.

In February 2006, the Brownings were able to get him committed on an involuntary basis, this time to Harborview Medical Center, where doctors diagnosed him with schizophrenia.

He was 20 years old.

For Liz Browning, her son's diagnosis confirmed a haunting heritage she had feared on some level since her children were young -- a genetic loading the family couldn't escape.

A genetic bullet

On a recent morning, Browning hurried to meet her mother-in-law, Gloria Browning, at a Belltown cafe. They have much in common -- both strong-willed and articulate, they also share a body of knowledge few of their friends comprehend. It's Gloria to whom Browning turns when she needs someone who understands how mental illness shape-shifts a life.

The cafe is just steps from where Gloria Browning lives in a luxury high-rise condominium, and also where many of the city's mentally ill wander the streets, untreated and unhinged. She rarely goes out in her neighborhood after nightfall.

This irony is not lost on Gloria, now the matriarch of her famous family, but she speaks unflinchingly about the Browning legacy. Browning inventions helped build the most widely used firearms of the 20th century -- weapons that saw the nation through two world wars.

No gun John M. Browning designed, however, and no amount of wealth the family enjoyed, could defend against the genealogical bullet ricocheting through their family tree.

Gloria had six sons. Her eldest, namesake of his famous grandfather, leapt from the Golden Gate Bridge at age 27 after suffering for years with symptoms of schizophrenia and struggling to tolerate his medications.

He left a note saying he wished he could have lived.

A few years after his older brother's death, a second son shot himself. That son had struggled with addictions, including to anti-anxiety medications.

Now, two of Gloria's grandsons, including Marc, also struggle with mental disorders.

Gloria keeps track of advances in brain research and hopes for the day better treatments and earlier interventions let more of those with severe mental illness reclaim their lives.

The imposter

Liz Browning thought Marc had almost gotten his own life back.

After hospitalization at Harborview in the spring of 2006, he was released and lived for seven months at the Inn, a transitional group home in Seattle, which since has closed. There, he was supervised to make sure he took his medications, and soon, the witty and easygoing Marc re-emerged.

Encouraged, his family supported a move to his own apartment. He found one himself, outfitted it from Ikea and started back to school at Seattle Central Community College. He stayed on his antipsychotic medication, and paid his bills on time. His past few years began to seem a surreal detour.

But it's under this cloak of normalcy that mental illness lays its trap. People living with mind disorders start to believe that they no longer need the programs or medications that keep their thoughts in line, the voices at bay.

Within a year, Marc quit his medications. He stopped going to school. Quit paying his bills. Stopped making sense.

Because he had been out on his own, the mental health system had no mechanism for intervening, no way to break the freefall to come. Untreated, schizophrenia has its own kind of gravity, sucking its victims in like a black hole.

Even Marc could feel himself slipping. In January, he called his parents for help.

Browning saved the message, and plays it when she wants to make a point -- to doctors, to lawyers, to mental health professionals -- that the Marc they see -- the hostile youth, the disoriented inmate, the uncooperative patient -- that Marc is an imposter.

She plays it for herself.

Call back later

Liz Browning puts out a pot of tea for visitors on her back porch one recent sunny morning. She has a low threshold for small talk, and the conversation quickly turns to mental disorders. If schizophrenia has seized her son's mind, it has also taken over her own life, consuming most of her time and energy. After the April assault charges, a mental health court ordered Marc to an involuntary commitment at Western State Hospital, where he remains today. His progress there has been slow, aggravated she feels by the long periods of time he spent off medications as he pinballed through the system.

Doctors confirm that it's harder to recover from each psychotic break.

"My greatest fear is the psychosis will be so damaging, we can't get him back at all -- that he will be so ill, he's not really treatable," she said. "I might not know what I am fighting for."

She's helping to spearhead a movement to train more defense attorneys for work in mental health courts. She's advocating for the need to get commitments sooner. She's trying to organize an effort to create long-term care facilities where people with intractable mental illness can live together, work and have a decent quality of life.

But what she really wants, right at this moment, is to reach her son. She picks up the phone and dials the pay phone in the community room of his ward at Western State. A patient answers. She introduces herself and reminds the patient that she's met him, that she's Marc's mother, that Marc's the one who always wears a stocking cap. Could he tell him she's on the line?

Browning hangs on, the phone cradled against her shoulder. A few minutes pass. The patient never returns. Marc never picks up.

"I'll have to call back later," she says, to no one in particular.

This is what having your life hijacked by mental illness is like, being on perpetual hold.

Waiting to connect.

Too sick to Realize

A lot of mentally ill persons can be too psychotic to realize they are extremely ill. Most people do not want to medicate anyone unless they are not in the proper frame of mind to make positive decisions. If a person is so sick, like the man in Washington State this week, that they think God is talking to them and they shoot innocent people in the name of God, then some intervention should be done for the sake of the innocent in the community. The laws used to be, years ago in one direction, now they have gone too far in the other direction. Surely we can find some happy medium so that the diagnosed mentally ill can be happy and the community does not have to suffer having their loved ones shot down by someone who is not in cooperation with what the medical staff has prescribed for their treatment. I keep repeating this after another innocent person has been needlessly killed.

Liz

Experts: Larry Evans Jr. faces long stay in mental facility after verdict in murder trial

Treatment Need for new law? Time for healing

MANSFIELD -- Larry Evans Jr. probably won't leave a mental health facility anytime soon.

Evans, 40, was found not guilty by reason of insanity Tuesday for the Dec. 26 shooting deaths of his brother and his neighbor. He will be committed to the Timothy B. Moritz Forensic Unit, a maximum security psychiatric hospital in Columbus.

In six months, the court will receive a status report on Evans. The court then will revisit his case every two years.

Relatives of the victims -- Mansfield police Officer Brian Evans and Robert Houseman -- worry that Evans could be a free man in a relatively short time. If convicted, Evans would have faced the death penalty.

But according to one local expert, those like Larry Evans who are placed in psychiatric facilities usually serve terms very close to what they would have served in prison.

"The length of time they can be held is equal to the maximum sentence for the highest charge they would have faced," Richland County Mental Health & Recovery Services executive director Joe Trolian said. "Very rarely are people restored (to sanity) in six months. If that happens, that's a pretty good indicator something was missed."

The Moritz Forensic Unit, under the direction of the Ohio Department of Mental Health, has a capacity of 76.

"It's maximum security by any sense of the term," department hospitals deputy director James Ignelzi said.

Ignelzi explained the facility's role.

"With Larry, he's already been found insane," he said. "Our job is to treat him. He's committed to us, not sentenced to us."

Recommendations on the Evans case will be made by hospital officials.

"We work for the court," Ignelzi said. "The court has total control of this case."

Sandra Cannon, chief of the Office of Forensic Sciences for the state health department, elaborated.

"Larry will stay under the jurisdiction of the court for life," she said. "He will not be released until he is no longer a threat. The judge makes that decision.

"He might not (end up) in Moritz, but he'll be in a facility for a good long time."

Hospital officials would continue to monitor Evans if he is ever released.

"We really do try to balance public safety," Cannon said. "If he's a risk, we're not going to recommend him (for release)."

Only one-half of 1 percent of criminal cases involve people found not guilty by reason of insanity, Ignelzi said.

Trolian said it is much more common for people to be found incompetent to stand trial. They often can be restored to the point where they can help with their defense.

Evans was found competent to stand trial, but three doctors ruled he was insane the night of the shootings.

"They're basically taking a look back at the time of the crime," Trolian said. "Was the person in a position to determine right from wrong?"

Relatives of the victims lamented the ruling, saying Evans wouldn't be sufficiently punished.

Trolian said he could understand their feelings.

"I feel there should be a sentence included so you serve the minimum sentence in some type of restrictive facility," he said. "We're letting the mental illness completely excuse the action."

Ohio House Bill 299 would change that. Introduced in August 2007, the bill would establish a process for courts to order and community mental health boards to oversee the provision of assisted outpatient treatment.

Assisted outpatient treatment is a less restrictive alternative to involuntary hospital commitment. It's for people with mental illness who may not require hospitalization, but who don't adhere to voluntary outpatient treatment.

The proposal targets patients who have had multiple psychiatric hospitalizations and have histories of dangerous behavior.

"It would be more consistent with laws around the country," Trolian said. "Ohio is definitely behind the times."

Rep. Tom Patton, R-Strongsville, introduced the bill after a May 2007 incident in which Timothy Halton, who had a severe mental illness, shot and killed Cleveland Heights police Officer Jason West. Halton, who reportedly was known to be violent when off his medication, shot West with no provocation.

Mary Kay Pierce, executive director of the National Alliance on Mental Illness, Richland County, is another backer of House Bill 299.

"There has to be a way we can get people help," she said. "These are brain disorders. They may not even realize how ill they are.

"I'd like to get people help when we know they need it. Under Ohio law, you can't make people get treatment unless they're a threat to themselves or others."

Pierce was in the courtroom Tuesday for Evans' trial. She saw the pain, anger and hurt that followed the verdict.

"There's so many families that are hurting right now," Pierce said. "The incidents that happened are devastating, not only to the immediate families, but to many individuals who know and loved both men who lost their lives."

Pierce knew Brian Evans, who went through National Alliance on Mental Illness crisis intervention training, and found him to be compassionate. She has talked to Trina Evans, Brian's widow, several times. Pierce said she is available to any of the families involved.

"We're only in the beginning stages of helping our community get through this," she said.

Long Article, but worth the Read

The biggest price "humans" pay for mental illness is not the cost of treatment, but the cost and consequences of failure to treat. Another recent story of someone who is severely mentally ill, living in the woods,(sound familiar, Uni-Bomber?); the family not able to "convince" him to seek treatment. All states need Kendra's Laws, this becomes a community problem when the diagnosed, un-medicated person kills innocent people. This person and family needed more help. Throwing money at the problem is not the answer. The laws must be changed. If your loved one gets killed by a mentally ill person who is delusional, or if your loved one is the one who is doing the killing because he is "hearing" God telling him to do so; then both of these scenarios are unacceptable. Wake up America. Our innocent people are continuously being killed and our mentally ill loved ones don't need money thrown into a system that obviously does not work. We need the hands of the medical professionals and the hands of our police forces to be untied and allowed to intervene in the lives of the diagnosed mentally ill if they have chosen to be in non-compliance with their prescribed medication.

State pays in blood for flawed mental health system

Laws kept suspects from care

By CAROL SMITH AND DANIEL LATHROP
P-I REPORTERS

The shooting rampage that left six dead Tuesday in Skagit County is the latest tragic incident involving a person with apparent mental illness who didn't get treatment in time to prevent violence.

	Harps

Six more names to add to an already grim list: Sierra Club worker Shannon Harps, stabbed to death outside her Capitol Hill apartment last New Year's Eve; Jewish Federation employee Pamela Waechter, gunned down at work; Newport High School coach Mike Robb, shot in his car; firefighter Stan Stevenson, stabbed to death in a crosswalk walking back from a Mariners game; pregnant Kari Osterhaug, shot by her husband.

In each case, a person with severe, untreated mental illness has been charged or convicted in the killing.

And in each case, family members or others tried to intervene to get the suspect help before he committed a horrific crime but were stopped by Washington's strict commitment laws and overburdened, ineffective mental health care system.

Now it appears Isaac Zamora, 28, who was arrested after the shooting spree this week, may fit that same profile. His mother, who characterized her son as "increasingly psychotic," said she had tried for years to get him help without success.

"The laws are insane," Dennise Zamora said Wednesday. "He needed to be in a facility."

Robb

Her statements echo those of countless other families who say Washington's mental health system fails those who need it most.

A Seattle P-I analysis found the state is spending $1.8 billion on mental illness. But most is spent in courtrooms, squad cars, jail cells, homeless shelters and emergency rooms, not on prevention or long-term treatment. The biggest price taxpayers pay for mental illness in this state is not the cost of treatment -- it's the cost, and consequences, of failure to treat.

Isaac Zamora's lengthy court record contains a sprinkling of references to concerns over his mental health, including a 2003 reference to biting a staff member who was trying to restrain him at North Sound Evaluation and Treatment Center, a mental health clinic in Sedro-Woolley.

Zamora also was ordered by a Skagit County Superior Court judge to undergo a mental health evaluation as part of his court-ordered community supervision, said Department of Corrections spokesman Chad Lewis. Zamora was released Aug. 6, but that evaluation had not taken place before the shootings.

This pattern of not getting help soon enough is endemic to Washington's health care system.

The P-I's analysis found that of the taxpayer dollars spent on people with severe mental illness each year in this state, about seven of every $10 go to services that don't directly address underlying sickness. Little goes to long-term solutions such as treatment, housing and support for people whose symptoms are otherwise so severe they can't function. Of all the money the state spends dealing with mental illness, $530 million goes specifically to address mental health care.

To figure out where the money goes, the P-I interviewed prison officials, government workers, psychiatrists, families, attorneys, police, social workers, patients and others to put a dollar amount on ways the mentally ill interact with public agencies. In cases where specific dollar figures could not be calculated, the P-I prepared its own estimates based on public records and the views of experts.

With no central source keeping track of the money, the P-I built a database of these numbers. What emerged was a view of a largely disconnected system with multiple bottlenecks that mostly is driven by emergency or short-term care.

King County recognizes more needs to be done and has taken some steps toward dealing with the crisis, said Amnon Shoenfeld, director of King County Mental Health. A 0.1 percent sales tax approved last fall will infuse more than $50 million a year into substance abuse recovery and mental health services. The council is expected to take action on the plan later this month.

Families, and even many of those who work within the system, argue that the current crisis-response model doesn't work, makes people sicker and puts the public at risk.

Prison treatment

There's a case for that argument: The state's second-largest psychiatric treatment center for the severely mentally ill is also a maximum-security prison.

At the Monroe Correctional Center's Special Offender Unit, the patients are prisoners first. Their psychiatric facility, originally built for maximum-security incarceration, is embedded within a matrix of cameras and massive steel doors that control and monitor access to their cells.

"Anything you see in a state hospital or emergency room or acute setting, you see here," said Eric Harting, who has worked in the mental health field as a counselor and caseworker for 30 years and now supervises 400 beds at Monroe.

Monroe also houses many of the state's designated "dangerous mentally ill offenders," those violent inmates considered to be high risk to the community. Most of the unit's residents -- up to 80 percent -- have alcohol and drug abuse issues on top of mental and personality disorders.

The population of prisoners with mental illness has been rising each decade since the big push during the 1960s to "deinstitutionalize" patients by releasing them from psychiatric hospitals into community care.

But the community care piece of the plan never materialized as social engineers envisioned. President Johnson's "Great Society" plan was to build 2,000 community health centers around the country to provide comprehensive care for people with mental illness who were being sprung from institutional care. Fewer than 500 were built, leaving the severely mentally ill, who were least capable of coordinating their own care, to scavenge for services and fend for themselves.

"The situation is considerably worse than it was 10 years ago," said E. Fuller Torrey, psychiatrist and author of several benchmark books on the social consequences of the deinstitutionalization of the mentally ill.

Funding for community health and hospital beds has been cut back, but the population of people needing those services, if anything, is increasing, he said. "Basically, to get help, you have to get arrested."

In an ironic twist, Zamora's alleged rampage took place just down the road from the old Northern State Hospital in Sedro-Woolley -- once a psychiatric hospital -- that closed in 1973. At its peak, it housed more than 2,000 patients.

Meanwhile, the percentage of state prison inmates diagnosed with serious mental illness has increased from 11 percent of the total inmate population in 2001 to 16 percent last year, said Karen Daniels, assistant secretary for Washington's Department of Corrections.

At the national level, the Justice Department estimates about 45 percent of federal inmates have serious mental issues.

Even using the state's more conservative figure, that means more than 2,500 of state inmates have serious mental illness. It costs an average of $85 a day to house a regular inmate. It costs $110 a day to house one who is mentally ill, which means an additional $23 million a year. The state now spends $7.2 million a year on psychiatric drugs -- 51 percent of its total prescription budget.

The King County Jail spends $8.7 million on inmates with mental disorders, and the Seattle Police Department spends $8.4 million responding to incidents involving people experiencing symptoms of their mental illnesses.

Washington spends more than $100 million a year incarcerating people with mental illness. Yet many of these incidents -- the petty thefts, vandalism, assaults, trespassing, public urination -- might have been avoided had those who needed it gotten effective treatment and support to begin with, said Torrey, who is now president of the Treatment Advocacy Center, a Virginia-based nonprofit working to eliminate barriers to treatment for people with severe mental illness.

The opinion that treatment can cut down on offenses has been borne out locally. The state's dangerously mentally ill offender program which provides intensive supervision of released felons resulted in a 37 percent reduction in recidivism rates. But only a select group of offenders qualify for this program.

Preventable tragedies

Treatment might also have prevented some horrific crimes.

People with untreated schizophrenia and bipolar disorders committed about 1,000 of the estimated 16,000 homicides in the United States last year, according to figures kept by the Treatment Advocacy Center.

The names of victims are now memorialized in new treatment laws in many states:

	Waechter

"Kendra's Law" in New York was named for a young woman who was pushed under a subway by a man with untreated schizophrenia.

"Laura's Law" in California is named for a college student who was working at a public mental health clinic and was shot to death by a man who had been refusing treatment.

"Nicola's Law," the latest such effort, is named after a young New Orleans police officer who was overpowered by a suspect with paranoid schizophrenia and shot to death with her own gun.

The majority of people with mental illness do not commit crimes, but of those who do, it's frequently when they are not taking medication or sticking to treatment plans.

Currently, about 40 percent of the 4.5 million individuals with schizophrenia and bipolar disorder in the United States are not getting treatment, said Torrey.

'Outpatient commitments'

In this state, more people don't get treatment -- or stay in it -- for a complex array of reasons: shortages of beds and housing, overextended mental health care workers and no legal means to treat people early on in the progression of their disease.

One of the key reasons, however, is that many people with severe mental illness don't believe they are sick and refuse interventions -- something Zamora's mother said was true of her son.

To address these issues, a growing number of states are moving toward "outpatient commitments" -- which are court orders mandating that people with serious mental health issues get treatment and take medication while out in the community. Sometimes called "assisted outpatient therapy," this approach works, in part, because treatment providers are also accountable to the courts for providing care.

In states that do use outpatient commitment, data show it reduces homelessness, hospitalizations, arrests and violence, said Jon Stanley, lawyer for the Treatment Advocacy Center. In New York, "Kendra's Law," an outpatient commitment law in effect since 1999, reduced arrests of those involved in treatment by 83 percent, and 74 percent less of those in the program ended up homeless.

Technically, Washington's mental health law allows for court-ordered outpatient treatment, but it isn't used much. In 20 years, Dr. Peter Roy-Byrne, head of psychiatry at Harborview Medical Center, recalls it being used only twice.

Noose around the neck

In theory, the state's involuntary treatment act allows, or even encourages, the placement of people in a "least restrictive alternative" such as community treatment, but here's the catch: The primary reason people can be ordered to get involuntary treatment is for being in such a state they pose imminent harm to themselves or others.

By definition, those are not people who can be released to the community, said Shoenfeld, whose office handles involuntary commitments.

"Basically, to get a commitment now, you have to be climbing the telephone pole, with a noose around your neck," said a mother with a mentally ill son, who did not want to be named for fear of jeopardizing her son's current care situation. "You're forced to watch your child spiral out of control."

Many families are desperate to get help sooner rather than later for loved ones who are coping with mental illness. But unlike in more than 40 other states, families in Washington can't petition to get someone into involuntary treatment.

Instead they have to go through a gatekeeper called a designated mental health professional -- a county worker who gets called in to collect evidence and make that determination. A staff of 28 such workers -- the same number there has been for the last decade -- is responsible for King County's 1.8 million residents.

This approach means only the sickest get committed for involuntary treatment -- and then only to inpatient care, an approach that also means foregoing the opportunity to intervene sooner when treatment might result in better outcomes.

ER backups

Even when patients do meet the threshold of being a danger to themselves or others, it doesn't guarantee they will get treated.

"The system is dramatically underfunded," said Roy-Byrne of Harborview's psych unit. "We don't have the capacity to see the people needed."

Washington has a severe shortage of beds -- about 19 beds per 100,000 residents, said Torrey.

The national recommendation is 50 psychiatric beds per 100,000 in population.

And the shortage is getting more acute. Budget cuts are forcing the closure of four more wards at Western and Eastern State hospitals by next year -- a total loss of 90 beds.

Meanwhile, some people put on involuntary holds simply wait them out in emergency rooms that aren't staffed to provide psychiatric care, a practice called "boarding." King County boards three to 19 patients a day in emergency rooms, depending on bed availability, Shoenfeld said.

Boarding patients in the emergency rooms is hazardous for the staff around them, and for the patients themselves, said Matt Goodheart, one of the county workers who has to make those involuntary detainment decisions.

"These patients are not receiving any psychiatric care and could go walking out of the ER they are in and hurt themselves or someone else."

A shortage of places to discharge patients also keeps them in the hospital longer than necessary.

"Today we have 120 people at Western State who are clinically cleared for discharge -- no longer at risk to self or others -- but who have significant support needs, and nowhere to go," said Richard Kellogg, head of the mental health division of the state Department of Social and Health Services.

"We wouldn't have backups if we had patient flow -- if we could get people out in a timely manner," he said. "In the short term, what is significantly lacking is housing alternatives -- housing connected to support services, employment and social networks."

Such housing, scarce to begin with, has been disappearing. King County recently closed several group homes with a total of 100 beds because of code violations, licensing and funding issues.

Bottlenecks impede care

The bottlenecks in the system keep people from getting better, which keeps them coming back to the emergency room, or jail, in crisis mode, which is where Goodheart sees them.

"I detained someone this week who had 19 previous psychiatric hospitalizations," said a weary-looking Goodheart, who spoke recently after coming off a night shift.

"Last night I evaluated someone who just came out of West Seattle (psych hospital) four days ago," he said. "People get let loose, and they are still really sick."

The trend is to push patients out the door with no follow-up, said Torrey. "They throw their medication in the garbage on the way out of the hospital."

Social Distancing

This is a good and appropriate term for the stigma of mental illness; while there are newer treatments available, there is still a wide stance of social distancing among the general public. Keep the conversation going should be our mantra!!! KTCG!

Americans Show Little Tolerance For Mental Illness Despite Growing Belief In Genetic Cause

Main Category: Mental Health
Also Included In: Genetics; Schizophrenia; Depression
Article Date: 01 Sep 2008 - 1:00 PDT

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A new study by University of Pennsylvania sociology professor Jason Schnittker shows that, while more Americans believe that mental illness has genetic causes, the nation is no more tolerant of the mentally ill than it was 10 years ago.

The study published online in the journal Social Science and Medicine uses a 2006 replication of the 1996 General Social Survey Mental Health Module to explore trends in public beliefs about mental illness in America, focusing in particular on public support for genetic arguments.

Prior medical-sociology studies reveal that public beliefs about mental illness reflect the dominant mental-illness treatment, the changing nature of media portrayals of the mentally ill and the prevailing wisdom of science and medicine.

Schnittker's study, "An Uncertain Revolution: Why the Rise of a Genetic Model of Mental Illness Has Not Increased Tolerance," attempts to address why tolerance of the mentally ill hasn't increased along with the rising popularity of a biomedical view of its causes. His study finds that different genetic arguments have, in fact, become more popular but have very different associations depending on the mental illness being considered.

"In the case of schizophrenia, genetic arguments are associated with fears regarding violence," Schnittker said. "In fact, attributing schizophrenia to genes is no different from attributing it to bad character - either way Americans see those with schizophrenia as 'damaged' in some essential way and, therefore, likely to be violent. However, when applied to depression, genetic arguments have very different connotations: they are associated with social acceptance. If you imagine that someone's depression is a genetic problem, the condition seems more real and less blameworthy: it's in their genes, they're not weak, so I should accept them for who they are."

Schnittker's study also shows that genetic arguments are associated with recommending medical treatment but are not associated with the perceived likelihood of improvement.

"While the stigma surrounding mental illness has not diminished, the rate of treatment for psychiatric disorders has increased," Schnittker wrote. "The culture surrounding mental illness has become more treatment-focused with direct-to-consumer advertising of psychiatric medications now a mainstay of popular media."

According to Schnittker's research, genetic arguments have, in fact, increased public support for medical treatment but at the same time aren't clearly associated with improvements in overall tolerance levels. The study explores tolerance in terms of social distancing: unwillingness to live next door to a mentally ill person, have a group home for the mentally ill in the neighborhood, spend an evening socializing with a mentally ill person, work closely with such a person on the job, make friends with someone with a mental illness or have a mentally ill person marry into the family.