If we want more evidence-based practice, we need more practice-based evidence.*

 


Chapter 9 - Archives of Headlines
Community Mental and Social Health


Health Canada Online gets REAL
(Health Canada, 5 October 1998)- Family violence, especially as it affects children, is a major health concern for Canadians. REAL Health, the new electronic magazine from Health Canada Online, gives readers a general overview of this serious health problem, provides links to in-depth information on what Health Canada is doing, and points to many other relevant sources on the Internet.


Network and CD-ROM launched to improve mental health of young Canadians
(24 September 1998)
Health Minister Allan Rock announced two important new initiatives promoting positive mental health in Canada's young people. The two new resources were unveiled by Health Canada and its partners during the annual conference of the Canadian Mental Health Association in Charlottetown. - National Youth Network is being created, for and by young people, to bring together youth and those who work with youth in the fields of mental health, education and community action to promote open discussion about the life experiences they face today. - Mauve is an interactive CD-ROM for crisis prevention, created by and for teens in collaboration with mental health and multimedia professionals. It is an interactive learning aid for teenagers covering topics such as life, love, school, family, and friendship, as well as depression, suicide, drug abuse, school drop-out, and delinquency. For more information, visit
http://www.hc-sc.gc.ca/english/media/releases/1998/98_63e.htm


U.S. Mental Health System in "State of Third World Collapse"
Weston Got Gun Permit Despite Mental Illness

Russell Eugene Weston Jr.'s sudden descent into violence probably could not have been predicted, but it might have been prevented by a mental health system better equipped to monitor patients before they become obvious threats, mental health specialists told the Washington Post Monday, July 27.

The idea of the mental health system, of course, is to treat people with psychiatric problems -- not just to prevent them from storming the Capitol or committing other acts of violence, but to help them lead productive lives. That system broke down in its tracking of Weston, who was forced out of Montana with court orders to continue mental health treatment, but soon quit treatment and stopped taking his medications in Illinois.

In Montana, one of just three states that does not recognize the insanity defense, officials have declined to discuss the specifics of Weston's case, citing privacy concerns. But Wesley Alcorn, an advocate for the mentally ill in Montana, described his state's decision to release Weston to the Illinois system as "Greyhound therapy: Put him on the bus and your problem disappears." He said it was typical of a state that has few mental health resources for anyone who is not ill enough to require hospitalization.

"This system is in a state of Third World collapse, and no one wants to pay to fix it, man," said Alcorn. "That's why this tragedy happened."

Robert Singer, clinical coordinator of Human Support Services, the community mental health center in Waterloo, Ill., declined to comment on Weston's treatment there. But he did point out that there is not much his clinic can do to make sure patients show up for counseling and take their medications. The clinic makes several attempts to contact patients by telephone and mail, then sends them letters terminating their cases, he said.

Illinois and Montana are among a growing number of states with laws allowing judges to force the mentally ill to comply with treatment outside a hospital, a sentence known as outpatient commitment. However, it is rarely used in either state.

"In the 10 years I've been at this agency, we've had one case like that and it wasn't Weston," Singer said. "It's not illegal to stop taking your meds. A lot of this becomes a question of individual rights, a legal issue. It's a delicate balance."

Illinois mental health advocates do not argue that Weston should have been committed, or even forced to take his medications. But they do question whether he received the oversight he needed, a problem they say is common in their state -- especially for poorly functioning patients who are more likely to miss appointments and ignore prescriptions.

"It's gotten a little better, but we still need to provide better services to people early, so we don't need to commit them later," said Zena Naiditch, president of Equipped for Equality, a disability rights group in Illinois. "I don't know if this tragedy could have been prevented. But I do know that it helps to make services available."

The ability of psychiatrists to predict dangerousness -- and the discretion of judges to commit people to hospitals against their will -- have been a frequent source of debate and litigation. Civil libertarians who oppose involuntary commitment often cite studies from the 1960s and 1970s arguing that predictions are about as reliable as coin tosses. But some mental health advocacy groups have argued that the pendulum has swung too far away from civil commitment, and have urged lawmakers to make it easier to force people into treatment.

An estimated 2.5 million Americans suffer from schizophrenia, and about a third of them are paranoid schizophrenics, convinced that they have been targeted for harm. In the spring of 1996, the Secret Service, which often consults with mental health professionals for advice about people like Weston, investigated paranoid comments he made about Clinton, but concluded he was a "low-level threat" and did not consult other agencies. That summer, Weston paid a bizarre two-hour visit to the CIA, explaining to a security officer that he received "special presidential programming through interactive television and radio," but the agency just sent a memo to the Secret Service.

Weston managed to avoid confinement until that fall, when a Montana judge committed him to the state mental hospital in Warm Springs after he threatened a Helena resident. But doctors there released him after 52 days, on the condition that he leave Montana and continue his treatments at a clinic near his parents' home in Waterloo, Ill. He still managed to get an Illinois gun permit earlier this year, although authorities believe the .38 Smith & Wesson he brought to the Capitol was stolen from his father, sources said.

Those may sound like tepid responses, but America has moved away from the days when schizophrenics like Weston were regularly forced into overcrowded mental institutions. That changed in the early 1960s with the advent of Thorazine, the first of a host of antipsychotic drugs that have changed the culture of mental illness. The drugs, along with revelations about poor conditions at hospitals and concerns about costs, led to a pattern of deinstitutionalization that began in the 1970s and accelerated in the 1980s.

In the 1990s, most schizophrenics live much more normal lives in the community. And authorities are now much more reluctant to seek involuntary commitments, which usually require evidence that the patient poses a danger to himself or others, or is incapable of caring for himself. To the federal agencies that encountered Weston's delusional behavior, he didn't seem to qualify. Paranoia is not a crime. Fantasies are not the same as threats.

"Look, the guy seemed like a garden-variety nut," one government source said. "In the United States of America, you're allowed to be a garden-variety nut."


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