Catch mental illness earlier with enhanced services

The recent tragedy on Roanoke, Virginia, that resulted in the murders of reporter Alison Parker, cameraman Adam Ward, and the suicide of Vester Lee Flanagan II, has raised the usual questions about the prevalence of guns and their availability to those with homicidal rage fueled by mental illness. It has also raised important questions regarding how employees with mental illness, their employers and co-workers’ can work together within the framework of the Americans with Disabilities Act to maintain a safe work site.

Yet, as we struggle to answer these questions, there are fundamental ways we can now act to address the inadequacies in our approach to mental healthcare and reduce the chances that lives are lost in the future:

▪ Continue to invest in mental illness anti-stigma programs that highlight the fact that the vast majority of people with mental illness, particularly those seeking treatment, are not dangerous.

Flanagan had a long history of abnormal behavior resulting in his being referred to a mental-health professional by his employer, television station WDBJ. But in his writings just before his death, Flanagan made clear his disdain for mental healthcare. He was a dangerous powder keg who exploded.

But, before a knee-jerk response is employed to place tighter controls on the lives of people with mental illness, we have to remember Flanagan was a horrifying exception to the general behavior of those with mental illness. Our response should be focused on his profile, and those of others like him in the past, that made them uniquely difficult and dangerous to society.

Provide greater funding for research and demonstration projects into earlier recognition and treatment of seriously persistent mental illness. From being fired at different jobs to moving across the street from WDBJ to killing his pets, Flanagan was exhibiting signs of mental illness long before the catastrophic events of Aug. 26. Though he apparently did not seek out mental healthcare, if he had seen a primary-care doctor as an adult or, in his youth, seen a teacher or school nurse, would there have been an opportunity to make an early intervention preventing this tragedy?

Already prevention efforts in reducing environmental toxins, such as lead, reducing fetal alcohol exposure and integrating mental-health professionals and screenings in schools, churches and work places have shown benefits in preventing early risks or signs of illness from becoming serious and persistent.

▪ Increase funding for rehabilitation services for those afflicted with seriously persistent mental illness and substance-use disorders. By all accounts so far, Flanagan did not have an alcohol or drug problem. However, the risk of a person with seriously persistent mental illness committing violence more than doubles when he or she is actively using substances.

As a psychiatrist working daily at Jackson Behavioral Health Hospital in Miami, I see patients with seriously persistent mental illness more often than not saddled with alcohol-, crack- or marijuana-use problems. Despite my treatment team’s best efforts to get them well as quickly as possible, there is little to offer them after hospitalization to aid their lifelong recovery from mental illness and to prevent their relapse on drugs or alcohol.

Without good rehabilitation services, people with the dual diagnoses of seriously persistent mental illness and substance-use disorders grow more likely to commit violence in the future.

▪ Increase funding for support services to family members trying to help people with seriously persistent mental illness. Though Flanagan took his rage out on former co-workers, the reality is, if a person with seriously persistent mental illness turns violent, the violence is more likely to turn against their own family members or friends. These family members are often between the rock and a hard place — wanting the best for their loved one, trying to cajole them to seek treatment and having to take the brunt of their loved one’s anger when in denial about being ill. Greater public support of programs, like the National Alliance on Mental Illness’ Family-to-Family Program, www .nami.org/Find-Support/NAM I-Programs/NAMl-Family-to-Family, which give tools to family members to better understand and support one another, including their loved one with mental illness, would help reduce the risk of future violence associated with mental illness.

It is too late to save Alison Parker and Adam Ward. It is too late to retrace our steps and prevent Flanagan’s rage. But, it is not too late for our society to do better in our mental healthcare.

Dr. Stephen Mcleod-Bryant is a faculty member of the University of Miami’s Department of Psychiatry.

This story was originally published September 12, 2015 at 2:11 PM with the headline "Catch mental illness earlier with enhanced services."