Changing the way we think about mental illness

by MICHELLE SCHMITT

A young man was walking down a Salt Lake City street. Police spotted him and branded him a suspicious-looking character, so they pursued him. The young man ran. Officers caught up with him and took him in for resisting arrest. It turns out the young man was a diagnosed schizophrenic.

This is just the type of issue that Sherri Wittwer, executive director of the National Alliance on Mental Illness (NAMI) in Utah, is fighting against.

“It’s scary that this happens in this country. When you talk about this group [that] tends to lag behind as far as rights in the disabled community … I had no idea that this stuff happened until I started this work,” said Wittwer, who joined NAMI four years ago.

Wittwer became involved when her son was diagnosed with depression at 13 years old. She noticed something was different about her firstborn in his early years, but thought it was just a matter of personality. Now with treatment and mental health understanding, she and her family are able to cope.

“The mentally ill are the most overlooked in the disabled community,” said Janis Tetro with the Disability Law Center.

Wittwer said the mentally ill are neglected because of stigmas. Unlike a physical ailment, mental illness is not visible. She wants people to know that disorders such as obsessive-compulsive, panic, post-traumatic stress, schizophrenia and bipolar, and illnesses including depression are biological brain disorders.

“I always used to say that these are not unlike diabetes and asthma, and yet, unlike diabetes and asthma you can be incarcerated for having an untreated mental illness and not necessarily because you’re dangerous, but because you’re ill, and that is a major difference,” Wittwer said.

Connie Hines, a spokeswoman for Valley Mental Health, said the Utah Legislature does not pay enough attention to issues of mental illness, which is one reason that VMH and similar organizations are drastically underfunded.

“The legislature considers us a black hole” when it comes to funding, Hines said. Because mental health advocates lack outcome data, which is information that demonstrates the effects of treatment, lawmakers are unable to see empirical evidence that treatment works.

But Rep. Carol Spackman Moss, D-Salt Lake City, said it is not that Utah representatives are not sympathetic toward the needs of the mentally disabled, there just is not enough money.

“More and more representatives are becoming more and more informed about the mentally ill,” Moss said.

Moss sponsored H.B. 101 in the 2009 general session. The bill would have created a “pilot program” for individuals who transition out of a hospital or jail and back into society. The program would provide funding for health service professionals to visit mentally ill people in their homes for regular check-ups.

The bill eventually failed on the house floor due to funding issues, but Moss said she is still working on it for future passage.

We need to do “what we can to help the funding to make the program viable,” Moss said. Although the cost would be about $10,000 to $15,000 per patient, it is not high when compared to alternative fees, such as hospital bills, court fines and incarceration, she said.

Wittwer said a common crime committed by a mentally ill individual is disturbing the peace. She said police do not know how to handle the person, so they will just arrest the individual.

“Our jails and prisons are the largest mental health institutions in our country, far ahead of state hospitals,” Wittwer said. The real issue, she said, is criminalizing mental illness for those who simply do not have access to treatment.

NAMI focuses on trying to “break the cycle” of the mentally ill going to prison, not receiving treatment, being released and then going right back to jail. Wittwer said some people are booked in the Salt Lake County Jail up to 50 times a year.

“We can’t build enough jails to keep housing people. We have to look at this problem differently,” Wittwer said.

NAMI has begun to try to alleviate some of these dilemmas. Wittwer talked about NAMI’s Bridges Program in which people who are treating their own disorder participate in peer-to-peer counseling and go to the prisons to help the incarcerated.

Salt Lake, Utah and Cache counties have instigated mental health courts that are designed to facilitate treatment for the mentally ill, while still holding the individual accountable for the crime that was committed.

But the biggest challenge, Wittwer said, is to address the stigmas that go along with mental illness.

Janis Tetro, with the Disability Law Center, believes “people are scared.” “I think they see the headlines and assume the mentally ill are dangerous, and this is just not the case.”

In fact, Wittwer said the mentally disabled are more often the victim rather than the offender because their illness makes them more vulnerable and less able to defend themselves.

At VMH, Hines puts importance on responding to questions from the media and from schools. She thinks it is necessary to be available to clarify and respond to questions about mental health.

Another misconception is that mental illness is the result of “lack of will power, lack of character,” Wittwer said. She wants people to know it is treatable.

But Utah is not winning its battle to provide appropriate help to the mentally ill.  According to NAMI’s “U.S. report card,” Utah got a “D,” which is also the national average.

Wittwer said there are many reasons for our state’s poor grade. She emphasized the importance of educating hospital staff, law enforcement officers and court employees so they are better equipped to handle a person who has not received treatment for their illness.

Wittwer insists we must change the way we do things. “There are better, more effective, more cost-effective, more individual and family friendly ways that we should be dealing with these issues.”

Hines lauded the efforts NAMI has made to advocate for individuals and their families. She said while VMH focuses on treatment, NAMI has made significant efforts to spread awareness and provide training for families who may need to care for a mentally disabled loved one.

Tetro said a common problem arises when a mentally disabled individual tries to rent an apartment and the property owner discovers the individual has an illness, so the landlord does not rent the space. This is a scenario that Tetro chalks up to discrimination and lack of education.

“I think people would be amazed to find how many people who have a mental illness are productive members of our society,” Tetro said.

Wittwer said one out of four adults will suffer from a mental illness each year, and although those who suffer are often overlooked as members of the extensive disabled community, they are not part of a “fringe” group in our society.

“So that’s what we want people to know; that there is hope out there, treatment works, recovery is possible, and no one has to feel alone because there are others who have walked this walk,” Wittwer said.

Mental illness affects more than the diagnosed

Story and photo by EMILY A. SHOWGREN

Harmony's ex-husband was treated at UNI for his mental illness.

Harmony's ex-husband was treated at UNI for his mental illness.

About one in four adults and one in five children suffer from a diagnosable mental illness, according to the National Institute of Mental Illness.

There are many reasons why a person develops a mental illness. There are also many examples of how the effects of a mental illness can affect relationships, especially marriage and family.

When Harmony met her future husband online, he told her he had post-traumatic stress disorder (PTSD), but it was under control. 

“He said he had been in counseling for PTSD for 20 years but he had it under control and things were fine,” said Harmony, who asked that only her first name be used for safety reasons. She later found out it was not under control and he had been diagnosed with bipolar disorder as well.

Harmony moved from Australia to Utah and the couple decided to marry. She had two young daughters at the time. But her husband’s mental illnesses strained not only their relationship, but also the relationship with her and her daughters.

“There were times where I had to put my children second. He forced me to put him first and it pushed them away,” Harmony said.

Her daughters were so young they did not understand their stepfather had problems.

“After the divorce, they didn’t trust me for awhile. They were resentful,” she said.

Dr. Herman Peine, a licensed psychologist in Salt Lake City, said the most dangerous patients are the ones with narcissistic personalities, or people who think only of themselves. He said when he sees a narcissistic patient, he will sometimes bring in their spouse after their first meeting and tell them to “run, run, run.”

Harmony said her husband was dangerous. He abused her emotionally and psychologically most of their marriage.

“He had to be in control. He would control the money, degrade me in front of my kids and he would use his depression to control me,” Harmony said.

She said if he was not getting attention he would threaten to kill himself, overdose on pills, or cut himself. It was after a physical beating that Harmony left.

“The connections between domestic violence and mental illness are numerous and complicated,” said Dr. Melissa Galvin of the University of Alabama at Birmingham during a seminar in 2006. Galvin also said researchers at John Hopkins University found that “adolescents who see domestic violence between their parents are far more likely to suffer symptoms of clinical depression – including headaches, digestive problems, social isolation, insomnia, and thoughts of suicide.” This is an example of how mental illness affects the entire family.

A 2007 article by the National Alliance on Mental Illness (NAMI) in Fort Wayne, Ind., said it is important to set boundaries in families with a person who has a mental illness.

“In a marriage where one partner is mentally ill, the well spouse must aggressively set and enforce boundaries if the family is to survive. Boundaries are absolutely vital to the survival of the family,” said Kathy Bayes, executive director of NAMI.

Something that Dr. Peine finds absolutely necessary is “to get a proper diagnosis.” Without that, the medications and other remedies are not going to work.

Sometimes if the patient feels like the medication they are on is not working, they will decide to discontinue it. Sometimes it takes family to get them back on track.

“A lot of times their family will bring them into the ER because they want the meds back,” said Dr. Dean Orton, who works in family practice and the ER in Lincoln City, Ore. “At that point [after quitting medication] they become fairly psychotic and are in the hypo-manic stage.” When it reaches that point, medication is necessary.

“Sometimes the patients who know or feel they want to hurt themselves come because they need to talk,” Orton said. “We help them get counseling — a support system. Medications are not administered immediately in that case.”

Another example in Harmony’s life dealt with medication and the abuse of it. Her husband was a drug seeker. She said he would hear about different disorders on commercials or read about them. He would go to different doctors and tell them he had symptoms related to disorders ranging from insomnia to restless legs syndrome in order to get medications. Anything he could get his hands on, he would use.

“One time I had a horrible toothache and he took me to the ER to get something for it. The doctor gave me hydrocodone. I used it a couple times but I didn’t like the way it made me feel,” Harmony said. Her husband finished it off.

Harmony said she had once filled up a garbage bag with all the medicine she found in the medicine cabinet.

“It is very common to see other drug abuse. Any mind-altering substance – illicit or legal,” Orton said.

According to the National Drug Intelligence Center, disorders like bipolar, PTSD and anti-social disorder are associated with chronic drug abuse. The National Institute of Mental Health reports that those who have anti-social disorder are at a 15.5 percent risk of drug abuse. On the other side of things, abusing drugs like ecstasy can also cause mental illness, like depression and anxiety.

However, this should not deter anyone from going on the correct medication. Peine said that getting kids diagnosed early and getting them on medication will actually lead them away from drug abuse later in life.

Children, especially those of a parent with a mental illness, are susceptible to developing a mental illness. “Young people growing up with parents dealing with emotional problems are at greater risk of having behavioral/emotional problems themselves due to genetic factors and harmful psychosocial experiences,” said Dr. Michelle D. Sherman in an article for Social Work Today. However, Sherman also said these children can develop valuable personal strengths like compassion, sensitivity, resourcefulness, strength and independence.

Sherman said making sure a child understands what his or her parent is going through is important. There are ways of helping children cope when a parent has a mental illness, like keeping a stable home environment, making sure the child knows it is not his or her fault and showing them they are loved.

Harmony, who is now divorced, is working full time and her daughters are doing well in school. “My life has been so much more peaceful since he’s been gone. My girls are more relaxed and even our dog is more relaxed and happy,” she said.