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Each has good points – and a glaring oversight

Both these bills address some very relevant issues in contemporary mental health. I disagree with Rep. Tim Murphy’s assertion that the present government policies and bureaucracies don’t place enough emphasis on the severely mentally ill. The community mental health system is geared primarily to serving the severely mentally ill.

Murphy is absolutely correct in highlighting the substantially mentally ill person’s inability to exercise free will. It is society’s obligation to take charge in that situation and protect the ill person as well as society from dangerous consequences of untreated mental illness. I fully support the provision for exchanging information with family and caregivers.

Murphy’s proposal about oversight of outcome to optimize resource utilization is also quite welcome. It would be important, however, to make sure that the oversight focuses on the spirit of the law rather than just the letter of the law. Too often, oversight is carried out by bureaucrats with little insight into the spirit of the law. It therefore degenerates into a bureaucratic paperwork exercise. Care providers should not have to waste time in meeting the nominal requirements of the law but use their time and energy in provision of services. I have often seen mental health care providers demoralized with a burden of paperwork designed to meet bureaucratic oversight requirements that have little to do with the patient’s welfare.

In my three decades of mental health practice, I have seen little constructive focus in protection and advocacy programs. Protection and advocacy resources should be primarily focused on identifying treatment settings where patient rights are systemically violated. Their ritualistic and/or overzealous second-guessing of well-intentioned professionally recommended treatment can be wasteful or damaging.

I agree with Rep. Ron Barber that community mental health agencies need more resources, but I’m very much for building in outcome assessment in the process of resource allocation.

Regarding bullying prevention, it is important to understand family and social dynamics underlying phenomena such as bullying. There are complex individual, family and social dynamics on both sides of the bullying situation: the victim as well as the perpetrator. Simplistic solutions such as bullying counseling may not suffice. Cause-and-effect relationship between mental illness and bullying is complex. Any reductionistic approach would not do us much good in this area.

An area neither of these bills addresses is research funding. Somehow the primary focus in mental health research funding has been on biological variables. Very little consideration is being given to good research in the area of psychological, interpersonal and social variables. That imbalance too needs to be corrected.

Dr. Prevesh Rustagi is a psychiatrist with Fort Wayne Psychiatry. He wrote this for The Journal Gazette.

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