Parents: Mental health lessons from the Tucson tragedy

James A. Cohen in USA Today, January 13, 2011

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By Liz Szabo, USA TODAY

The deadly shooting in Tucson last week should remind families of the importance of getting help for troubled children, mental health experts say. But parents of young adults struggling with mental illness may feel helpless to help them, even once a problem has been diagnosed.

You can't force them to see a doctor, or even to follow up on their treatment or medication.

Hearing about the Tucson rampage or the Virginia Tech massacre of students by a classmate or other such horrific events can be terrifying to parents of mentally unstable older children. Could this kind of thing happen to their family? Will they one day get a phone call from the police informing them of something terrible their child has done?

While parents can take a young child to a pediatrician, experts acknowledge that getting help for adult children — especially those who resist treatment — can be a challenge.

"If you have a heart attack or a broken arm, everyone knows where to get services," said Michael Fitzpatrick of the National Alliance on Mental Illness. "If someone has bipolar disorder or psychosis, it's less clear where to get care."

In some ways, young adults are very vulnerable to mental health crises, said Paul Ragan, associate professor of psychiatry at the Vanderbilt University School of Medicine in Nashville.

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Although people in their early 20s are in the prime of their physical health, they're also going through huge changes — such as graduating college, moving away, starting a new job — that leave them without important support structures, he said.

Ragan notes that, according to the Centers for Disease Control and Prevention, the three leading causes of death for people ages 15 to 24 all involve some kind of violence or trauma: unintentional injury, homicide and suicide.

Young adulthood — the late teens and early 20s — is also a time when many mentally ill people experience their first psychotic break, Ragan said. Although none of the experts interviewed for this story have personal knowledge of Jared Loughner, the 22-year-old accused gunman in the Tucson shooting, Ragan and others said that his behavior strongly suggests paranoid schizophrenia.

In many cases, the best place to begin to help troubled youth is by talking to a family doctor or pediatrician, particularly one who knows the patient well, said David Pickar, an adjunct professor of psychiatry at Johns Hopkins University School of Medicine in Baltimore.

A family doctor can help refer patients to a mental health specialist, he said.

Parents should consider taking an ill child to their own psychiatrist or doctor, and accompanying them to the appointment, Ragan said.

Adult children often can be included on their parents' health plan, Fitzgerald said.

And federal law now requires that health insurance plans — many of which once provided little mental health coverage — make no distinction between medical/surgical care and mental health care, Fitzgerald said. He hopes that will encourage more psychiatrists, many of whom have worked on a cash-only basis, to resume taking health insurance.

Yet as kids grow up and move away from home, parents may not see a mentally ill child every day, making it harder to help. That makes it important for others in the community to speak up if they're concerned, Ragan said.

In Arizona, anyone — such as a classmate, professor or employer — can request that a person showing signs of mental illness undergo a psychiatric evaluation, said forensic psychiatrist Jack Potts of Phoenix.

Many colleges and universities have mental health centers and counselors who can help, while cities and counties usually have community mental health centers, Fitzpatrick said.

In the military — where many young recruits are in their teens and 20s — a commander can order someone to undergo a psychiatric evaluation, Ragan said.

People also can bring a mentally ill person to the emergency room, where doctors can evaluate them and admit them for psychiatric care, Potts said. In extreme cases, when someone is being disruptive or dangerous, people can call the police, who also can take the person to a hospital, Ragan said.

Most people who are committed to psychiatric care do so voluntarily, because they know they need help, said James Cohen, a defense attorney and professor at Fordham Law School who teaches psychology and criminal law.

Psychotic patients may not realize how sick they are, however, and may refuse care or medication, Cohen said.

In this case, people can file a petition to have a mentally ill person committed involuntarily, Potts said. In many states, a judge will agree to commit a patient only if the person poses a danger to himself or others, or if he is profoundly disabled by medical illness. Arizona makes involuntary commitment slightly easier, allowing people to be sent to a psychiatric facility if they are deteriorating and could benefit from treatment.

In other states, parents' options are more limited, Cohen said.

"There's very little that parents can do with an uncooperative child who has mental illness," Cohen said. "Even if police are called, the police aren't going to do anything unless they seem like a danger to themselves or others. Often, police won't even take them to the hospital."

Ragan said concerned parents shouldn't give up hope. "The majority of people with mental illness, if only by trial and error, manage to get help."