You can blame the schools for misdiagnosing ADHD, and you can blame them for a poor IEP, but you can't blame them for a child not having a normal life due to one of the most tragic diseases known to man.
Schizophrenia is not the kind of disease you can treat with an IEP, and it sounds like the author's son fell out of the system from a very young age. Trying to blame anything but genetics and development for his son's state is disingenuous - treating schizophrenia is a complicated, involved, and ultimately very stressful process for everyone involved, and in the end it can only bring someone on the brink of homelessness or self-harm into a situation where they can be stable most of the time, but never all of the time, or even almost always.
> The word “disability,” for instance, should have covered Tim and children like him.
ADHD or blindness are not even in the same room a schizophrenia. It's like comparing having six toes on your left foot to being comatose.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
Teachers have enough on their plate, and more importantly, that's not what teachers are for. It sounds like the author took his son to plenty of mental health professionals, and he still wasn't properly diagnosed until he was nearly an adult.
> I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams.
Many mental health diseases don't manifest to the levels for proper diagnosis until adulthood, and even then the process of diagnosis is not scientific.
> I’d put much more money into community mental health services...
All of that sounds great, but mental health services are one of the first things cut into in a down economy.
> Tim is where he is today because of a host of public policy decisions we’ve made in this country.
No, he isn't. The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'
This fatalistic attitude isn't wrong, but it is manifestly unhelpful and surprisingly expensive. Being homeless is not a zero-cost alternative to real treatment; in many cases, the cost of lavish treatment is far lower than the cost of ER visits and criminal proceedings that would otherwise be incurred. I believe Malcolm Gladwell wrote an article about chronic homelessness a few years ago, about Denver rolling out a program to take some number of homeless folks and set them up in an apartment free of charge with on-site nursing 24/7, and it was saving the city millions just by keeping them out of the ER. I believe the program ultimately came under fire because of how essentially un-American such a system is, even when it makes both ethical and financial sense.
His son might not have been contributing, but having him homeless and bouncing in and out of jails is more expensive to society than appropriate institutional support.
Furthermore one of the stated issues is his unwillingness to take antipsychotic medication, and one of the characteristic traits is that in a structured jail environment, where he's presumably receiving those medications, he is able to function well. That indicates that with a proper support system that includes support to make sure that he takes the required medication, he might have a shot at being a contributing member of society.
Schizophrenia is a severe mental disease that can absolutely be treated with a comprehensive treatment plan, including medication and psychosocial interventions (including an IEP).
I didn't think the author was stating that his son wouldn't have schizophrenia if the schools had done better. I think he was saying that his son would have a better outcome with his chronic severe mental illness if various government agencies and actors were better organizing to identify and treat the illness.
Perhaps it's fair to say that Tim is where he is today because of his mental illness and a host of public policy decisions we've made in this country around how we treat mental illness.
I think you've missed the point of the article. The author isn't saying that Tim would be normal but for the policy changes. He's saying Tim wouldn't be out on the street. Which is true--there has been a huge scaling back of mental health services in this country, not just in the down economy but over the past 30 years.
> The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'
I have met very many people with a diagnosis of schizophrenia. Some of those people were drug users (or had been drug users); some of those people were "forensic" patients and were being held in secure hospitals; some of those people were in the community, on medication, with full time work.
Schizophrenia is a complex illness that expresses in a wide range of behaviours, and a broad depth of severities of behaviours. One person may hear a few voices, but be able to cope well with those voices, while another people may hear more voices which are very threatening and hard to cope with.
Please, I understand what you're saying. (Some people with schizophrenia are very ill, and will need extensive support just to avoid homelessness) but I find your comment a bit stigmatising. Many people with schizophrenia do work; not all of them work full time paid employment but it's certainly possible for someone with a diagnosis of schizophrenia to lead a full and productive life.
"The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society."
In many less developed countries people with schizophrenia have better outcomes. It's only in the US where the condition is usually debilitating for life, because:
A) The US healthcare system relies on longterm use of anti-psychotic medication as the main form of treatment, which tends to lead to worse outcomes in the long run.
B) Family relationships in the US are generally not conducive to properly recovering from schizophrenia.
In other countries the people aren't completely normally, but they're also generally not completely unable to hold a job for their entire lives like in the US.
I completely agree with you. I think these demands on society are unrealistic. You can't expect that out of teachers and pediatricians.
My experience with the school system (I have a daughter with autism) has been much better then his sounds (I hope so given it's 40 years later). We have no push back in getting our developmental pediatricians' input into our daughter's IEP. Our school provides speech and occupational therapy. But as you mentioned, schizophrenia is a whole other world (even from autism in my opinion). There is no cure. There are only lesser of many evils. You can't expect society to fix that.
One thing that really bothers me are these crazy statistics - "one in every five children and one in every four adults has a diagnosable mental illness. A quarter of all mental illnesses are considered serious." One in four? Come on. If the bar is so low that one in four have a mental diagnosis it makes the term meaningless. It drives my wife and I crazy when parents claim there kid had autism but after a month on this fad diet or other they are now cured. Guess what - your kid never had autism! Don't tell that to a parent who knows their daughter will likely never leave home, never marry, and probably never hold down a meaningful job. It's just insulting.
> it's very unlikely that his son would have ever been a contributing member of society.
I'm having trouble getting past this comment. I don't wish to malign you debacle - I'm sure you're not being malicious - but it seems like a very unkind & privileged mindset. I hope this isn't representative of the community.
Paul Gionfriddo certainly doesn't consider his son to lack contribution.
I just finished my Psychiatry rotation as part of my training and there are three things, of many, that I learned: First, America has a long way to go in developing the best screening and management tools for people with mental disabilities. Second, schizophrenia is an incredibly complicated illness that can take manifest in a whole host of unsuspecting symptoms, and is not easily treatable. And third, diagnosing and treating a mental disorder in children is really hard.
The last two points, I think, are very relevant to this article. While I sympathize with you, understand that child development is a very, very complicated thing. You have naturally hyper children, naturally withdrawn children, etc, and physicians are very wary to label any child with an illness, especially schizophrenia. When we're adults and have leveled out, it's easier to discern what is "normal" from "abnormal." But children are constantly changing, being molded by their environment, and so it's much harder to outline a symptomatic threshold of what's considered normal. Additionally, children exhibit mental disorders in very different ways than adult do; there are different sets of symptoms to look out for. And these symptoms can be anything from "pressured speech" (talking too fast. some kids are just naturally fast talkers, right?) to auditory hallucinations (but the child could have a vivid imagination, right?).
The treatment for schizophrenia is an entirely different beast. The goal is usually to just suppress the symptoms and to restore the patient to a functional baseline. In many cases, the disease progresses and the prognosis worsens. In your case, your child had early-onset schizophrenia, which is associated with a worse prognosis than late-onset cases.
Although there are studies that show that early detection and treatment of schizophrenia can improve the course of the disease, chances are your kid would have still developed much of the same symptoms and issues that he has now. It really sucks, and I sympathize with you, but that's the nature of the disorder. It's terrible, difficult to manage effectively, and can ruin lives. I've seen it.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.
I was recently watching a program talking about the somewhat controversial theory that schizophrenia (and other mental disorders) are either parasitic in origin or that parasites may simply contribute [1] [2].
The culprit in this case being toxoplasmosis. There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].
At the same time the elimination of parasites is arguably related to the rise of autoimmune diseases in the developed world (the so-called "hygine hypothesis" [4]). For example, hookworms may combat asthma and other allergies [5].,
I wonder if the coming century will be a revolution in mental health as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
Schizophrenia like autism is not something to pin down to any one cause. The symptoms are like an equation and the defects are the values which cause the expression of the disease/satisfy the equation/describe the surface. There are many genes that are culprit to the disease as well a number of environmental factors, so it is possible that parasites may induce the symptoms for certain (possibly less robust) phenotypes. But it does not mean that the disease is caused by parasites any more than a plane can be a point.
One hypothesis I read recently is that schizophrenia is an emergent phenomenon of a brain trying to compensate for any number of gene induced deficiencies in wiring but instead over compensating due in part to the faulty wiring in the first place, thus creating a negative feedback loop as the brain develops and wires itself.
Again on connectivity errors, schizophrenia is also associated with a malfunction in how the default mode and task positive networks interact with each other, where in schizo, default is not properly attenuated leading to higher likelihood of dissociativity. I read recently on using ketamine to study this particular malfunction: see http://www.schizophreniaforum.org/new/detail.asp?id=1809
As for [4] it is worth reading: http://www.bmj.com/content/345/bmj.e6673. Aside from the separate dangers of overuse of antibiotics, the matter is way more subtle than being too clean. Yes we have lost contact with certain reinforcing environmental pathogens, but it is also true that the gain from cleanliness far outmatches the current risk of autoimmune disorders.
UK researchers say that they have dismantled the “myth” that allergic diseases have risen to epidemic levels because people now live in sterile homes and have become “too clean.”
....
The report says that although deficiencies in microbial exposure could be important in the rise in allergies and chronic inflammatory diseases—driven also by genetic predisposition and modern lifestyle factors such as different diets, stress, inactivity, and pollution—it is not yet clear how the trend can be reversed.
Rook said, “There are lots of ideas being explored, but relaxing hygiene regimes won’t reunite us with our old friends—just expose us to new enemies like E coli 0104.”
Responding to your first comment about teachers not being psychiatrists, I agree with that observation but disagree that this means teachers should not be trained to recognize the signs of mental and other disabilities. The tendency today is often to ignore the problem, given there is little penalty for failing to intervene. But there are heavy costs to individuals and society.
As an example, when I was growing up I was extremely nearsighted but didn't get glasses until I was out of the home and in college. I was unable to read the chalkboard from K through 12. Yet no teacher intervened to suggest glasses to my parents, or to suggest I see an eye doctor. Only when a college prof noticed that I was squinting my eyes at the board and said "hey man, you need glasses!" did I get my eyes examined and discover what the world looked like in focus.
Along the way, everyone from the public school nurses who administered eye and hearing tests to a DMV examiner fudged my eye test results to "help" me pass those tests. And I was pretty good at doing things with limited vision. I know I'm not alone in this regard -- many children find a way to get by with a range of limitations because they don't know there is an alternative.
But we're living in the modern world, and many limitations can be controlled given early intervention. And teachers are well positioned to observe children over extended periods of time, while doctor visits are often 5 minutes ling and most children will never see a psychiatrist at all.
You wrote "This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].". First of all, if you read the article you reference, you'll note that Heliobacter Pylori is a bacterium, not a virus. Second, the presence of h. pylori in the gut is not conclusively proven to be a causal relationship for ulcers. That is, in some people h. pylori is just part of the normal gut flora. Further, it HAS been shown that stress is a strong cofactor in peptic ulcers.
I heavily doubt that there we'll find a single cause for what essentially can be described as faulty wiring in the brain. Drugs, genetic predisposition and a whole lot of other causes could be the trigger just as well.
> but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.
rather to the contrary, i think. Or you haven't had occasion to attempt teaching enough?
> There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
As I recall, this was more recently debunked, largely on the basis of correlation/causation confusion. ... Unfortunately, I failed in googling the counterpoint. Don't take my word for it, obviously. But consider: the popularity of cat-themes, and of mental-health quackery, especially on the internet.
OTOH, my grandmother, who was paranoid schizophrenic, refused to spay/neuter her cats because she had, to her, important conversations with them. So maybe you/they are correct.
Also note, the fluoridation of the public water supply may be sapping our precious bodily fluids[1].
> ...as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
It is not that hard to recognize symptoms of mental illness. You certainly don't need to be a psychiatrist or a clinical psychologist. You don't even need to be a LCSW or a LPC.
It would be, at most, a single course in an undergraduate or a graduate program. It could probably be rolled in to existing curricula just as a chapter or an exam as a component of a related class.
We're not talking about diagnosis, just recognition of symptoms to the point where a referral can be made.
We're so used to political debates where the Republicans say "less regulation will solve X", the Democrats say "more spending will solve X", the libertarians say "X is none of the government's business", and each suggests that things will go swimmingly under their preferred way of attacking the problem.
Some things, though, just suck.
Schizophrenia is one of those things. You can't cure it. You can't treat it very well. There's not much to be done.
Sometimes bad things happen to good people, and no amount of "training teachers" or "diagnosing diseases" or whatever will change that.
I think this is too fatalistic. This sets the bar far too low -- you could substitute poverty or crime in here without substantially altering the meaning. No, you cannot "cure" it or "fix" it, but the alternative isn't "do nothing." That's a false dichotomy.
At a minimum you can look for ways mitigate the impact it has on our society. See the pieces elsewhere in this thread which discuss the cost to our society incurred by ER visits from the mentally ill and/or homeless. That's a trivial example.
It might be worth discussing how other western industrialized nations approach this; I suspect that those countries which have some kind of socialized health infrastructure do more than the US than shrug their shoulders and avert their eyes.
Tragedy yes, though I do believe that if it was caught earlier and appropriate help was provided while the child was younger. The tragic outcome may have been avoided. There are a lot of people who live with Schizophrenia and live 'relatively' productive lives. I believe he could have been one too.
"Every year, one in every five children and one in every four adults has a diagnosable mental illness. A quarter of all mental illnesses are considered serious."
What a timely article. Just today received a call from the school that my grade 3 son had thrown a girl to the ground threatening her. This was the second incident in a week. A team of councilors and mental health workers were called in as an emergency response team.
The similarities between the child in the article and my son are startling and scary.
Although we are still at the beginning of our story, I do believe that in my area in Canada, the system has gotten better. I can only hope that this continues and the system does not let him down like it did to the child in the article.
My son will be seeing a counselor and accessing services that were previously unavailable to us starting in 2 days. Thanks Hacker News, you are always so poignant.
I'd go easy on that counselling and do my best to figure out first what actually happened.
It would not be the first time that the visible aggressor was in fact the victim of a long drawn out teasing campaign by a group of bullies, and girls can be bullies just as easy as boys.
One of the best bits of fun seems to be to goad someone until they snap and then let them take the blame for it all.
One of the major problems that I've seen first hand with mental illness is that the diagnosis is so subjective and often times relies on accounts of the patient and family. If you have family who don't know what to look for or the patient doesn't know how to explain it or is under the duress of the illness at the time, you run the chance of misdiagnosis.
This happened to me. My senior year of high school I had a "breakdown" of sorts. I was suspended from school until I saw a mental health professional. After the first visit, I was diagnosed with Bipolar disorder and given meds to treat it. After awhile, the diagnosis changed to Schizo-affective disorder and more drugs were added to help. Finally, I was diagnosed with epilepsy and told that the mental health diagnosis were wrong since epilepsy can cause both depression and hallucinations if untreated.
I shared my story for a few reasons. One the brain is complex and there can be many factors that causes symptoms. If mental health professionals can't get it right, there is no way to expect teachers or school administrators to get it right. I was lucky and had phenomenal insurance at the time that I went through that ordeal. Because of that, I was able to get tests and scans that I know others wouldn't not be able to afford. I fortunate enough to have a parent who could afford for me to get a SPECT scan which is (or was) considered cutting edge and would not be covered under insurance. That was what helped the neuro-psychiatrist realize that I have epilepsy and not a mental illness. Many people can't afford these things. Had I not had that scan, I would still probably be taking 20 pills a day and having to wake up early to take Adderall so that I'm able to physically wake up in time to be functional and the worst part is, that would be all for naught. It wouldn't help me since I don't have any problems.
There is so much wrong with the mental health system (at least in the US) that it really makes me sad. You start at the education level (such as the article talks about) but then when you move to insurance, so much isn't covered that it becomes either pay out of pocket or just let the individual suffer.
My old eyes cannot handle very very long lines of very small type, and after several tries I was not able to guess the URL for the story in human friendly form.
Please submit links for humans, not machines. Add the machine link in a comment if you wish.
PS: I'm aware of Readability and the ability to increase font sizes. There are other problems in general with print links that those do not address:
• Print links generally do not include extras like comments. This particular story had a large number of comments at the original site.
• Although not applicable in this particular case, stories often include sidebar links to related stories, and these are often omitted from print links.
• The non-print link usually includes a very easy way to get to the print version. Typically, you just click a print icon and you are there. The print link, on the other hand, usually does not include any link or other mechanism to get to the non-print version (other than the "back" button if you happened to have come from the non-print version).
Taking this all into account, particularly the last part about it being very easy to get to the print link from the non-print link, and not easy to go the other way, in almost all cases the link submitted should be the non-print link.
PPS: there are some sites that offer an "all on one page" link, which is distinct from the print link. The former simply does away with splitting the article into pages, keeping the comments and sidebar links and human-friendly formatting. Submitting "all on one page" links is great.
I'm out of words. Here everybody seem saying smart words about being mentally disable/ill, about politics and so on but you all miss the pivot.
This (young) adult was diagnosed with schizophrenia. If the US wouldn't have the health-care system it has, this guy would receive proper treatment without hassles. Being hospitalized and so on. But he wasn't, and now he's just the last of the leasts. Why he wasn't? Because he wasn't elegible according to the insurance. Obviously he wasn't i'd say. Companies exist to make profit, this is old story, no insurance want really to treat people who are going to require life-long medications and care.
So, try to learn something from this story and realize how the US system is broken when it comes to care about people who isn't Paris Hilton.
I heard Romney saying "nobody is dying in this country because of lacks in terms of health-care, they jsut go to the first aid". He said this because he's just evil. Anyone smart realizes that being stabilized and being treated are 2 different things.
It's pretty sad that the best way to get mental health treatment is to commit a crime and go to jail. What an epic failure.
It really goes to show how our society thinks of people: if we're punishing someone for a wrong, then spend as much money as necessary. But helping someone before they do something wrong: that's socialism.
This is often discussed among homeless advocates, because such a large percentage of homeless have mental illnesses of various kinds.
I do think reform had quite a bit arguing for it: old-style "insane asylums" were really not nice places, and involuntary commitment was used fairly widely, at times even producing involuntary surgeries (like the notorious period in which involuntary lobotomies were performed), which I think are serious problems for civil liberties and easily abused. But the problem is that we just closed the asylums and didn't replace them with much of anything at all, in most states not even voluntary facilities that people can check themselves in to.
I grew up around a situation similar to this. Thankfully, it hasn't turned out that badly. People with that kind and depth of mental illness have to have someone watching out for them. One little slip, one missed pill has the potential to send them down a road that they will not be able to recover from on their own. It can get bad fast and take a long time to bring back under control.
My cousin has (had?) schizophrenia. Despite the best efforts of his wealthy family and a willing mental health system in Germany he disappeared and we haven't heard anything in a very long time. He lived on the streets for a number of years but it's very hard to get schizophrenics on the needed medication and even harder to keep them on it.
This is quite a personal story and It's not near this level but I grew up with a parent with Schizophrenia and still am.
I'm 18 and currently live alone with this parent and am moving out soon as I work on my company. The situation is fine (for me) because there are few things to set them off these days and I've just had to learn how to deal with many of the disturbances. Like paranoia of me (What I talk about to others), using certain words in relation to illness like saying something is "mental" or even how are you. The illness only pops up at certain times. People wouldn't know they are ill from speaking to them, most of the time. It's 10X better than it was when I was much younger and lived with both of my parents.
I won't go into detail out of respect to my family but their illness has broke up their marriage (Although sometimes couples don't work) and now they refuse to take any medicine or see anyone. Because they aren't anymore at the level that they are forced into treatment there's nothing that can be done.
What I've learned from this is most policy on mental illness is under the assertion that if the person is at extreme harm to themselves or the public, they require treatment. If this isn't the case and the person refuses to believe they are ill or that they need treatment, little is done.
In a former job, I was confronted with a heartbreaking string of cases of individuals who are homeless, clearly suffering from mental illness, yet repeatedly breaking into local businesses, often not to steal anything of value.
The frustrating choice for those in the prosecutorial or defense systems, is how to best perform your duty to the public and these individuals.
If you simply release them, the business owners continue to face victimization. If you send them to jail, you put them in a completely inappropriate community, and damn them to poor or nonexistent care for complex problems.
It's not isolated cases, mental health issues took up a significant portion of our resources in the criminal justice system (a system that, when overburdened, suffers both Type I and Type II errors simultaneously, leading to higher rates of hasty convictions while also letting more guilty individuals walk free).
The best solution I heard, discussed only in chambers with heavy sighs as to its political infeasibility, was some sort of mental health court, analogous to a drug court.
Drug courts are designed to take a significant number of cases and prosecute them more efficiently, while focusing on what reduces recidivism most, and helps those "offenders" (treatment and monitoring is the general template, though individual cases can be highly customized, rather than one size fits all incarceration).
Drug courts don't always work, sometimes they can be systemically flawed. This American Life presented just such a case a few years ago, describing a judge who abused the process. But in most jurisdictions, drug courts lower costs to the system while putting a lot of people in a far better place.
A similar institution, a "mental health court," might feed people from courtrooms into community treatment facilities, with monitoring and care, while putting them on probation instead of placing them in jail.
This would, of course, work best with significantly increased funding for humane and competent mental treatment facilities. But at least some of those costs would be offset by lower burdens on the justice system and systems of incarceration.
Such a system would certainly help more people, and it deserves wider public discussion.
This says so much about what's broken in our legislative system:
> Six weeks into my legislative career, I was the legislature’s reluctant new expert on mental health.
After six weeks, he was not an expert. In nearly all cases, our legislators are not experts in any of the things which they are legislating, yet that never stops them from forming strong opinions and trying to "reform" or "fix" things. On HN, we see this frequently with Internet and technology legislation, but this article shows it's a problem with other areas, too.
It's really sad that this isn't a priority in the United States. Somehow we have so little money for the government to pay for anything, that any possible solutions are either underfunded or written off completely. Overloaded case workers, run-down facilities, lack of facilities, lack of integrated programs, are just a few of the consequences.
It's an odd sort of poverty where all sorts of gadgets and innovations are commonplace, but where the marginalized in society still suffer through neglect and lack of funding for any viable solutions.
This is a tough story of a state legislator who became an adoptive father finding out that policies that he thought were humane reforms didn't end up helping people in this generation like his adoptive son. Some of my perspective on these issues comes from knowing Irving Gottesman,
who was credited as the main adviser on schizophrenia relied on by the author of the book A Beautiful Mind. Gottesman has spent much of his career researching schizophrenia and debunking former theories about the origin of schizophrenia. Twin studies, especially studies of the unusual cases of monozygotic twins reared apart, and adoption studies have consistently shown that schizophrenia develops from an underlying genetic vulnerability (probably varying greatly from patient to patient, according to the best evidence from genome-wide association studies) that makes a patient all too likely to develop full psychotic symptoms over the course of childhood without careful treatment. Gottesman's research goal is to define "endophenotypes" that can be reliably measured clinically to identify patients who need one kind of preventive or supportive treatment rather than another. But we are nowhere near identifying endophenotypes for any major mental illness.
"Self-medicating with marijuana, Tim’s drug of choice for lowering the volume of the voices in his head, got him suspended from the first high school he attended — a public, vocational-technical school in Middletown, Conn. — and placed on court-ordered probation." We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry.
"If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses."
Teacher who are credentialed to teach elementary school receive specific training in how to teach reading, and receive specific training in how to teach elementary mathematics, but mostly do a remarkably poor job in those important tasks anyway. There are not today any reliable lists of early symptoms of mental illnesses to guide an adult who sees young children as to who will develop severe mental illness in adulthood. Diagnostic criteria for psychology and psychiatry are not that well developed yet, and communicating criteria for best practice to future teachers in schools of education or to in-service teachers through in-service training programs is already a vexing problem in reading instruction and mathematics instruction.
"I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams."
I think some of that is already done today. At least, my four children certainly seemed to be asked routine questions in well-child pediatrician visits that could raise red flags on the basis of certain answers to those questions. Again, there simply aren't that many effective early screening tools for mental illness today of any kind. One of the best tools for identifying people at highest risk for developing mental illness is to know the complete medical history of their nearest relatives--but that is the hardest tool to use for some adopted children.
"I’d require school administrators to incorporate recommendations from pediatricians and mental health professionals into students’ IEPs."
What I hear from parents whose children have IEPs (individual education plans, under federal law about special education) is that it is often annoyingly difficult to get a school to follow an IEP, even though that is mandatory by law. It is the parents's responsibility, in the first instance, to make sure that all relevant information is provided to the professionals who work with the parents in drafting the IEP. The parents have to push back if the IEP isn't drafted helpfully at first, and they have to keep an eye on whether or not the school implements the IEP.
All in all, this sad story is a good reminder that EVERY parent, and maybe especially an adoptive parent, needs to be cautious about reducing risk of future harm for all children in the parent's care. The author's description of his situation makes his situation sound very rough. He surely hoped that his son would be living independently and thriving by the son's current adult age. What I've learned about parenting after two decades is that parenting never completely ends. Launching a child into self-sufficient adulthood is wonderful. (I have done that once so far.) But there will always be scary issues for parents to watch out for that they have to take care of themselves.
AFTER EDIT: Several comments below this comment talk about the risk of drug abuse for persons who have underlying vulnerabilities to mental illness. I agree with the suggestion that alcohol (legal for all adults) is surely dangerous in such cases and perhaps tobacco (also legal for all adults) is too. But I will remind all readers here that marijuana was specifically mentioned as the now homeless person's "drug of choice" in the submitted article, and marijuana alone, plus the genetic vulnerabilities, is enough to turn some formerly productive young people out on the street unable to support themselves. (It was probably observations of situations like this decades ago that helped convince legislators to change marijuana's legal status from permitted to largely banned. The article submitted here makes the correct point that sometimes legislation has unintended consequences, and perhaps the "drug war" is ineffective policy for reducing the harm that mind-altering drugs cause individuals and society.) Richard Branson has argued that Portugal's different pattern of regulating drugs has reduced drug use and has reduced various social harms from drugs that are Schedule I drugs here in the United States.
But that said, I will stand by my statement "We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry" because it is a factually correct statement. I don't know of any physician who regularly treats psychotic patients in emergency rooms who recommends that young people with family history medical risk for psychosis use marijuana. That is a distinctly bad idea.
ONE MORE EDIT:
I shared the article submitted here among my Facebook friends, and one thoughtful friend suggested the article, from the same newspaper in 2005, "Social Network's Healing Power Is Borne Out in Poorer Nations"
as an interesting contrast to the situation described in today's article. There is some good back and forth among experts on schizophrenia in different countries in the previous article. Diseases influencing human behavior often manifest differently in different cultures.
We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision.
That marijuana is classified as a "schedule I drug" is, itself, obscene and a result of politics, not science.
Therefore, the rest of your suggestion regarding them "playing with fire" does not apply in this instance.
"We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision."
Considering that "Schedule I" is nothing more than a legal classification, I would like to see how that works. Does it just so happen that drugs in that legal classification coincide with drugs that people at risk of mental illness should not take? That seems like quite a coincidence, if true. If he were self-medicating with tobacco or caffeine, would you express similar concern?
The whole "Schedule I" thing is probably a bad choice of words on the authors part. Perhaps something along the lines of "mind altering substances"? Anything with the potential to significantly impact a persons impressions of the world around them is a bad idea in this situation.
There are useful diagnostic criteria and well-understood risk factors for all sorts of mental illnesses. Schizophrenia is a particularly vexing case, but that does not mean that one cannot recognize that someone is at-risk for or already dealing with a mental health problem.
Author's first impulse is to look to the state for the care of his child. WRONG!!!! YOU and your family are the primary folks responsible for this kid. Your wife had about the same chance of success as any set of teachers or state gov't goons but with much more incentives. What the hell was she doing? (probably getting her 'career' on - woo hoo!)
Why are ppl so apt to think that state employees are miracle workers? Central command/control and one-size-fits-all solutions (or any approximation thereof) are bound to fail for most of us who have special needs.
I have a very dear loved one who suffers from schizophrenia. I've seen firsthand how useless the system is. Before a diagnosis, everybody (schools, friends, etc) are judging the parents because their child doesn't fit into "norms". After a diagnosis, they have no idea how to handle it, so things don't get better.
We pushed everybody out of state hospitals (which were horrible places) but never really answered the question of where those people need to go.
Fortunately, my loved one's disease is being well treated at the moment. I constantly fear the day that a serious psychotic event occurs, especially if it occurs after she moves out of her parents house (which, like most teenagers, she really wants to do).
[+] [-] debacle|13 years ago|reply
Schizophrenia is not the kind of disease you can treat with an IEP, and it sounds like the author's son fell out of the system from a very young age. Trying to blame anything but genetics and development for his son's state is disingenuous - treating schizophrenia is a complicated, involved, and ultimately very stressful process for everyone involved, and in the end it can only bring someone on the brink of homelessness or self-harm into a situation where they can be stable most of the time, but never all of the time, or even almost always.
> The word “disability,” for instance, should have covered Tim and children like him.
ADHD or blindness are not even in the same room a schizophrenia. It's like comparing having six toes on your left foot to being comatose.
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
Teachers have enough on their plate, and more importantly, that's not what teachers are for. It sounds like the author took his son to plenty of mental health professionals, and he still wasn't properly diagnosed until he was nearly an adult.
> I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams.
Many mental health diseases don't manifest to the levels for proper diagnosis until adulthood, and even then the process of diagnosis is not scientific.
> I’d put much more money into community mental health services...
All of that sounds great, but mental health services are one of the first things cut into in a down economy.
> Tim is where he is today because of a host of public policy decisions we’ve made in this country.
No, he isn't. The author is wrong, and I'm sorry for that, but it's very unlikely that his son would have ever been a contributing member of society. Schizophrenia is a severe mental disease that cannot be treated like a 'special need.'
[+] [-] fusiongyro|13 years ago|reply
[+] [-] btilly|13 years ago|reply
Furthermore one of the stated issues is his unwillingness to take antipsychotic medication, and one of the characteristic traits is that in a structured jail environment, where he's presumably receiving those medications, he is able to function well. That indicates that with a proper support system that includes support to make sure that he takes the required medication, he might have a shot at being a contributing member of society.
[+] [-] hmahncke|13 years ago|reply
I didn't think the author was stating that his son wouldn't have schizophrenia if the schools had done better. I think he was saying that his son would have a better outcome with his chronic severe mental illness if various government agencies and actors were better organizing to identify and treat the illness.
Perhaps it's fair to say that Tim is where he is today because of his mental illness and a host of public policy decisions we've made in this country around how we treat mental illness.
[+] [-] rayiner|13 years ago|reply
[+] [-] DanBC|13 years ago|reply
I have met very many people with a diagnosis of schizophrenia. Some of those people were drug users (or had been drug users); some of those people were "forensic" patients and were being held in secure hospitals; some of those people were in the community, on medication, with full time work.
Schizophrenia is a complex illness that expresses in a wide range of behaviours, and a broad depth of severities of behaviours. One person may hear a few voices, but be able to cope well with those voices, while another people may hear more voices which are very threatening and hard to cope with.
Please, I understand what you're saying. (Some people with schizophrenia are very ill, and will need extensive support just to avoid homelessness) but I find your comment a bit stigmatising. Many people with schizophrenia do work; not all of them work full time paid employment but it's certainly possible for someone with a diagnosis of schizophrenia to lead a full and productive life.
[+] [-] niels_olson|13 years ago|reply
How about partially wrong? Maybe it's more accurate to say "Tim is where he is today partially because of a host of health policy decisions..."
absolutes often lead to unnecessary, counterproductive arguments.
[+] [-] Alex3917|13 years ago|reply
In many less developed countries people with schizophrenia have better outcomes. It's only in the US where the condition is usually debilitating for life, because:
A) The US healthcare system relies on longterm use of anti-psychotic medication as the main form of treatment, which tends to lead to worse outcomes in the long run.
B) Family relationships in the US are generally not conducive to properly recovering from schizophrenia.
In other countries the people aren't completely normally, but they're also generally not completely unable to hold a job for their entire lives like in the US.
[+] [-] efa|13 years ago|reply
My experience with the school system (I have a daughter with autism) has been much better then his sounds (I hope so given it's 40 years later). We have no push back in getting our developmental pediatricians' input into our daughter's IEP. Our school provides speech and occupational therapy. But as you mentioned, schizophrenia is a whole other world (even from autism in my opinion). There is no cure. There are only lesser of many evils. You can't expect society to fix that.
One thing that really bothers me are these crazy statistics - "one in every five children and one in every four adults has a diagnosable mental illness. A quarter of all mental illnesses are considered serious." One in four? Come on. If the bar is so low that one in four have a mental diagnosis it makes the term meaningless. It drives my wife and I crazy when parents claim there kid had autism but after a month on this fad diet or other they are now cured. Guess what - your kid never had autism! Don't tell that to a parent who knows their daughter will likely never leave home, never marry, and probably never hold down a meaningful job. It's just insulting.
[+] [-] kyebosh|13 years ago|reply
I'm having trouble getting past this comment. I don't wish to malign you debacle - I'm sure you're not being malicious - but it seems like a very unkind & privileged mindset. I hope this isn't representative of the community.
Paul Gionfriddo certainly doesn't consider his son to lack contribution.
[+] [-] Daniel_Newby|13 years ago|reply
25% of prisoners are there because of ADHD. In aggregate it probably causes much more harm than schizophrenia.
[+] [-] kyro|13 years ago|reply
The last two points, I think, are very relevant to this article. While I sympathize with you, understand that child development is a very, very complicated thing. You have naturally hyper children, naturally withdrawn children, etc, and physicians are very wary to label any child with an illness, especially schizophrenia. When we're adults and have leveled out, it's easier to discern what is "normal" from "abnormal." But children are constantly changing, being molded by their environment, and so it's much harder to outline a symptomatic threshold of what's considered normal. Additionally, children exhibit mental disorders in very different ways than adult do; there are different sets of symptoms to look out for. And these symptoms can be anything from "pressured speech" (talking too fast. some kids are just naturally fast talkers, right?) to auditory hallucinations (but the child could have a vivid imagination, right?).
The treatment for schizophrenia is an entirely different beast. The goal is usually to just suppress the symptoms and to restore the patient to a functional baseline. In many cases, the disease progresses and the prognosis worsens. In your case, your child had early-onset schizophrenia, which is associated with a worse prognosis than late-onset cases.
Although there are studies that show that early detection and treatment of schizophrenia can improve the course of the disease, chances are your kid would have still developed much of the same symptoms and issues that he has now. It really sucks, and I sympathize with you, but that's the nature of the disorder. It's terrible, difficult to manage effectively, and can ruin lives. I've seen it.
[+] [-] cletus|13 years ago|reply
> If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses.
but teachers aren't psychiatrists or clinical psychologists and can't really be expected to be.
I was recently watching a program talking about the somewhat controversial theory that schizophrenia (and other mental disorders) are either parasitic in origin or that parasites may simply contribute [1] [2].
The culprit in this case being toxoplasmosis. There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
This kinda reminds me of how peptic ulcers were once thought to be caused by stress until they were found to caused by a virus [3].
At the same time the elimination of parasites is arguably related to the rise of autoimmune diseases in the developed world (the so-called "hygine hypothesis" [4]). For example, hookworms may combat asthma and other allergies [5].,
I wonder if the coming century will be a revolution in mental health as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
[1]: http://www.sciencedaily.com/releases/2009/03/090311085151.ht...
[2]: http://www.stanleyresearch.org/dnn/LaboratoryofDevelopmental...
[3]: http://health.nytimes.com/health/guides/disease/peptic-ulcer...
[4]: http://en.wikipedia.org/wiki/Hygiene_hypothesis
[5]: http://www.gizmag.com/hookworms-prevent-asthma-allergies/129...
[+] [-] Dn_Ab|13 years ago|reply
One hypothesis I read recently is that schizophrenia is an emergent phenomenon of a brain trying to compensate for any number of gene induced deficiencies in wiring but instead over compensating due in part to the faulty wiring in the first place, thus creating a negative feedback loop as the brain develops and wires itself.
Again on connectivity errors, schizophrenia is also associated with a malfunction in how the default mode and task positive networks interact with each other, where in schizo, default is not properly attenuated leading to higher likelihood of dissociativity. I read recently on using ketamine to study this particular malfunction: see http://www.schizophreniaforum.org/new/detail.asp?id=1809
As for [4] it is worth reading: http://www.bmj.com/content/345/bmj.e6673. Aside from the separate dangers of overuse of antibiotics, the matter is way more subtle than being too clean. Yes we have lost contact with certain reinforcing environmental pathogens, but it is also true that the gain from cleanliness far outmatches the current risk of autoimmune disorders.
UK researchers say that they have dismantled the “myth” that allergic diseases have risen to epidemic levels because people now live in sterile homes and have become “too clean.” .... The report says that although deficiencies in microbial exposure could be important in the rise in allergies and chronic inflammatory diseases—driven also by genetic predisposition and modern lifestyle factors such as different diets, stress, inactivity, and pollution—it is not yet clear how the trend can be reversed.
Rook said, “There are lots of ideas being explored, but relaxing hygiene regimes won’t reunite us with our old friends—just expose us to new enemies like E coli 0104.”
[+] [-] mammalfriend|13 years ago|reply
As an example, when I was growing up I was extremely nearsighted but didn't get glasses until I was out of the home and in college. I was unable to read the chalkboard from K through 12. Yet no teacher intervened to suggest glasses to my parents, or to suggest I see an eye doctor. Only when a college prof noticed that I was squinting my eyes at the board and said "hey man, you need glasses!" did I get my eyes examined and discover what the world looked like in focus.
Along the way, everyone from the public school nurses who administered eye and hearing tests to a DMV examiner fudged my eye test results to "help" me pass those tests. And I was pretty good at doing things with limited vision. I know I'm not alone in this regard -- many children find a way to get by with a range of limitations because they don't know there is an alternative.
But we're living in the modern world, and many limitations can be controlled given early intervention. And teachers are well positioned to observe children over extended periods of time, while doctor visits are often 5 minutes ling and most children will never see a psychiatrist at all.
[+] [-] mst|13 years ago|reply
True.
Equally: Programmers aren't operations staff.
But we can damn well learn how to call them in when we need them.
[+] [-] paulerdos|13 years ago|reply
[+] [-] VMG|13 years ago|reply
Upvote for the first point though.
[+] [-] lambdaphage|13 years ago|reply
_H. pylori_ is a bacterium, as your source indicates.
[+] [-] baxrob|13 years ago|reply
rather to the contrary, i think. Or you haven't had occasion to attempt teaching enough?
> There's been research to show that there is correlation between the incidence of schizophrenia and the domestication of cats.
As I recall, this was more recently debunked, largely on the basis of correlation/causation confusion. ... Unfortunately, I failed in googling the counterpoint. Don't take my word for it, obviously. But consider: the popularity of cat-themes, and of mental-health quackery, especially on the internet.
OTOH, my grandmother, who was paranoid schizophrenic, refused to spay/neuter her cats because she had, to her, important conversations with them. So maybe you/they are correct.
Also note, the fluoridation of the public water supply may be sapping our precious bodily fluids[1].
> ...as parasties, viruses and bacteria (or even the lack thereof) may be far more immportant than currently realized, possibly even causal in many cases.
Agreed. Eg: http://www.npr.org/templates/story/story.php?storyId=1298621...
[1] http://www.youtube.com/watch?v=N1KvgtEnABY
[+] [-] eavc|13 years ago|reply
It would be, at most, a single course in an undergraduate or a graduate program. It could probably be rolled in to existing curricula just as a chapter or an exam as a component of a related class.
We're not talking about diagnosis, just recognition of symptoms to the point where a referral can be made.
[+] [-] lwat|13 years ago|reply
[+] [-] tjic|13 years ago|reply
We're so used to political debates where the Republicans say "less regulation will solve X", the Democrats say "more spending will solve X", the libertarians say "X is none of the government's business", and each suggests that things will go swimmingly under their preferred way of attacking the problem.
Some things, though, just suck.
Schizophrenia is one of those things. You can't cure it. You can't treat it very well. There's not much to be done.
Sometimes bad things happen to good people, and no amount of "training teachers" or "diagnosing diseases" or whatever will change that.
It's a tragedy.
[+] [-] wonderzombie|13 years ago|reply
At a minimum you can look for ways mitigate the impact it has on our society. See the pieces elsewhere in this thread which discuss the cost to our society incurred by ER visits from the mentally ill and/or homeless. That's a trivial example.
It might be worth discussing how other western industrialized nations approach this; I suspect that those countries which have some kind of socialized health infrastructure do more than the US than shrug their shoulders and avert their eyes.
[+] [-] dgavey|13 years ago|reply
[+] [-] showerst|13 years ago|reply
1/16 adults having a serious mental illness seemed awfully high to me, but I went and looked it up and that may actually be low-balling it: http://www.nimh.nih.gov/health/publications/the-numbers-coun...
[+] [-] dgavey|13 years ago|reply
The similarities between the child in the article and my son are startling and scary.
Although we are still at the beginning of our story, I do believe that in my area in Canada, the system has gotten better. I can only hope that this continues and the system does not let him down like it did to the child in the article.
My son will be seeing a counselor and accessing services that were previously unavailable to us starting in 2 days. Thanks Hacker News, you are always so poignant.
[+] [-] tisme|13 years ago|reply
It would not be the first time that the visible aggressor was in fact the victim of a long drawn out teasing campaign by a group of bullies, and girls can be bullies just as easy as boys.
One of the best bits of fun seems to be to goad someone until they snap and then let them take the blame for it all.
Been there, done that, have the t-shirt.
[+] [-] unknown|13 years ago|reply
[deleted]
[+] [-] jetti|13 years ago|reply
This happened to me. My senior year of high school I had a "breakdown" of sorts. I was suspended from school until I saw a mental health professional. After the first visit, I was diagnosed with Bipolar disorder and given meds to treat it. After awhile, the diagnosis changed to Schizo-affective disorder and more drugs were added to help. Finally, I was diagnosed with epilepsy and told that the mental health diagnosis were wrong since epilepsy can cause both depression and hallucinations if untreated.
I shared my story for a few reasons. One the brain is complex and there can be many factors that causes symptoms. If mental health professionals can't get it right, there is no way to expect teachers or school administrators to get it right. I was lucky and had phenomenal insurance at the time that I went through that ordeal. Because of that, I was able to get tests and scans that I know others wouldn't not be able to afford. I fortunate enough to have a parent who could afford for me to get a SPECT scan which is (or was) considered cutting edge and would not be covered under insurance. That was what helped the neuro-psychiatrist realize that I have epilepsy and not a mental illness. Many people can't afford these things. Had I not had that scan, I would still probably be taking 20 pills a day and having to wake up early to take Adderall so that I'm able to physically wake up in time to be functional and the worst part is, that would be all for naught. It wouldn't help me since I don't have any problems.
There is so much wrong with the mental health system (at least in the US) that it really makes me sad. You start at the education level (such as the article talks about) but then when you move to insurance, so much isn't covered that it becomes either pay out of pocket or just let the individual suffer.
[+] [-] lostlogin|13 years ago|reply
[+] [-] tzs|13 years ago|reply
Please submit links for humans, not machines. Add the machine link in a comment if you wish.
PS: I'm aware of Readability and the ability to increase font sizes. There are other problems in general with print links that those do not address:
• Print links generally do not include extras like comments. This particular story had a large number of comments at the original site.
• Although not applicable in this particular case, stories often include sidebar links to related stories, and these are often omitted from print links.
• The non-print link usually includes a very easy way to get to the print version. Typically, you just click a print icon and you are there. The print link, on the other hand, usually does not include any link or other mechanism to get to the non-print version (other than the "back" button if you happened to have come from the non-print version).
Taking this all into account, particularly the last part about it being very easy to get to the print link from the non-print link, and not easy to go the other way, in almost all cases the link submitted should be the non-print link.
PPS: there are some sites that offer an "all on one page" link, which is distinct from the print link. The former simply does away with splitting the article into pages, keeping the comments and sidebar links and human-friendly formatting. Submitting "all on one page" links is great.
[+] [-] jnar|13 years ago|reply
This (young) adult was diagnosed with schizophrenia. If the US wouldn't have the health-care system it has, this guy would receive proper treatment without hassles. Being hospitalized and so on. But he wasn't, and now he's just the last of the leasts. Why he wasn't? Because he wasn't elegible according to the insurance. Obviously he wasn't i'd say. Companies exist to make profit, this is old story, no insurance want really to treat people who are going to require life-long medications and care.
So, try to learn something from this story and realize how the US system is broken when it comes to care about people who isn't Paris Hilton.
I heard Romney saying "nobody is dying in this country because of lacks in terms of health-care, they jsut go to the first aid". He said this because he's just evil. Anyone smart realizes that being stabilized and being treated are 2 different things.
[+] [-] jrockway|13 years ago|reply
It really goes to show how our society thinks of people: if we're punishing someone for a wrong, then spend as much money as necessary. But helping someone before they do something wrong: that's socialism.
[+] [-] _delirium|13 years ago|reply
I do think reform had quite a bit arguing for it: old-style "insane asylums" were really not nice places, and involuntary commitment was used fairly widely, at times even producing involuntary surgeries (like the notorious period in which involuntary lobotomies were performed), which I think are serious problems for civil liberties and easily abused. But the problem is that we just closed the asylums and didn't replace them with much of anything at all, in most states not even voluntary facilities that people can check themselves in to.
[+] [-] emeraldd|13 years ago|reply
[+] [-] zwieback|13 years ago|reply
I don't think there's a policy solution for this.
[+] [-] brackin|13 years ago|reply
I'm 18 and currently live alone with this parent and am moving out soon as I work on my company. The situation is fine (for me) because there are few things to set them off these days and I've just had to learn how to deal with many of the disturbances. Like paranoia of me (What I talk about to others), using certain words in relation to illness like saying something is "mental" or even how are you. The illness only pops up at certain times. People wouldn't know they are ill from speaking to them, most of the time. It's 10X better than it was when I was much younger and lived with both of my parents.
I won't go into detail out of respect to my family but their illness has broke up their marriage (Although sometimes couples don't work) and now they refuse to take any medicine or see anyone. Because they aren't anymore at the level that they are forced into treatment there's nothing that can be done.
What I've learned from this is most policy on mental illness is under the assertion that if the person is at extreme harm to themselves or the public, they require treatment. If this isn't the case and the person refuses to believe they are ill or that they need treatment, little is done.
[+] [-] brownbat|13 years ago|reply
The frustrating choice for those in the prosecutorial or defense systems, is how to best perform your duty to the public and these individuals.
If you simply release them, the business owners continue to face victimization. If you send them to jail, you put them in a completely inappropriate community, and damn them to poor or nonexistent care for complex problems.
It's not isolated cases, mental health issues took up a significant portion of our resources in the criminal justice system (a system that, when overburdened, suffers both Type I and Type II errors simultaneously, leading to higher rates of hasty convictions while also letting more guilty individuals walk free).
The best solution I heard, discussed only in chambers with heavy sighs as to its political infeasibility, was some sort of mental health court, analogous to a drug court.
Drug courts are designed to take a significant number of cases and prosecute them more efficiently, while focusing on what reduces recidivism most, and helps those "offenders" (treatment and monitoring is the general template, though individual cases can be highly customized, rather than one size fits all incarceration).
Drug courts don't always work, sometimes they can be systemically flawed. This American Life presented just such a case a few years ago, describing a judge who abused the process. But in most jurisdictions, drug courts lower costs to the system while putting a lot of people in a far better place.
A similar institution, a "mental health court," might feed people from courtrooms into community treatment facilities, with monitoring and care, while putting them on probation instead of placing them in jail.
This would, of course, work best with significantly increased funding for humane and competent mental treatment facilities. But at least some of those costs would be offset by lower burdens on the justice system and systems of incarceration.
Such a system would certainly help more people, and it deserves wider public discussion.
[+] [-] agwa|13 years ago|reply
> Six weeks into my legislative career, I was the legislature’s reluctant new expert on mental health.
After six weeks, he was not an expert. In nearly all cases, our legislators are not experts in any of the things which they are legislating, yet that never stops them from forming strong opinions and trying to "reform" or "fix" things. On HN, we see this frequently with Internet and technology legislation, but this article shows it's a problem with other areas, too.
[+] [-] lilsunnybee|13 years ago|reply
It's an odd sort of poverty where all sorts of gadgets and innovations are commonplace, but where the marginalized in society still suffer through neglect and lack of funding for any viable solutions.
[+] [-] tokenadult|13 years ago|reply
http://en.wikipedia.org/wiki/Irving_Gottesman
who was credited as the main adviser on schizophrenia relied on by the author of the book A Beautiful Mind. Gottesman has spent much of his career researching schizophrenia and debunking former theories about the origin of schizophrenia. Twin studies, especially studies of the unusual cases of monozygotic twins reared apart, and adoption studies have consistently shown that schizophrenia develops from an underlying genetic vulnerability (probably varying greatly from patient to patient, according to the best evidence from genome-wide association studies) that makes a patient all too likely to develop full psychotic symptoms over the course of childhood without careful treatment. Gottesman's research goal is to define "endophenotypes" that can be reliably measured clinically to identify patients who need one kind of preventive or supportive treatment rather than another. But we are nowhere near identifying endophenotypes for any major mental illness.
"Self-medicating with marijuana, Tim’s drug of choice for lowering the volume of the voices in his head, got him suspended from the first high school he attended — a public, vocational-technical school in Middletown, Conn. — and placed on court-ordered probation." We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry.
"If I were a legislator today, I’d mandate — and provide funding to ensure — that every teacher receive training in recognizing symptoms of mental illnesses."
Teacher who are credentialed to teach elementary school receive specific training in how to teach reading, and receive specific training in how to teach elementary mathematics, but mostly do a remarkably poor job in those important tasks anyway. There are not today any reliable lists of early symptoms of mental illnesses to guide an adult who sees young children as to who will develop severe mental illness in adulthood. Diagnostic criteria for psychology and psychiatry are not that well developed yet, and communicating criteria for best practice to future teachers in schools of education or to in-service teachers through in-service training programs is already a vexing problem in reading instruction and mathematics instruction.
"I’d see that pediatricians are trained to make screening for mental health concerns a regular part of well-child exams."
I think some of that is already done today. At least, my four children certainly seemed to be asked routine questions in well-child pediatrician visits that could raise red flags on the basis of certain answers to those questions. Again, there simply aren't that many effective early screening tools for mental illness today of any kind. One of the best tools for identifying people at highest risk for developing mental illness is to know the complete medical history of their nearest relatives--but that is the hardest tool to use for some adopted children.
"I’d require school administrators to incorporate recommendations from pediatricians and mental health professionals into students’ IEPs."
What I hear from parents whose children have IEPs (individual education plans, under federal law about special education) is that it is often annoyingly difficult to get a school to follow an IEP, even though that is mandatory by law. It is the parents's responsibility, in the first instance, to make sure that all relevant information is provided to the professionals who work with the parents in drafting the IEP. The parents have to push back if the IEP isn't drafted helpfully at first, and they have to keep an eye on whether or not the school implements the IEP.
All in all, this sad story is a good reminder that EVERY parent, and maybe especially an adoptive parent, needs to be cautious about reducing risk of future harm for all children in the parent's care. The author's description of his situation makes his situation sound very rough. He surely hoped that his son would be living independently and thriving by the son's current adult age. What I've learned about parenting after two decades is that parenting never completely ends. Launching a child into self-sufficient adulthood is wonderful. (I have done that once so far.) But there will always be scary issues for parents to watch out for that they have to take care of themselves.
AFTER EDIT: Several comments below this comment talk about the risk of drug abuse for persons who have underlying vulnerabilities to mental illness. I agree with the suggestion that alcohol (legal for all adults) is surely dangerous in such cases and perhaps tobacco (also legal for all adults) is too. But I will remind all readers here that marijuana was specifically mentioned as the now homeless person's "drug of choice" in the submitted article, and marijuana alone, plus the genetic vulnerabilities, is enough to turn some formerly productive young people out on the street unable to support themselves. (It was probably observations of situations like this decades ago that helped convince legislators to change marijuana's legal status from permitted to largely banned. The article submitted here makes the correct point that sometimes legislation has unintended consequences, and perhaps the "drug war" is ineffective policy for reducing the harm that mind-altering drugs cause individuals and society.) Richard Branson has argued that Portugal's different pattern of regulating drugs has reduced drug use and has reduced various social harms from drugs that are Schedule I drugs here in the United States.
But that said, I will stand by my statement "We do know that young people whose family history suggests genetic risk for major mental illness (which might not be known for a particular adopted child) are playing with fire if they take schedule I drugs without medical supervision. Many of the worst outcomes found in families in which some relatives become mentally ill and some do not are among the persons who "self-medicate" (that is, abuse drugs) rather than reduce risk of perturbing their brain chemistry" because it is a factually correct statement. I don't know of any physician who regularly treats psychotic patients in emergency rooms who recommends that young people with family history medical risk for psychosis use marijuana. That is a distinctly bad idea.
ONE MORE EDIT:
I shared the article submitted here among my Facebook friends, and one thoughtful friend suggested the article, from the same newspaper in 2005, "Social Network's Healing Power Is Borne Out in Poorer Nations"
http://www.washingtonpost.com/wp-dyn/content/article/2005/06...
as an interesting contrast to the situation described in today's article. There is some good back and forth among experts on schizophrenia in different countries in the previous article. Diseases influencing human behavior often manifest differently in different cultures.
[+] [-] erichocean|13 years ago|reply
That marijuana is classified as a "schedule I drug" is, itself, obscene and a result of politics, not science.
Therefore, the rest of your suggestion regarding them "playing with fire" does not apply in this instance.
[+] [-] jlgreco|13 years ago|reply
Considering that "Schedule I" is nothing more than a legal classification, I would like to see how that works. Does it just so happen that drugs in that legal classification coincide with drugs that people at risk of mental illness should not take? That seems like quite a coincidence, if true. If he were self-medicating with tobacco or caffeine, would you express similar concern?
[+] [-] emeraldd|13 years ago|reply
[+] [-] eavc|13 years ago|reply
[+] [-] gms|13 years ago|reply
[+] [-] alphadogg|13 years ago|reply
[deleted]
[+] [-] acroyear|13 years ago|reply
Why are ppl so apt to think that state employees are miracle workers? Central command/control and one-size-fits-all solutions (or any approximation thereof) are bound to fail for most of us who have special needs.
[+] [-] SoftwareMaven|13 years ago|reply
We pushed everybody out of state hospitals (which were horrible places) but never really answered the question of where those people need to go.
Fortunately, my loved one's disease is being well treated at the moment. I constantly fear the day that a serious psychotic event occurs, especially if it occurs after she moves out of her parents house (which, like most teenagers, she really wants to do).