Blog

Therapists Talking about Medication

8/24/23

I sometimes hear therapists speaking with me with humility about talking with their patients about medications. It may sound something like, “I don’t know, I think my patient may need an antidepressant. But I don’t know because I am not a prescriber.” I have also asked therapists questions about how they see medication affecting their clients or even inhibiting productivity in therapy. They may say, “Well you would know that because you are the prescriber.”

I really appreciate humility in professionals. However, my experience is that well-meaning therapists are sometimes not only humble, but deny their own genuine knowledge because they are afraid of stepping on toes, or “not staying in their lane” (a phrase I hate because it was originally meant as a pejorative to politically attack qualified pediatricians so the NRA could continue to rake in hundreds of millions of dollars each year at the expense of children and the generational trauma of their family members ignited by their deaths).

But I digress. The truth is good therapists often know a lot more than the prescriber does about how patients respond to medication because:

1) They see their patients much more frequently and are therefore able to gather more data about how their patients are affected by the medication prescribed.

2) Depending on when the therapist started working with the patient, they may know what the patient “looks like” without medication and after having started a given medication.

3) Most of the therapists I have worked with have learned enough about psychotropic medication to be an extremely important in helping help to patients and prescribers when it comes to prescribing the right medication for the patient. For example, a therapist may have better insight into the motivation for a patient’s violence—was it impulsive? Premeditated? Did the kid just have a bad day? This affects what medication I may choose.

To explain the latter point, most therapists have acquired knowledge about psychotropic medication from what they have seen in their own practice, from their own experiences with medication, from their family’s experiences with medication, and what they have learned from their prescriber colleagues.

Not all therapists feel uncomfortable talking about medications to their patients or telling me what their thoughts are. However, I have had enough experiences (even recently) where it seems some therapists are worried about stepping on toes. While the ultimate responsibility of the mediation being prescribed completely rests on the prescriber, we can actually do a better job with input from members of a patient’s “team” than we can with what little data we have in comparison. The only caveat I would note is I think it can be a mistake for a non-prescriber to suggest a particular medication to a patient. This is opposed to bringing up classes of medications such as “antidepressants, ADHD medications, antianxiety meds, or antipsychotics.” Sometimes a therapist will have witnessed a dramatic improvement in one patient on a specific med, and suggest that particular med to another patient, and the therapist is not aware of why brining up a specific medication can cause problems. There are many problems I have run into with this, but that is for a different blog post or podcast.

With regard to otherwise giving input to prescribers, I think therapists play a crucial role in my belief that the more eyes on a patient, the better. This is especially if there is disagreement among providers. Psychiatry and psychology is a field where the primary tool used to help patients is the mind of the provider. This is not a perfect situation because minds are often confused. Minds cannot know reality for certain. Minds have their own biases that effectively skew the perception of an otherwise accurate picture of a human being, not to mention humans are too complicated to have an “accurate” picture of them. I think it is dangerous, in this field, for a provider to have too much confidence that they are seeing things completely accurately in a clinical picture. Providers are right a lot. However, we can really mess up peoples’ lives if we are subject to hubris in our assessment of our own perception. Ideally, well-meaning, competent providers of all kinds (therapists, case managers, skills workers, group home staff, school staff, mentors, chemical health sponsors, prescribers, etc.) are working together to keep patients safe by sharing information; clarifying with each other what they are doing; and are able to have respectful, rational debate about care.

10/23/22

The following is a heavy critique of a New York Times (NYT) article entitled, “What Are the Real Warning Signs of a Mass Shooting?” The main purpose of this critique is to illustrate how grossly undereducated the public is about what mental illness is, and how this mental health illiteracy is reinforced in the media—even from sources typically thought of as reliable such as the NYT. The goal of the critique is not to slam the author for a poorly written article. It is to educate the reader about mental illness and warn the public that the concept, “school shooters are not mentally ill” is a dangerous idea that will contribute to more tragedies.

What Are the Real Warning Signs of a Mass Shooting?

- Shaila Dewan

The freshman who walked into the high school cafeteria in Marysville, Wash., in 2014 with his father’s .40-caliber Beretta did not fit anyone’s profile of a mass murderer. He was a crack athlete. He embraced his Native American traditions, wearing a headdress at tribal events and offering freshly killed deer to his grandmother. He was popular, so much so that he had just been elected homecoming prince. He had no history of mental illness — just what several classmates described as an uncharacteristically bad mood that week.

Jordan’s Notes (the rest of the article my notes will be in blue):

It is misleading to indicate in this story that “he had no history of mental illness.” A lay person may think, “there was no mental problem present prior to the student shooting people.” Whenever you read, “there was no history of mental illness,” you should know that this means no mental illness was ever diagnosed. You cannot declare anyone is free of mental illness if they have never been assessed by a qualified mental health professional.

It was only after he killed four fellow students and wounded another that the armchair diagnosis of his mental state began.

Blaming mass murder on mental illness is a time-honored impulse, used by law enforcement and politicians alike. “Mental illness and hatred pulls the trigger, not the gun,” President Donald J. Trump said in 2019 in response to mass shootings in El Paso, Texas, and Dayton, Ohio. After a teenage gunman killed 19 children and two teachers at Robb Elementary School in Uvalde, Texas, in May, Gov. Greg Abbott said, “Anybody who shoots somebody else has a mental health challenge. Period.”

These are extremely important comments because both democrat and republican political parties make use of statements such as Trump’s or Abbot’s to further their aims. I agree with the statement, “Blaming mass murder on mental illness is a time-honored impulse, used by law enforcement and politicians alike.” And yet, it is possible to make a true statement for the wrong reasons. It seems the reason many politicians make these statements is nefarious—to turn the attention away from much needed gun regulation laws for example. Or to attack their opponents as not caring about gun reform. This is why the relationship between mental illness and school shootings is so important for the public to understand clearly. The fact is, both points commonly argued are true—we need much better gun regulation laws AND more help for mentally ill children in this country.

Such explanations satisfy a deep longing to understand the incomprehensible. And they appeal to common sense — how could a person who kills indiscriminately be in their right mind?

The first sentence is an insult to anyone who has respect for science or psychiatry.

Yet America’s mass killers fit no single profile and certainly no pattern of insanity — many, if not most, had never been diagnosed with a serious psychiatric disorder.

The first part of this statement is, to put it simply, incorrect. It is also misleading. If we are going to solve the problem of mass shootings, I think it is very important to be precise in our language rather than dramatic, especially because of the political games played with this issue.

One way that it is helpful to be precise is to use a standardized language within the mental health profession. I like the DSM-V and I am familiar with it. I argue, to exchange the word, “mental illness” with “insanity” evokes a different emotional response in most readers. I suspect most readers read “insanity” and images of strait jackets, horror movies, or other dramatic images come to mind. Whereas “mental illness” likely conjures more neutral or even compassionate images. I think people will learn more if the wording, “mental illness” is used consistently. If I exchange them, the first part of the second statement reads, “Yet America’s mass killers fit no single profile and certainly no pattern of mental illness—”

Regarding the second half of that same statement--many, if not most, had never been diagnosed with a serious psychiatric disorder—it is just clinically incorrect. The Oxford Language dictionary definition of profiling is “the recording and analysis of a person's psychological and behavioral characteristics, so as to assess or predict their capabilities in a certain sphere or to assist in identifying a particular subgroup of people.” Every time a mass school shooting occurs, even lay people are reminded that there is a profile because it is delivered (often accurately) from news outlets:

--“leaking” clues about intent to behave violently

--low frustration tolerance

--a pattern of difficulty coping with disappointment in a healthy way

--failed love relationship

--verbalizes feelings of persecution/ has multiple resentments toward others

--signs of depression

--narcissism

--loner

--lacks empathy

--morbid sense of humor that is expressed in inappropriate environments

--paranoia

--interest in significantly violent media

--access to guns

--significant family stress

Background checks can prevent someone with a diagnosis of mental illness from acquiring a gun, but psychologists say there is a wide divide between a clinical diagnosis and the type of emotional disturbance that precedes many mass killings.

This sentence is confusing. I think it means “mental illnesses” are different than “emotional disturbances.” The author defines neither of these terms.

The other issue with this statement is that it suggests: a) there is indeed a “type of emotional disturbance that precedes mass shootings” b) there is a profile of such an emotional disturbance, and c) the “emotional disturbance” (despite being significant enough to cause a mass shooting) is not a diagnosable mental illness.

The real problem, those experts say, is that mental illness is not a useful means to predict violence. About half of all Americans will experience mental health issues at some point in their lives, and the vast majority of people with mental illness do not kill.

“Do you or do you not have a mental health diagnosis?” said Jillian Peterson, a co-founder of the Violence Project, a research center that has compiled a database of mass shootings from 1966 on and studied perpetrators in depth. “In many cases, it doesn’t really matter. It’s not the main driver.”

This is a very common argument that is illogical. Suppose you needed to see an ER doctor for an emergency. Would you not look for the nearest hospital or ANY hospital for that matter? The only place you will find an ER doctor is in the hospital. “Well, there are many employees within a hospital. That doesn’t mean every employee in a hospital is an ER doctor.” Do you see how in order to find someone with the qualities that make one an “ER doctor,” you have to start by going to the only place you will find ER doctors?

Because this is so important, I want to offer a slightly more complicated analogy that fits more closely to the subject. One could argue, “bleeding is not a useful means of determining whether or not your child should be rushed to the hospital. About half of all Americans will have children that bleed from some kind of major or minor physical trauma, and the vast majority of Americans do not have children that need to go to the hospital for it. Have you, or have you not ever had a child who was bleeding?” A person being part of the population of Americans who have a mental illness is obviously not enough to predict who will be violent. But the mental health evaluation, and ongoing care one receives to get diagnosed and treated for mental illness will tell us with high certainty the risk of this person becoming violent. For example, a qualified mental health professional will find out what kind of mental illness (what kind of bleeding—internal or external)? Which combination of mental illnesses (what are all the areas the bleeding is coming from)? How severe (how much blood loss, how much internal bleeding)? What constellation of symptoms (regardless of how much blood loss, how is this child functioning—are they conscious or not)? What led up to the illness (was the child in a car accident, or did they fall off their bike)?

If a 911 responder were answering a call about someone saying their child is bleeding, shouldn’t that responder as “where is the bleeding?, What happened? How much? What is the child doing right now? etc?” We know most people who have mental illnesses are not violent, but it is frankly stupid to then decide mental illness has nothing to do with violence.

Instead, many experts have come to focus on warning signs that occur whether or not actual mental illness is present, including marked changes in behavior, demeanor or appearance, uncharacteristic fights or arguments, and telling others of plans for violence, a phenomenon known as “leakage.”

And it should be noted that the linked report in the sentence above identified “mental health” as the most prevalent “stressor” among the shooters discussed in the report.

This focus is far from perfect — it can be exceedingly difficult to weed out serious threats from many more that are idle, impetuous or exaggerated. But the warning signs approach has benefits: It can work even when the mental health system does not, and it sidesteps the complaint that blaming mass shootings on mental illness increases negative attitudes and stigma toward those who suffer from it.

That is a stigma not well fought buy denying the reality that shooters are mentally ill. Furthermore, it would NOT be “exceedingly difficult to weed out serious threats from many more that are idle,” if there was enough funding for mental health providers for the children in this country. As a child/adolescent mental health provider, we weed out these threats ALL THE TIME.

For Dewey Cornell, an education professor at the University of Virginia who helps train schools to conduct behavioral threat assessments, a bellwether case was that of a high school freshman in West Paducah, Ky. In 1997, he brought guns to school disguised as an art project and opened fire, killing three students and wounding five.

The gunman had schizophrenia and was severely delusional, but that was not what helped Dr. Cornell develop his model for averting school violence.

Rather, it was that the killer’s mental state had clearly worsened over time, meaning there had been opportunities to intervene. He had been bullied, had made threats to his peers and had turned in an essay about shooting a bully at school.

Yes, the “killer’s mental state worsened over time” is the same salient point I would care about to make in a psychologically-informed model to avert school violence—shootings especially—not that what may sound dramatic to a lay person such as a student having “schizophrenia and was severely delusional.”

“There were many, many warning signs and leakages and not a single student came forward and said, ‘Hey, I’m concerned,’” Dr. Cornell said. “It’s a case I use in all of my training programs to show how we can make a difference.”

That’s right. It should be us adults coming forward and doing our jobs to protect children—by lobbying our representatives to fund mental healthcare. And mental healthcare providers should be doing our job of providing accurate assessments and warning others—not relying on children to do that for us.

Dr. Cornell said the mental health system is ill-suited to avert mass violence, because insurance companies limit what conditions they will pay to treat, and the laws governing psychiatric commitment, which can prevent people from acquiring guns, have a narrow definition of mental illness.

Fleshing out these issues should be the focus of a good article regarding the truth of what contributes to mass shootings. These two points fail to support the concept that mental illness is not related to mass shootings. “OK, well since insurance companies limit what conditions they will pay to treat, I guess mental illness has nothing to do with mass shootings.”

“We identify individuals who are threatening to harm someone, but they do not meet the criteria for hospitalization because they don’t have schizophrenia or bipolar disorder and they don’t express imminent intent to carry out their actions,” Dr. Cornell said.

This statement is very unhelpful and misleading in a number of ways. It suggests that if a professional thinks a patient is at serious risk of harming someone else (imminent threat of carrying out threat or not), nothing can be done, which is absolutely false. Second, it suggests that hospitalization would fix it, which could be false. Finally, having schizophrenia or bipolar disorder in no way means that one would get hospitalized, even if that person is floridly psychotic. Also, because I care about people understanding psych terminology, “psychotic” means having either hallucinations, delusions, or both. It does not mean a person is violent.

Red flag laws are intended to get around some of those limitations by allowing for the temporary removal of a person’s guns if they are showing signs of dangerousness, regardless of mental illness.

The problem with relying on mental health diagnoses to predict gun violence has become apparent.

“The problem with relying on mental health diagnoses to predict gun violence..” Relying on mental health diagnoses is NOT RELATED to the concept that mental illness is what causes mass shootings. I agree one could never rely on the mental health diagnoses of a person to predict a mass shooting. A diagnoses is a label that says very little about the person and his/her risk for anything.

The Uvalde gunman had no history of diagnosed mental illness.

He fucking would have if our system had not failed him and he had gotten some quality help. The argument “this shooter was never diagnosed with a mental illness” or “this shooter had no history of mental illness” is as stupid as saying anyone kid or adult on the waitlist of a mental health provider just doesn’t need to be seen because they have never been diagnosed with a mental illness. Why bother seeing them? They clearly have no problem!

A teenager in Santa Fe, Texas, had never been diagnosed before he was accused of killing 10 schoolmates in 2018, though he has repeatedly been found mentally incompetent to stand trial.

Just because someone has “never been diagnosed before” does not mean they do not have a mental illness! You cannot make a diagnosis if there is no patient in the office to diagnose! Why wasn’t he diagnosed? That is what is worth reporting on.

More than once, people who would go on to kill have been evaluated and sent on their way.

This statement seriously needs references. It also needs A LOT of commentary and context. It is incredibly irresponsible to suggest that a person at risk of a school shooting would be seen by a qualified mental health professional—deemed healthy, and “sent on their way.” Where the fuck did this statement come from?

In some cases, treatment did not avert violence. The man who killed 12 people in a movie theater in Aurora, Colo., in 2012 had been seeing a psychiatrist specializing in schizophrenia.

The link in the above sentence is to a 2012 NYT article about James Holmes including, “At one point, his psychiatrist, Dr. Lynne Fenton, grew concerned enough that she alerted at least one member of the university’s threat assessment team that he might be dangerous, an official with knowledge of the investigation said, and asked the campus police to find out if he had a criminal record. He did not. But the official said that nothing Mr. Holmes disclosed to Dr. Fenton rose to the threshold set by Colorado law to hospitalize someone involuntarily.” Now the latter part—" the official said that nothing Mr. Holmes disclosed to Dr. Fenton rose to the threshold set by Colorado law to hospitalize someone involuntarily” says jack shit. The fact is, the psychiatrist was concerned and tried to warn. Also, the last sentence is confusing in mixing “involuntary hospitalization” with the concept of taking any action whatsoever. Involuntary hospitalization is by far not the only means to prevent a mass shooting! And one major point of this critique is that OUR LAWS ARE NOT CURRENT WITH OUR PSYCHOLOIGCAL AND PSYCHIATRIC UNDERSTNADING OF VIOLENCE!

After the 1999 Columbine High School shooting, also in Colorado, the journalist Dave Cullen deflated many of the myths surrounding the massacre when he revealed that the perpetrators were neither outcasts nor bullied. Rather, he reported, one of the two gunmen was a psychopath, lacking in conscience and empathy but abundant in grandiose ideas, and the other was a suicidal depressive who went along with the plan.

Oh, did Dave Cullen deflate many of the myths? What myth that I have described so far did Dave Cullen deflate? Whose myths did Dave Cullen deflate? Providers aren’t the ones saying the bullied or outcasts are at risk of mass shooting events! Also, what Dave Cullen clearly “uncovered” is mental illness in both boys that committed the massacre.

And in Florida, where a jury is hearing testimony before sentencing on what motivated Nikolas Cruz to kill 17 people at a high school in Parkland in 2018, the defense is expected to present evidence beginning this week that Mr. Cruz suffered from a range of troubles, including brain damage, central nervous system abnormalities and cognitive deficits.

But there were warning signs: While Mr. Cruz was still a student, behavioral health professionals had been called to the school repeatedly because he made threats and exhibited disturbing behavior. Two guidance counselors and a sheriff’s deputy had advised that he be forcibly committed for psychiatric evaluation, but no such commitment ever took place.

Now it seems the author is providing evidence that mental illness is, indeed, related to mass shootings.

In Dr. Peterson’s database, more than two-thirds of the perpetrators had some history of mental health concerns, including hospitalization, counseling, psychiatric medication or a previous diagnosis. About 30 percent of the gunmen had some form of psychosis, a category of mental illness that involves difficulty determining reality, and of those, a third killed in direct response to delusions or hallucinations.

But in many cases, the psychosis did not have an influence on their crime, or was only one of several motivating factors. For example, a college student believed that school employees were conspiring against him and had him under surveillance, but turned violent only after failing to get a refund for his tuition.

This is one point of shining truth in this entire article. Psychosis—having hallucinations and/or delusions does not mean someone is dangerous in and of itself.

All of this has prompted some skepticism about the new federal gun law’s allocation of $8.5 billion to expand the country’s mental health care system, especially when the number of mass killers is vanishingly small. “If we were to cure serious mental illnesses, violence would go down by 4 percent,” said Jeffrey Swanson, a sociologist at Duke University.

Go down by 4% huh? What Professor Swanson say makes up the other 96%?

Dr. Swanson said his research has found that other factors, like drug and alcohol use, are more closely connected to violence.

The link in this sentence is to Dr. Swanson et al’s article that in no way shows that mental illness is not the cause of violence. The article not only indicates mental illness is related to violence, but goes a step further than saying “drug and alcohol use are more closely connected to violence.” The article states explicitly that drug and alcohol USE DISORDERS—BOTH MENTAL ILLNESSES are closely related to violence. Also important is that the authors, including Swanson, indicate that people with substance use disorders and low socioeconomic status are at an increased risk of violence, “The study painted a picture of a group of individuals with serious and disabling mental health conditions, but also a marginalized group with very low social capital—mostly unemployed, economically impoverished, typically residing in disadvantaged neighborhoods, often misusing alcohol and illicit drugs, and reporting alarmingly high rates of trauma and violent victimization over their life course. Many of these characteristics and experiences were found to be highly significant correlates of violent behavior. Conversely, participants in the study who merely had a diagnosis of serious mental illness but did not have a history of violent victimization, were not exposed to neighborhood violence, and were not abusing drugs or alcohol, had annual rates of violent behavior in line with the general population without any mental illness—about 2% [30].”

A mental health professional like myself reads this “painted picture” or “profile” as a constellation of mental illnesses—trauma, substance use disorders, and a likelihood of other mental illnesses often caused or exacerbated by poverty—depression, anxiety, Conduct Disorder…

You see there is a major game being played that is much more important than a semantic argument. Someone or some group of people somewhere along the way decided that “mental illness means schizophrenia or bipolar disorder. If someone has PTSD, depression, or substance use disorders, these are not actually considered mental illnesses”—despite the fact they are all diagnosable mental illnesses according to the American Psychologic Association and printed within he DSM. This person or group further seems to have asserted that “these disorders are not predictive of violence along with the assessments that can be made by a qualified mental health professional.” These incorrect and stupid ideas are the cause of immeasurable suffering. Please understand this point. Mental illness is greater than schizophrenia and bipolar disorder. And, saying mental illness is related to gun violence is not the same as saying all mentally ill people are violent.

And study after study has shown that the availability of guns has a far stronger link to violence than psychosocial factors.

Clearly access to guns is extremely important, and we have created immeasurable harm with how easy we have made it to access guns in this country. However, “psychosocial factors” is not clearly defined, but the apparent sentiment of this sentence gets it very wrong. The reality is violence is perpetrated by people with mental illnesses that can be properly diagnosed and helped by qualified professionals prior to a crisis occurring.

Perpetrators are driven by a complex array of factors that can include a desire for fame, radicalization on the internet and childhood trauma, and experts say the means of intervention should be just as broad. Potential killers may be in need of a mentor, substance abuse treatment, cognitive support at school, or even help for their parents such as child care and transportation. Attention to social climate, like anti-bullying campaigns and programs that teach students how to recognize and counteract signs of isolation, may also avert violence.

Even here, the author fails to notice that each of these interventions affect the psychology of the potential perpetrator. This clearly suggests there is something more than access to guns that is going on for the perpetrators of mass shootings.

J. Reid Meloy, a forensic psychologist and F.B.I. consultant, said that whether or not they are mentally ill, most mass killers develop a sense of having been wronged and choose a group to blame. “The personal grievance, then, typically leads to the individual deciding that there is only a violent solution to the distress that they’re experiencing,” he said.

This deeps sense of having been wronged, choosing a group to blame, and deciding there is only one solution are qualities that can be and are assessed for and learned about from qualified mental health professionals doing standard assessments.

Dr. Peterson of the Violence Project has framed perpetrators not as monstrous outsiders but members — and products — of their communities who are often signaling that they need help.

And articles like this teach them that we are not listening to them.

She and other experts say that interventions should emphasize respect, dignity and inclusion. Punitive, exclusionary responses like expulsion from school are likely to increase the risk of violence.

Articles like this that increase stigma regarding mental illness (suggesting mental illness primarily means psychotic disorders where the patient is very, very sick).

Four out of five of the perpetrators in the project’s database, Dr. Peterson said, showed signs of crisis — defined as a period when one’s circumstances overwhelm one’s coping mechanisms, shortly before carrying out their crimes.

Crisis can be triggered or exacerbated by mental illness, but also by loss of a job, a breakup, divorce, death or other events. The mother of the Parkland gunman died three months before he carried out his attack at the high school, from which he had been expelled.

This suggests that potential violence can be averted. In a TEDx talk called “I Was Almost a School Shooter,” a man named Aaron Stark recounted how a friend’s simple invitation to watch a movie helped divert him from his plans. “When someone treats you like a person when you don’t even feel like a human, it’ll change your entire world,” he said.

Yes, this is obvious to someone that works in mental health. And, this is what mental health providers do every day. It is our job to assess people’s health and respond in ways that avert internal and external psychiatric crises.

In interviews with perpetrators, Dr. Peterson said, “We would always ask, is there anything that could have stopped you? And they would always tell us, yes.” She added, “I think one of them said probably anyone could have stopped me, but there was just no one.”

Patricia Mazzei contributed reporting.

Audio produced by Jack D’Isidoro.

Shaila Dewan is a national reporter and editor covering criminal justice issues including prosecution, policing and incarceration. @shailadewan

A version of this article appears in print on Aug. 23, 2022, Section A, Page 1 of the New York edition with the headline: Life Crisis Is Often a Warning of Mass Shootings.

Our healthcare system’s role in school shootings.

06/03/22

I am not going to sidestep the fact that mass shootings would be more largely prevented with better gun regulation. That is the statistical truth. However, I am going to focus on an issue both sides of the firearm debate purport to care about—mental health.

I am a child/adolescent psychiatric nurse practitioner in Rochester who works with outpatients—kids with mental illness that are not in the hospital. I am one of a very diminishing supply of outpatient child psychiatric prescribers in Rochester. I don’t think most parents of Rochester, MN realize that kids suffering from mental illness in this community who need medication are on a long waiting list or will just never be seen due to purposely shady practices of health insurance companies.

The practices I am referring to are “hoops” designed to prevent payment when your child is sick. I would really like to help as many children as possible, but I spend hours each week jumping through hoops of insurance companies rather than seeing more sick children. And I see very ill children. About 10% of my caseload includes kids that are dangerous to others. These kids, without help, are at very high risk of future incarceration due to harming others physically and/or sexually. There are kids on my growing waiting list that have these same problems.

Rather than helping more kids with mental illness, I spend hours each week on activities such as the following:

-updating “required” info on a database that insurance companies supposedly use

-interacting with insurance companies directly who want the same info but don’t use the database

- having meetings or emailing contractors I hired to bill and fill out endless paperwork required by insurance

-attempting to get an insurance company to pay for a cheap, generic, evidence- based medication because the insurance company has found a new way to attempt to deny payment

-being bounced from person to person on phone calls to insurance companies

None of these activities give any value to my patients or to society. They are simple, purposeful roadblocks put up to prevent them from paying for your sick child’s care. Health insurance companies create the illusion that they providing overall benefit to society while hiding unethical practices that prioritize bonuses for employees over the health of their clients. The primary weapon insurance companies use to hide their practices is creating what appears on the surface to be a very complicated system. Jargon is used to make things seem so complicated that Americans understandably believe “paying for healthcare is so convoluted, I could never understand.” The truth is, insurance companies play games to justify paying for fewer services while charging more and more to clients each year.

Where the rubber meets the road for Rochesterians is: mentally ill children become mentally ill adults. Our community is less safe. More money is spent on the penal system rather than money generated by healthy socially productive people, and everyone’s quality of life diminishes.

Parents in Rochester should know:

The depths to which insurance companies sink to prevent payment are limitless and are actively harming the children of Rochester and making our community less safe.

Universal healthcare would prevent this from even being an issue, and would certainly cost less and improve health outcomes for our kids.

Parents and people with mental illness can use their voices to call or email their representatives to complain about lack of care, poor care, poor insurance service, expensive insurance, or that they want universal healthcare to change this.

I have worked with very mentally ill children for the past 13 years. I am convinced that if children get good treatment early enough, school shootings and other massacres can be absolutely prevented.