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Connecticut U.S. senators continue call for better mental health services

New Haven Register (CT) - 11/25/2014

Nov. 25--NEW HAVEN -- The failure to coordinate care for Adam Lanza and provide intervention early in his life are viewed as important lessons that should help drive future federal mental health policies and resource decisions.

U.S. Sen. Chris Murphy, D-Conn., in his latest roundtable discussion with experts on behavior health funding, used the report prepared by the Office of the Child Advocate to drive the discussion on Monday.

Almost two years ago, Lanza, whose serious mental health issues were not dealt with over his lifetime, combined with an easy access to firearms, killed 20 first-graders, six educators and his mother before he committed suicide at Sandy Hook Elementary School.

Murphy said he was struck by the number of institutions that interacted with the Lanza family.

"There were a lot of people who were opining without talking to each other and it wasn't clear who was in charge of this young man's mental health and his treatment plan going forward," Murphy said.

He said inevitably the burden fell to the school system, which did not have the resources to handle it.

U.S. Sen. Richard Blumenthal, also D-Conn., said the health system has to be overhauled and reformed so there is equal treatment of mental health issues as there is for physical maladies, something that has been the law for years but is essentially ignored.

"We need more than words. We need actions and resources and that begins with the insurance companies," Blumenthal said. The state's senior senator said "the insurance companies have never followed their responsibility" to give parity to mental health treatment.

"One thing we know with absolute certainty (is) that mental health issues are inextricably intertwined with violence. Whether it is domestic violence or gun violence, violence on our campuses and sexual assault, we all reap the whirlwind of failing to deal with mental health patients effectively," he said.

Blumenthal said the overriding message of the report is to "intervene, screen, get the family engaged at the earliest possible stage, pre-school where disability or issues first become apparent as they did with Adam Lanza."

"Think of how much pain and suffering could have been spared that family and ... the families that ultimately were victims, if earlier screening, earlier intervention had been involved," Blumenthal said.

The practitioners, who deal with the bureaucracy daily, had a number of suggestions.

Dr. Ece Tek, who is chief of behavorial health at the Cornell Scott Hill Health Corp., said the rules mitigate against good timely care.

In order to get approval of insurance companies, you need a diagnosis, but they are unwilling to pay for the assessment that often takes more than one session with a child. She said the clinic, if it sees the patient without the approval, takes the risk of not getting paid.

Talking to insurers can take up to an hour, which can wreak havoc with scheduling.

Murphy said the rules imposed by the state Department of Mental Health and Addiction Services also present a barrier to the "handoff" of the child from one agency to another to get the necessary care.

He said the amount of bureaucracy and paperwork necessary to get a child with a broken leg to an orthopaedic specialist is fundamentally different to approvals required for help with a behavioral health problem.

The discussion that should be talking place among social workers, practitioners, school officials and a family is not paid for, said Abby Anderson of the Connecticut Juvenile Justice Alliance, unless there is a private grant they can tap.

"That's a huge problem. ... Nobody pays for anything that is patient centered," she said.

Several practitioners argued for education to address the stigma of mental health treatment, as well as education on the over-reliance on drug solutions.

Kristie Barber, director of the regional South Central Connecticut Mental Health Board, talked about the games that numb kids to violence and asked as a society "why do we normalize violence, but can't normalize mental health conditions?"

Dr. Vinod Srihari, a psychiatrist on the faculty of the Yale Medical School, runs a program of intervention for patients starting from age 16 to 35 in the early stages of psychotic illnesses.

Srihari said late adolescence and early adulthood is when many of the most serious conditions present themselves, which is the same time "societally we set people to fall out of (treatment) systems."

Shirhari said there are successful models in the United Kingdom and Australia. He said a focus on emerging adulthood will pick up on a lot of challenges around mental illnesses.

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