Gentle Fudge
religion, politics, current events, and other fashionable dinner conversation.
Thursday, April 17, 2008
Minority Report
On Sunday, it was announced in a local paper that UVa would alert parents of students if students showed signs of mental illness, focusing on those who were "a threat to themselves or others." To make sure that this policy did not violate HIPAA, the Health Insurance Portability and Accountability Act that all competent adults are entitled to, UVa's Visitor's Bureau made sure that their clause read that they would only allow notification if there was " 'substantial likelihood' in the near future that their child will harm himself or others, as evidenced by the student's recent behavior or any other relevant information."

This reactionary invasion of adult privacy comes in the wake of the Virginia Tech shooting from a year ago. Again, understand that the shooting hit home for me. It was mere hours away from where I live. I knew friends who attended, people who lost loved ones, people who almost lost loved ones. It isn't something I take lightly. But 'criminalizing' those who have mental illness or those who express frustration and then labeling those individuals as "unstable" -- as our medicated society is so apt to do -- will only create more walls and close off communication from the still-developing mental health field and those who are considering pursuing treatment for multiple reasons.


The Individual
Anyone who has considered that something has been wrong knows how long that thought has lingered in the back of the head. And how long it took to come to the personal realization that something actually was wrong, that it all wasn't just in the head, and to start looking for help. How many voices, both personal and professional, sneered to the contrary. How many medical tests proved the opposite. How many doctors have been seen. How many insurance payments have been made. How many years were been wasted. How many different diagnoses were made. How many miles were driven. How much hope was lost. How many different drugs were tried. How much sleep was lost. How much money was spent. How many friends were lost. How many relationships were strained or dissolved. Sometimes it works. Sometimes you wonder if it ever will.

The Family & Mate
Anyone who has had to break the news to family that they have a mental illness knows that there are as many reactions as there are species of butterflies. Some are accepting and stay the course throughout treatment. Some deny everything. Some tell you it is your fault and walk away. Some tell you if you had prayed more or had more faith, G-d wouldn't have deserted you with this illness. Some run hot and cold. Some are too caught up in their own world to care. Some ignore it and don't do anything. Some make fun of it. Some try to exorcise your demon. Some are just as ill and don't see it themselves. Some are confused and don't know what to do. Some lecture and become self-righteous.

The Friends
Friends often have similar reactions as family, depending on closeness. Many feel helpless and don't know what to do. Many go on and pretend the illness doesn't exist because they don't know any better.


I've been through this mass production myself, as I'm manic depressive lite. (Bipolar II to the less poetic.) And that's as personal as I'm getting in this edition. It's right back to the usual chewy news and religion after this.

Sure, this sounds all romantic and mysterious, but it can be absolute hell -- or heaven. I couldn't blame any friend or family member for any reaction. It is very much like a death and there is a grief phase. But could you imagine a stranger giving you this news instead of your loved one? There is no way I would want my school giving such personal news in place of someone I knew. I prefer to be in control of who in my family I tell. I know who I can trust and who will shun me.

I sought feedback on this in the political scene, from those who know Delegate Rob Bell, the head of this policy. Of course, this would only apply to 1% and not the 99% who eventually seek treatment. Tangent: it reminds me in a way of the parable of the 99 sheep and the 1 who gets away, lost, who was chased after through rocky crags and prickly thickets, and brought back in. (Why is it always 99 and 1 with politicians? With bipolar, the stats are around 97% normal and 3% irregular. Maybe the math needs to be easier...) And of course a judge has to make the determining factor that the individual is a danger [to society]. Duh. I know that. But I also know that if you are in a psychotic state, you can be committed temporarily without a judge's order. To be committed permanently, you need a judge's order. Without the family's permission. And even then, there is room for debate. All this was looked at based on Cho, who was court-ordered to get help. But he didn't want to. You cannot force someone to get help who does not want it. Anyone ever live with an addict?

Oh, and the policy would only qualify for those students still qualifying as dependents and would only go to the custodial parents. So again, privacy is not an issue. Right? And of course, if a friend or family member mentions to one of the 99 that (s)he needs help, (s)he will get it. Because that's what all the research from the parents, patients, advocates, mental health professionals, police, school officials, and others had showed... goddIlovestatistics. Everything is happy-happy and this is the perfect plan. They all lived happily ever after.

But again, how do you determine 'dependent'? On a tax-return? Or someone who is a minor? Any parent of course would want to know about his or her child, because you will always be a kid to your dad or mom. Or step-parents. Or grandparents. Or whoever raised you. Come to think of it, who qualifies as the 'custodial parent' in this policy? I detest legalese.

And an energy efficient light bulb will suddenly appear over an individual's head once a friend or family member sees something wrong and suggests getting help. "I never thought of that..." Hmmm... ok, in some cases, usually with depression, that does happen. In most cases, there is an inkling that something could be off and no one else sees a damn thing because it's easy to mask or con out of or ignore. And it can take years for reality to sink in.

Anyone who has been through the mental health system knows that it needs some serious tweaking. It can take years to get an accurate diagnosis in many cases, let alone getting around to deciding to seek help. As the old joke goes, it only takes one psychiatrist to change a light bulb, but the light bulb has to want to change.

The last thing we need from The Powers That Be is heaping those who wish change for themselves into the same basket as more dangerous disorders. Someone with major depression is different from general depression is different from schizoaffective disorder is different from an anxiety disorder is different from a compulsive disorder... and there are all different colors and flavors and mixtures of each of these and we all get different treatments.

Have any of these representatives pushing policy been through any of this themselves or read the actual bills instead of getting briefed by aids, well-meaning parents, school officials, and lobbyists? Are they aware of the personal implications for the individuals, the time it takes to go through the system, the backlash once a diagnosis is made, once the family or friends have been told? And now there is the added fear that someone will see something, label it as a 'danger,' and tattle to mommy and daddy without telling us. That's how I interpret the policy.

There needs to be better dialogue regarding mental health and mental illness and the stigma needs to be taken away instead of being feared and again associated with Bedlam, jackets and/or restraints, and psychotic killers like Jeffrey Dahmer and Cho.

Those in legislature and pushing these policies have little understanding behind what they are pushing. It isn't going to be a quick fix. It isn't black and white, cut and dried, or easy. Not everything is prevented or seen, especially mental illness. We can always look back with our 20/20 hindsight and hypothesize on how things could have been done differently and prevented. Not everything can be predicted. Humans are entirely too unpredictable, unstable. The wiring is faulty. For the most part, it works. But every once and a while, there is a glitch in the Matrix. We find it, we use the duct tape, solder a little here and there, and we move forward.

I'm getting tired of taking my shoes off at the airport, wasting good shampoo, and trying to figure out if hair sculpting wax is a liquid or a solid according to whichever random NSA agent. This is the same instance. We are reacting to a random, tragic and violent event that happened instead of seeking prevention through good dialogue and looking at our available resources, improving them.

Please petition your House Representatives, letting them that this is a very slippery slope regarding personal privacy, mental health and treatment of it, and encourage them to look at alternatives.

Those in the Virginia who supported this policy:

Labels: ,

posted by Sara @ 10:02 AM  
  • At 8:03 PM, Blogger Chip said…

    Thanks for that post. I am only too familiar with the mental health system and life with depression. My ex had severe clinical depression but thankfully, she found a good seres of therapies and is doing really well now. Your thoughts on policy were informative.

  • At 12:54 PM, Blogger Sara said…

    I had one comment (will leave anonymous) made by an acquaintance stating something to the effect of the policy being a good idea if notification was made on the basis of non-privileged info, and if the notification was made by an RA, a close professor, or someone else who could tell that the student looked like (s)he was in immediate trouble. Then it would be appropriate; it wouldn't be different from a friend or acquaintance from speaking up and would be the responsible thing to do. However, taking information from a therapy session or private discussion between the student and a medical health professional would be inappropriate because that would disclose that adult's private medical information to the parents.

    First, what we know (or believe) that has led to this policy:
    What has been discussed in these meetings at VA Tech was that the medical records were available to VA Tech and that the authorities at VA Tech should have 'acted appropriately' by enforcing the judge's ruling. Also, the student (Ho) should not have been allowed at the school due to his dangerous mental condition; he should have been put in a mental health facility.

    Here is where it gets tricky. Letting the school have access to a [an adult] student's private medical record is in clear violation of HIPAA and personal privacy. If the judge believed that Ho was a clear danger to himself and others, the judge could have clearly placed him in institutional care without individual or parental consent. This happens. I don't have a problem with this at all.

    Secondly: If an acquaintance who does not know the individual well makes an observation and a recommendation to the mental health facility, can it truly be objective? The person may be having an off day. It could be normal behavior. There could be a stress reaction. Having untrained outside non-objective observation is not always the best way, either.

    Even the trained eye can be written off. Example: I have called child protection services for clear child abuse patterns. I was trained to know the signs and symptoms for behavior. I was asked by the person on the other end if I saw physical signs (bruising, scars, burns). I had not because the child wore long sleeves and pants constantly (even in the summer, I informed). The person on the other end of the line said there was nothing that could be done even though I had seen clear signs such as fear, pleasing behaviors, and avoidance.

    Even when we put wood chips under the swing sets and get rid of the teeter totters because we don't want our kids to get hurt anymore, bad things still happen and we still will ask why. I don't want to write it off blandly and say "this is life, get used to it" but I will say that we can't insulate every little bump and every little hurt.

    We can grow through pain. We live life in a spiral and when we come around to that same hurt, that school shooting that for some reason escalated to another level (Columbine, VA Tech), and we realize that we will not be overcome.

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Name: Sara
Home: gypsy wanderer, United States
About Me: Those who know me find me stubborn, opinionated, open-minded, strong-willed, of some intelligence, and yet they still hang around.
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There is wisdom in turning as often as possible from the familiar to the unfamiliar: it keeps the mind nimble, it kills prejudice, and it fosters humor. -George Santayana, philosopher (1863-1952)

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