A psychiatric social worker reflects on what it would take to improve the U.S. mental health system, with techniques and programs that have been shown to work.

by Barbara B. Smith

Much too frequently in America, we bear witness to horrific shootings. We try to make sense of these events and ask ourselves why they happened and how to prevent future tragedies. We call for gun control – anything – to stop the insanity. No doubt, stricter gun laws are needed in this country. But we also need a humane and effective mental health system that gives priority to young persons with emerging severe mental illness.

Bebe Smith headshot
Image courtesy Bebe Smith

In the aftermath of these events, people with mental illness, particularly schizophrenia and other psychotic disorders, become demons in the eyes of their fellow citizens. This ugly public perception of mental illness affects what happens privately – if a young person with a promising future develops psychosis, we don’t want to believe it. We ignore it or call it something else. And because many have this notion that a person with schizophrenia is equivalent to a monster, the person with psychosis isn’t likely to embrace that label. Denial delays treatment, and the cycle continues.

I know these challenges because I have spent the past 20 years working with people with schizophrenia. I love my clients. They are not monsters. They are your brothers and sisters, mothers and fathers. They are part of the human family, with the same hopes and dreams we all have.

Most people with emerging mental illness are in distress, and open to help if it is humane and addresses the problems they define. If psychosis is treated, perhaps we can prevent violent acts that stem from paranoid delusions.

As with any other illness, early intervention has the potential to create better outcomes in schizophrenia. But in the U.S., it’s almost impossible for young people with emerging severe mental illness to get the help they need. Over the past 30 years, our mental health system has suffered from fragmentation and underfunding. The resources we do have are sometimes misdirected. We have over-relied on medications – hoping for the quick and simple cure – for disorders that are complex. The emergence of a severe mental illness can affect every aspect of a person’s life. People with severe mental illness are best treated with a comprehensive approach that includes psychological treatment, and social and vocational supports, in addition to medication. For those with very severe psychosis, we also need safe and humane settings for treatment.

The international community is far, far ahead of us in the area of early intervention in mental health. Can you imagine the U.S. being so far behind in the treatment of cancer or cardiovascular disease? We can look to other nations – Australia, Canada, the UK, Japan, Finland and Singapore – to learn how to help our youth.

So, what can we do to improve our own nation’s mental health system? We need to strengthen our efforts at prevention and early intervention in psychosis. We need to put just as much emphasis on mental health as on physical health. We need to get the message across that psychosis is treatable, recovery is possible and mental health can be restored. Let’s do the following:

  • Treat emerging psychosis like a true medical emergency.
  • Make youth mental health a public-health priority.
  • Provide education to young people, their families, their teachers and their faith communities about early-warning signs of mental illness and how to get help.
  • Create specialized early-intervention teams that can respond rapidly and humanely to persons with emerging severe mental illness.
  • Strengthen the mental health workforce by developing training initiatives that focus on persons with severe mental illness.
  • Broaden the dominant medical model to include psychological treatment, social interventions, psychiatric rehabilitation and peer support.

Ultimately, as a clinical social worker, what I’d like to see is what I’d want for myself or someone in my family: early intervention, easy access to care, the best treatment from a multidisciplinary team of professionals, shared decision-making and enough support to lead a meaningful life as a contributing member of the community. If we had those things in our mental health system, we would all be better off.

Barbara B. Smith is a clinical assistant professor at the UNC-CH School of Social Work and the department of psychiatry. In 2012, she was recognized as “Social Worker of the Year” by the N.C. chapter of the National Association of Social Workers.

This commentary was originally published in the Durham Herald-Sun

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Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...

4 replies on “Commentary: Early Intervention in Youth Mental Health”

  1. Great article, Bebe! Thanks for putting into words what so many of us live and think about.

  2. The only time I see family as mentioned is “to provide information and education” . Families need to be respected and made without the paper shuffling, approval sorting as part of the treatment plan. Too many have experienced families being judged with inappropriate bias from practioners so that the systems of support that families provide are often over looked and more importantly not proactively and actively engaged. Also, many behaviors, as stated are being quickly evaluated, medications tossed at without the well rounded approach of making sure the behavior could stem from another marker that is not mental health but let’s say specifically ASD oriented. Approaches are different. But because evaluations are not spread to other professionals the patient is trapped ( unless family pushes for further Evals ) with a one sided view of ‘illness’ . Needless to say I am mortified as to the systems of care. I have worked 8 years within state hospitals, with the developmentally delayed several years, 4 years with NAMI, and a parent

  3. Excellent insights! I hope they help us consider new ideas about how we respond to young individuals having extreme and troubling experiences! They aren’t just “sick” but are having real-time experiences that better benefit by a more whole-person approach.

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