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General News    H3'ed 9/10/11

9/11: Another excuse to ignore seriously mentally ill

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When the World Trade Center was first bombed on February 26, 1993, it quickly became an excuse for those who were responsible for providing care for people with serious mental illness to abandon their responsibilities. The 1993 bomb was placed in a parking lot and killed seven people and forced others to abandon elevators and walk down the World Trade Center stairs. Some of those who walked received smoke-inhalation, sprained ankles and other injuries for which they were treated and recovered. The rest of the country watched on TV.
The reaction of mental health authorities in New York was to instantly pull off their jobs all the psychiatric outreach workers who were supposed to be helping psychotic, homeless, helpless, mentally ill individuals get treatment. The mental health authorities decided to abandon people who were already psychotic so the outreach workers could provide counseling for people who had to walk down stairs or felt bad from watching people walk down stairs on TV. 
It's a typical reaction of mental health authorities everywhere: reverse prioritization of services whereby those who need services the least go to the front of the line and those who need them the most go to the back. Abandon the seriously ill. Ignore schizophrenia at all costs. 
As Ethan Waters wrote in The Americanization of Mental Illness, "We are investing our great wealth in ... medicalizing ever larger swaths of human experience" Losing a loved one, witnessing something unpleasant are no longer a normal experience, grief no longer a normal reaction. These are now illnesses that are entitled to first call on mental health services. Those who are already undeniably mentally ill will have to undeniably wait.
It happened again on July 17, 1996, when TWA flight 800 crashed off Long Island and killed 230. Losing a loved one is always traumatic, whether in an accident, by heart attack, or in a plane crash. Losing a loved one is 'normal'. But in reaction to the crash, psychotic homeless individuals were again abandoned. Mental health authorities told outreach workers to stop helping the psychotic and start counseling those who lost loved ones. Losing a loved one was no longer a rite of passage, it was a medical incident with it's own line of coding on insurance reimbursement forms.
Every city has homeless, psychotic people who are delusional, believe they are the messiah or believe the devil is trying to kill them. They are eating out of dumpsters, screaming at voices only they can hear.  And they are routinely denied help for their illness so the worried-well can receive help for their normalcy.
Medicalizing lived experiences has become so commonplace, so part of our culture, that the Center for Disease Control recently came out with a report, unquestionably accepted and amplified by the media, that half of the US population will have a mental health issue over their lifetime. What CDC calls "mental health" issue, most would call a normal part of life. They also found that $300 billion is being spent on the "issues".
Ten years ago, September 11, 2011, when the World Trade Center was again, more successfully attacked, the pattern was repeated. All outreach workers who were supposed to help people who were already psychotic and homeless get into treatment were instead pulled off the job. Their new assignment became comforting people who escaped the attack, lost loved ones, or watched on TV.  
A Huffington Post blog, written by Dr.  Lloyd Sederer, medical director of New York State Office of Mental Health explains how massive the effort was:
In response to the attacks on the World Trade Center in 2001, New York City and 10 surrounding counties mounted the largest and most effective mental health disaster response in history. Approximately 1.5 million people were served, receiving crisis counseling and education in their community settings....
One and a half million people? On September 11, 2001, a maximum of fifty thousand  people were at work in the Trade Center. If every one of them died (only 3,000 did) and each had four close surviving family members, that means there were 200,000 people OMH could counsel. 
Who were the other 1,300,000 people OMH was serving? What were their illnesses? What was the cure rate? 
On September 11, 2001 and the period following it, many New Yorkers (and Americans) were justifiably upset, sad, blue, scared, and more. But being upset, sad, blue, or scared by seeing a horrific event is not a mental illness.   In fact, it is more likely that not being affected by the World Trade Center bombing would indicate the presence of an illness.
But on September 11, 2001, people with real illnesses, were abandoned by the New York State Office of Mental Health in favor of those who didn't have illnesses. 
During the months that followed the September 11, bombing it got worse. The government allocated incremental funds to run mental health hotlines. When calls didn't go up, the government funded TV campaigns encouraging people who watched the towers fall on TV to call hotlines for referral and counseling. When few called, more money was allocated to the TV campaign. Dr. Sederer puts the total spent at $137 million. Meanwhile, throughout New York City, already psychotic people were sleeping on park benches, diving into dumpsters for food, and no one would help them. There were no outreach workers, no services available. They were at the end of the line, if not the end of their lives. 
Most likely, the ten-year anniversary of September 11th will see a resurgence of efforts to convince people who are reminded of the day, that feeling sad about it is a illness that needs treatment. That they should reach out for help. And most likely, the services will be made readily available. Meanwhile, the already seriously mentally ill will continue to be left abandoned, imprisoned by their psychosis.  Alone at the end of the line.
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DJ Jaffe is a long-time advocate for people with very serious mental illness. He has written for NY Times, WSJ, Wash Post and others. He blogs on mental illness on Huffington Post
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