In mental health, some good came from Sandy Hook, advocates say

Editor's note: In a series of stories this week, The Mirror has been looking at how the shooting at Newtown last year has affected Connecticut.

Patricia Rehmer calls it a sea change, the shift in how mental health has been viewed in the year since the massacre at Newtown's Sandy Hook Elementary School.

Interest in behavioral health issues surged. Classes about the signs of mental illness and how to intervene now have waiting lists. More than 1,400 people who work with young people have received training on trauma in children. Rehmer, the state’s commissioner of mental health and addiction services, says the number of times she’s asked to speak publicly has more than doubled.

Policymakers are trying to address gaps in services for young adults with behavioral health problems and insurance companies, long criticized for not adequately covering mental health services, are participating in discussions on potential changes.

And in a tight budget year, legislators found the money to expand mental health programs advocates had long fought to get recognized.

For the advocates, the Newtown shooting brought both worry -- that people with mental illness would be further marginalized and inaccurately linked to violence -- and hope, that issues they had long hoped to spotlight would finally be addressed.

Nearly a year later, many say some of the changes are encouraging, even as some advocates warn that the system remains underfunded and at risk of further cuts.

And for Rehmer, who spent a significant amount of time in Newtown leading a department that played a major role in the immediate aftermath of the shooting, the changes bring conflicted feelings.

“There have been a lot of good things that have come for us, and it’s kind of really mixed for us,” Rehmer said. “[There is] additional funding to put things in place, which we think is really important."

"But it is at the expense of this sort of atrocity.”

Moving the dial

The changes to the state’s mental health system in the past year have been significant, people involved with it say.

Some are concrete, like funding to expand programs that serve people with serious mental illnesses and to develop a system for pediatricians to consult by phone with child psychiatrists for help addressing patients’ needs. The high-profile gun-control legislation passed in response to Sandy Hook also included changes in how insurance companies handle mental health coverage.

Other changes advocates cite are harder to measure, like increased interest in understanding mental health and a greater recognition among the public that a mental illness is one aspect of a person’s life, not the defining trait.

“I think that the event in Newtown sort of moved the dial,” said Kate Mattias, executive director of the National Alliance on Mental Illness Connecticut. “Whether you want to deal with issues or not, I think it’s going to be impossible to have certain conversations, [such as that] kids don’t have mental illnesses or that it’s just behavioral problems or the family needs to shape up. I think that those are going to be fewer and far between.”

Dr. Harold “Hank” Schwartz, psychiatrist-in-chief at the Institute of Living in Hartford, said he’s seen greater concern among parents and school officials when young people seem to exhibit risky behaviors or thoughts. 

“We have kids sent to our emergency room much more readily, and it’s not all an overreaction. Some of these kids we wind up hospitalizing,” Schwartz said. “So they’re getting at-risk kids coming up to our attention a little bit sooner and getting into treatment systems sooner.”

“Even the police are more responsive when they get calls,” he added. “We’re having the police in with adolescents who may be at risk more frequently.”

More focus on prevention

Many experts have urged lawmakers to focus on addressing issues in younger children, with a goal of preventing problems from developing. They say there have been advances, including in a new children’s mental health law that aims to make the system less fragmented and easier for families to navigate.  

There’s now a statewide campaign to promote early identification of young children at risk for developmental and behavioral problems and link them to programs that can help, noted Dr. Paul Dworkin, physician-in-chief at Connecticut Children’s Medical Center in Hartford.

There's been an increased interest in learning about how to address childhood trauma, which is linked to poor mental and physical health outcomes later in life. Since Sandy Hook, the Child Health and Development Institute of Connecticut has trained 1,470 people who work in health care, schools, child welfare and law enforcement in recognizing and addressing child traumatic stress.

Dworkin said he’s also seen improvements in addressing the needs of children in crisis, including more commitment from state agencies and contractors to find suitable options for children who need more acute help.

The capacity for the state’s emergency mobile psychiatric services to help a child in crisis has never been better, Dworkin said.

“But the flip side is the number of children presenting in acute behavioral crisis continues to rise,” he said.  

But problems remain

Jan VanTassel, executive director of the Connecticut Legal Rights Project, said Connecticut’s response to Sandy Hook is notable in part for what it didn’t include. State officials didn’t follow the lead of New York, where lawmakers hastily passed a measure that, among other things, requires mental health professionals to report to authorities when a patient is “likely to engage in conduct that would result in serious harm to self or others.” Professionals and advocates have warned that it could cause people to avoid treatment.

“The restraint they showed and the thoughtfulness in really looking at all of the issues very carefully I think is a credit to the Connecticut General Assembly,” said VanTassel, who co-chairs the Keep the Promise Coalition, a mental health advocacy organization.

But VanTassel noted that Connecticut’s strained finances limited the state’s ability to respond in a scope that could dramatically change the system, such as expanding the availability of school-based health centers that provide both physical and behavioral health services.

Similarly, the children’s mental health bill included a number of changes that advocates supported, but didn’t include additional funding.

And Sheila Amdur, a longtime advocate for mental health services, said funding for and access to care remains far too low.

Even as lawmakers provided new funds for mental health programs, she noted, Gov. Dannel P. Malloy proposed cutting state grants for mental health services provided by private nonprofits, leaving them to rely on Medicaid, which the providers said is an inadequate funding stream. Legislators ultimately reversed some, but not all, of the proposed cuts.

There’s still a need for far more resources to help people who need treatment, Amdur said.

“When a fireman’s trying to put out a fire and you have a garden hose, you’re not going to get very far,” she said. “You have to say, ‘How did the fire start and how do we prevent it, and what do we do in the future?’”

Amdur said advocacy for a better treatment system has been hindered by stigma about mental illness.

Some advocates say the stigma -- Rehmer calls it discrimination -- has lessened in the past year as more people learn about mental illness and as they point out that people with mental illness are more likely to be the victims of violence then the perpetrators. But there are setbacks.

“We spent a lot of time over the last year speaking to legislators and delinking the issue of violence and mental illness,” Mattias said. “But it’s very hard. You go two steps forward and then something like the Navy Yard happens.”

Will it continue?

About a month ago, Rehmer began to worry that the focus on mental health was receding.

“We haven’t addressed all the issues yet,” she said.

But Rehmer said she’s come to believe the interest isn’t diminishing as much as she feared, in part because of the focus she sees from lawmakers and the work of a task force examining behavioral health services for young adults. It is expected to release recommendations that could be addressed in next year’s legislative session.

“People are finally understanding the complexity of the issue. It is so much more complex than people think it is,” said Victoria Veltri, the state’s healthcare advocate. “There isn’t a simple concrete solution.”

Will the increased focus on mental health endure as time goes by, or will it recede as other crises take center stage?

Mattias thinks there will be an enduring interest ensuring that people, especially children, get the care they need. That, she said, is a conversation that won’t die off. “Does it have enough sustainability for a five-year conversation? I’m not sure,” she said. “But I think it has sustainability for at least the next couple of years.”

Schwartz said there’s more interest in mental health issues than he’s seen in his nearly 25-year career in Connecticut.

“The conversation is going. I’m encouraged about that to some degree, but conversations are just conversations, and if we look back five years from now, I think the jury is still out in terms of concrete change,” he said.

“With movements like this, there’s always the risk that they fade and they get pushed aside with the next big issue to come along,” Schwartz said. “I think even if that’s the case, the window’s going to be kind of wide here.”

“I think the state of Connecticut is still very raw with regard to Sandy Hook, and I don’t think that that’s going to diminish very soon.”

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