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ADVANCE Perspective: Nurses

Missed Lesson of Sandy Hook Elementary School Murders

Published December 17, 2012 5:36 PM by Rich Krisher
Friends, friends of friends and total strangers emotionally raw over the mass murder of students and staff at Sandy Hook Elementary School in Newtown, CT, expressed rage all weekend on my social media networks about the presence of guns in our society.

The theme carried over to mainstream media outlets. Here's a sampling of today's lineup of opinion columns at washingtonpost.com:

It's astounding how the near-singular focus has been on the weapons used in the killings rather than the circumstances over months and years that led the individual who perpetrated the tragedy to open fire at the school. I'm neither a gun owner nor an apologist for the gun lobby. But we could pass strict gun ownership laws and continue to be faced with these heartbreaking events if we fail to address the role played by our mental healthcare system.

Liza Lang, a writer from Boise, ID, generated much attention with her essay, "I Am Adam Lanza's Mother," posted online just after the school shootings. "I live with a son who is mentally ill. I love my son. But he terrifies me," she writes. She recounts experiences with her high-IQ, 13-year-old son, who she says has threatened to kill her and himself with a knife, among many other incidents. At a loss for answers, she was told by a social worker her only recourse is to have her son charged with a crime.

"No one wants to send a 13-year old genius who loves Harry Potter and his snuggle animal collection to jail," she writes. "But our society, with its stigma on mental illness and its broken healthcare system, does not provide us with other options."

Perhaps these conditions are an unintended consequence of the deinstitutionalization movement, which eliminated vast numbers of beds in public psychiatric hospitals and thus limited opportunities for providing comprehensive treatment - and exposed society to violent outbursts that seem to compound in degree of random horror.

It gets back to the stigma surrounding mental health. Evidence-based practice in psychiatric care is deficient, a longtime psych nurse admitted to me this morning. The relative paucity of knowledge about the human brain, combined with myriad psychiatric theories, medications that are not always effective or consistently used, and the legacy of abuse in now-shuttered public psychiatric hospitals, leads to public distrust of mental health treatment.

We surely could use a mature discussion of why civilians should possess semiautomatic guns, rifles and other weapons. But it sure feels like another political sideshow warming up - lines have been drawn on familiar partisan terrain in the days following the shootings.

Let's not allow the noise and hyperbole generated by gun-control fervor to trample the need for an equally urgent dialogue about mental healthcare services. Mental health research needs to become a top priority of public and private funding organizations, and vastly greater numbers of psychiatric beds are needed. Families and acquaintances of affected individuals, as well as the court system, should have more tools at their disposal to get those individuals treatment.

Of course, not everyone who requires mental health services is a danger to society. But this is an ideal time for mental health advocates to speak up for their cause. Nurses in all areas of practice can also take the lead by offering education and bringing mental health concerns into conversations about care. Nurses can help establish trust in treatment, which will go a long way toward eliminating stigma.

15 comments

It takes all of us to work for gun control laws and an improved mental health system. Cliches', such as guns don't kill people, people kill people are not helpful.  People kill people by pulling the gun triggers. So start with change here and also address the mental health system flaws.  Work together and dialogue and be willing to look at yourselves and what you might do to influence positive change for decreased violence in the US.

gail December 29, 2012 1:25 PM

Prior to retirement I worked 5 years in a psychiatric setting.  I agree with less weapons and a much better functioning health care system, especially when it comes to mental health.  However, in the case of the mother in CT, I understand she could  afford a very high level of health care. If that is the case, then education has got to be leveled at the parents.  Further, if you had a child who threatened you in any way, would having weapons available to them be wise or even lawful.  

judy rice, RETIRED RN December 27, 2012 5:45 PM
Apopka FL

Mental illness treatment is just as important to good health as diabetes, HIV, cancer and other diseases. The mind IS a part of the human body, a most significant part, being the 'control center' for the whole body & one's behavior. We can talk about lack of funding for mental health, but how much is a human life worth? What value do we place on the life of a dear child who was gunned down in school (a safe place??!)? Count the cost: deal with mental illness or deal with the cost of deviant behavior.

Frances Jones, Home health - RN December 27, 2012 1:31 PM
Mobile AL

I totally agree with Vera's comments about the amount of money that the US sends all over the world to help the poor, the hungry and those living in a war zone. I would prefer that we take care of the Americans that are poor and hungry and living in violent cities across America. I remember when Pennsylvania closed "Pennhurst State School" which was a "warehouse that housed and attempted to treat the mentally ill and the pysically disabled as well. Where did they go when they were discharged? To the streets and parks and tunnels where the homeless go - they are still mentally ill and will never get the help that they need and deserve because too many people refuse to believe that mental illness can be treated and that itn is our moral responsibility to take care of our own citizens. I can understand helping in Darfur in East Sudan but we need help in Camden NJ, Chicago Illinois and countless neighborhoods like Newtown CT. Families with mentally ill children cannot go it alone - we will provide kidney dialysis and transplants but we cannot provide food, shelter and counselling for the nations' homeless? We need to tell our legislators to open their eyes and see what is happening to our nations mentally ill. If we do not address the underlying problem we will have tragedy after tragedy until we do.

Kathleen M. Mulcahey MSN, RN, NCLEX Remediation - Director, Private practice December 26, 2012 5:10 PM
Collingswood NJ

Our government sends millions of dollars in foreign aid; spends millions of dollars for elections and advertisements; wastes millions of dollars in pork barrel programs that help line the pockets of a few; gives millions of dollars to bail companies out of debt, but cannot find the money to fund our hospitals that are in desperate need of help.  This is a sad state of affairs.

Vera, RN December 26, 2012 4:15 PM

Finally!  A thoughtful and well written comment about recent murders by mentally ill people with access to guns.  We need to contact our state representatives to clearly point out the main source of this problem: lack of effective mental health care in the community.  

Peggy, Nurse Practitioner December 26, 2012 12:17 PM
Canyon Lake TX

If guns don't kill people, then why has no one ever been killed while cleaning their baseball bat? We have got to get better at critical thinking. Of course there are multiple causes that need multiple solutions here. Let's not let the children and protectors of those children at Newtown have died in vain. Nurses and other healthcare profesisonals have to be more aware of their own biases, and willing to overcome them than the public. We are the protectors of their health.

Alice December 26, 2012 11:57 AM
FL

In the late 1960's and early 70's, the United States moved itself away from 'warehousing' the mentally ill in state facilities to a plan of community mental health centers (CMHCs).  These CMHCs were to have therapists, OT, PTs, and trained lay care-givers to support the mentally ill so they could be maintained in the community.  However, when the mentally ill were discharged, somehow the federal and state governments did not have the money to support the plan.   (The Vietnam War was occurring and money had to be diverted).%0d%0aTherefore, many of our mentally ill family members ended up in jails, prisons, on the streets, and dead.  So, here we are.%0d%0aHowever, if historical research could occur into that plan we would see it was a wonderful plan to maintain our mentally ill members in the community.

Debra Williams, RN., MSN., CS, retired December 26, 2012 11:54 AM
Edmond OK

So what are the chances of increased mental health funding as we near the fiscal cliff??? What are the chances of more psych beds becoming available??? Who will each one of you contact to demand this?

Kathryn Kulungowski, Psych - RN, BSN, Wm S Hall Psychiatric Institute December 26, 2012 11:50 AM
Columbia SC

I am originally form Monroe CT, so I know the area well.  I know over the last 30 years they have closed down many mental health hospitals.  One being right in Newtown CT. It was called Fairfield Hills.  Maybe if we hadn't been so quick to close down these mental health hospitals, these sick young adults would have a place to go and not be sitting in a ED dept. like they do in my hospital in NC.  We have no psych. dept. so they have to sit there one on one with a sitter till they get placed.  That can take days.  And if they are violent that could take longer.  These patients are mostly young and their heads are sick. Everyone all over the world loved those little children, but I'm sure the parents of these sick young adults love there kids just as much and would love to have the support to get them help before something like this happens again.

Patti, Med Surg - RN, LNRMC December 26, 2012 11:37 AM
Mooresville NC

   This makes more sense than anything I've read/heard thus far.  Throughout my nursing career, I've had dealings with the mental health system, and it is definitely Broken!

   Now, if only the "powers that be" will open their eyes and minds to this.

Jennifer Watkins , Med/Surg/Geriatric - LPN, Recently moved-looking December 26, 2012 11:15 AM
SC

I live in an area where a mental hospital was closed due to lack of funds. Our hospital has had to add a holding area for those patients needing mental health help. Wake up people!! Without the mental health facilities to send the people like the young man who committed this horrendous crime we will see more and more acts like this. Also I hear grumblings about stepping over mental patient's rights. Yes they do have rights but not at the expense of someone's life.

Beth McKinnon, MedSurg - nurse December 26, 2012 10:08 AM
Rome GA

Bravo Mr. Krisher - the field of Mental Health needs to step up to the plate with this and do a better job at identifying potentially violent mentally ill individuals, protecting society from them as you pointed out by rethinking the deinstitutionalization issue, and treating those who are mentally ill better than we are now. As care givers and researchers we need to think out of the box about the causes of mental illness with the intention of healing, not just putting a bandaid on it.

Michele, Correctional/Psychiatric Nursing - RN, BSN, CCHP, CT State DOC December 26, 2012 9:41 AM

I have never worked in psychiatric nursing, but I know it is a poorly funded specialty and people do not get the care they deserve or need.  My heart is broken over what happened to these adults and children in CT.  A school should be safe, and we shouldn't have to result in arming teachers or others to protect children in this environment.  One needs to look at what this young man was doing and why he slipped through the cracks. It begins at home.  Why were there weapons in this home anyway?  What was wrong with his family?  They need to step up first and realize their child has problems and needs help.  Gun laws need to be strengthened, but we need to start with the mental health issues here.  More help is needed and if it involves increasing inpatient psychiatric care so be it.  In addition, we need to take a good look at the world we are bringing children up in.  Society has become very violent and these incidents are becoming too commonplace.  Lets take into consideration morals and values.  People please wake up!

Carla , RN December 19, 2012 5:29 PM
MA

Guns don't kill people, people kill people.  I work in a very broken Mental Health system.  It cannot even be called a system.  People desparately need Mental Health Services and easy acces to those services.  If you leave a wound untreated it becomes infected, if you ignore diabetes you develop complications.  Society is suffering complications of a very broken mental health system.  Politicians need to address this issue not the guns.  

Renee , Pscyhiatric/DD/ID - RN December 19, 2012 4:38 PM
Colchester CT

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