Tuscon’s horrific shooting a little over a week ago has launched national dialogues on several fronts: Does violent imagery and heated or threatening rhetoric in the public make it more likely that violence will occur? Do our public officials require more security and will they become less accessible to us? How can we be more civil to each other?

While the political angle has dominated the airwaves, psychiatrist Larry Wissow of Johns Hopkins makes the case that we should be shifting the conversation to how we ensure treatment for mental illness. He notes the troubling symptoms that Loughner exhibited, and while clearly stating that a diagnosis cannot be made via news stories, he points to patterns that would be familiar to any mental health professionals, particularly those working with the late teen to early twenties demographic, when serious disorders often first emerge: withdrawal, suspicion, mood shifts, statements that don’t seem to make any sense, and behavior changes. Wissow says that many people notice these changes, but few act on it the way we might if we saw a friend rapidly losing weight or exhibiting signs of a physical illness. But symptoms of mental health disorders often result in avoidance rather than help. Wissow explains some of the reasons why:

“One big reason is that mental illness is among the most stigmatizing labels one can propose, and it is a huge barrier to getting care. Around the world, in nearly every society, people with odd and frightening behavior get hidden or risk being abandoned by their families — not only because they can’t be controlled or trusted but because they are an embarrassment and make life difficult for everyone else. All too often, mental illness is still seen as a defect of character or upbringing.”

To remedy this, Wissner calls for giving the issue of mental health a higher profile and priority. He suggests that “… we need much more widespread training for educators, employers and the public about the signs and symptoms of major mental disorders and what to do when it looks like someone might be ill. We need to make it a humane and nonstigmatizing standard to empathetically but effectively get someone to a source of care when the first concerns arise — when they are much more likely to agree to it.”

In a subsequent interview with NPR, Wissow talks more about how people who are in a position to do so might asssist a troubled person in getting help. He also notes that Loughner is not and should not be viewed as the “poster child” or face of mental illness because most people who are mentally ill are more of a danger to themsleves to others.

Employers with EAPs are in a good position to note behavior and performance changes and to point an employee to help resources. Employers shouldn’t attempt to diagnose – simply train supervisors to watch for changes in behavior and performance, and in how to make referrals to the EAP based on those behavioral or performance issues.

Unfortunately, Wissow’s pleas come at a time of severe budget constraints on both the national and the state level. While The Mental Health Parity Act was a welcome step in the right direction, there’s still a big battle in breaking down the stigma against mental health problems and in getting people timely help.

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