What the Parkland, Florida massacre reveals about our broken mental health system.

The recent shooting at a Parkland, Florida  high school which left 17 people dead, has sparked a lot of  outrage and debate about preventing these types of incidents.   Some call for stricter gun control and universal background checks while others suggest arming teachers and other school staff with guns.    Both the liberals and conservatives have strong opinions on the issue of school safety and gun control in an effort to prevent another tragic incident like what happened at Marjory Stoneman Douglas High school.  However as someone who lives on the autism spectrum,  I feel there is an important element that is missing from the discussion as well as media coverage in terms of reducing mass violence across the United States.  It  is about reforming our mental health system as well as our societal attitudes against people who have developmental disabilities and mental illnesses.   Before I go on writing in depth on why these factors are important, I want to make clear that I do agree we need more regulation on guns in this country.  I support universal background checks and believe that individuals who have a history of violent outbursts or who have suicidal tendencies should not be permitted to own a gun.    

There is no question that mental health care in America needs serious reform.    This is apparent in the number of  homeless people (most with serious mental illnesses) I see on the streets in places like Downtown Los Angeles or the Venice beach boardwalk.   Some end up in prisons and other places that are not equipped in addressing their mental health needs.   This is the result of  patients of being released from the hospital prematurely (due to overcrowding) with no action plan in place. After leaving the hospital, individuals with serious mental illnesses are left on their own wondering the streets if they have no family or other people around to support them.  The amount of homeless people with serious mental illnesses are the results of  deinstitutionalization from the community mental health act signed by president John F. Kennedy in 1963.     The intent of   this act was a good one since some of these institutions for those with mental illnesses were rife with abuse and neglect.  It focused on the need for community based mental health support.  The problem lies in the fact that we haven't followed through on establishing more community based mental and behavioral health  supports.  We also closed mental institutions too soon without gradually transitoning patients out  into the community. The consequence of closing down hospitals and lack of psychiatric beds, leaves many individuals with serious mental illnesses and their families without adequate resources.

Going back to the point I made in my last paragraph of  families having no resources when they are facing a crisis, we need to follow through with the Community Mental Health act in establishing more behavioral health centers that provides comprehensive supports to these individuals.  We also need to have a more comprehensive treatment and behavioral support plan when an individual is in crises. This one article mentions that states have been cutting hospital beds at an alarming rate.  This leaves the family with either few or no options for psychiatric care when their loved one is a threat to themselves or others. 

When the individual has a developmental disability along with mental health issues, finding adequate help becomes more complicated as some of the psychiatric facilities and other resources are not properly trained on developmental disabilities.    In this scholarly paper conducted by the University of Denver, there is disconnect between mental health system, developmental disability services as well as with primary care doctors.   In other words, research has highlighted the negative consquences such as law enforcement being called or being placed in a hospital in which staff are not adequately trained in dealing with developmental disabilities when there is disconnect between the different departments that cater to both developmental disabilities and mental health. Oftentimes,  individuals who are dually diagnosed are discharged from the hospital with no follow up services to prevent future crises or episodes.  I feel there needs to be a more proactive plan for individuals with developmental disabilities with co-occurring mental health issue when they are experiencing a mental health crisis as well as preventing future incidents from taking place.

Picking up on the point that we need to take a more proactive approach in our mental health system,  I heard of an approach via a John Oliver clip on youtube called  assertive community treatment.  This intensive approach does much more then just periodic visits with the psychiatrist that last 45 minutes to an hour.  It is an intensive individualized  approach in which services are delivered directly to the patient and provides assistance with everything from employment to finding housing etc.  It's structure is equivalent to supported living and supported employment models that are already available to individuals with developmental disabilities.   I feel like a service design that will do whatever it takes to keep the patient integrated in the community as much as possible will be more effective at preventing frequent hospitalizations of those with mental health challenges.

Then comes the confidentiality laws when an individual turns 18 and how parents and other family members feel powerless in helping their loved ones with either a mental illness or developmental condition.   Sometimes the laws that are meant to protect the privacy of an individual with mental illness and/or developmental disabilities can prevent important key people (parents, professionals etc.) and offices from intervening if problems arise.  There is a way around it in regards of signing a waiver that allows key people in the person's life to have access to personal information as well as being allowed to exchange information with offices or resources that cater to those with disabilities (doctors offices, counseling, college disability centers) ea about a particular individual.   I have firsthand experience of how these laws that are suppose to protect my privacy can at the same time be very burdensome and contribute to me feeling isolated.  When I turned 18 and moved onto college, the disability center were not allowed to communicate with my parents and other key people  because of those privacy laws.    Even the disability center were not allowed to communicate with my professors and other campus resources (e.g. the student psychological services) about my disability even though I am registered with their office.   The disconnect between various offices on the college level contributed to unnecessary heartache and also increased the sense of isolation I felt at college. These laws creates a sense of disconnectedness between different agencies and offices as well as people such as therapists and parents. Therefore, it can prevent them from effectively helping a person with a mental illness or other disabilities.  This the Catch-22 of many privacy laws that are meant to protect the dignity of those with disabilities and mental health challenges.   There has to be a better system of communication between different individuals and agencies for those adults who are not under a conservatorship.  I feel like these privacy laws don't take into account the importance of a team approach by making sure that anyone who helps a client or individual with disabilities is on the same page. 

Lastly, we need to change our societal attitudes of how we deal with those with disabilities and mental health conditions . This is the first part that needs to happen if we want to come up with effective supports for those who mentally ill or have disabilites.  There still seems to be a negative view of people with disabilities as burdens or that they are "crazy" and "violent."  This is evident in the media depictions on linking violence with mental illness and other conditions.  This leads to stigmatization and alienation of those who are not able-bodied and have brains with different wiring.   This is why mentally ill  patients are  discarded on the streets because society does not see value in them and wants nothing to do with them.  Americans think that it is the fault of the person with the disability for all the challenges they encounter in life.   As someone with autism, it is hard living in a society that is rife with ableism (both explicitly and implicitly) and continuously refuses to provide accommodations and supports because it is too inconvenient and burdensome for able bodied people.  To live everyday in which you are constantly reminded how much of a "burden" you are can sometimes can be too much to bear for some people. We need to stop marginalizing those with disabilities and start valuing them as human beings with feelings and contributions.   Instead, society should have the mindset of how we can lessen the stress that people with various physical, mental and developmental conditions face in their daily lives.

In conclusion,  I feel that the solution in reducing the number of incidents of mass violence ad shootings is more than having more effective gun control laws.   We need to reform our mental health care and how we deal with those with disabilities and mental health. This involves having deep and uncomfortable conversations about how we are going to fund or reform mental health care systems as well as other disability systems.  It should not be a solution of band aid fixes like how we solve other large scale problems in our country.  It should well thought out and should involve the insights of those who utilize such services. As I said in the beginning of this post, I believe in tighter regulations of owning weapons.  However, the solution to preventing mass violence in this country is multi-fold instead of just one universal solution.

Movie Review of "Please Stand By"

A few weeks ago, I had the privilege to watch the film"Please Stand By" which is the first ever fictional representation of an autistic female protagonist.   When I first heard about the film last December, I was excited and looking forward to its release because with the exception of the Temple Grandin movie,  there hasn't been any films or t.v. shows made about females on the spectrum.  Most film and t.v. shows like Atypical or The Good Doctor tend to feature white autistic males as protagionists.   To give you an overview on the plot, the film is about a 21-year old woman named Wendy (played by Dakota Fanning) who resides in a group home with her dog Pete and is a huge Star Trek fan. She has a job at Cinnabon. The bulk of the film focuses on her journey from San Francisco to L.A. to turn in her Star Trek script to Paramount Studios.  Throughout her pilgrimage, she encounters obstacles that she must overcome.  It is film about passion, confidence and self determination.

Overall, I really enjoyed the film and was impressed with how they developed Wendy's character.  I liked that the writers and directors portrayed Wendy as a full fledged character with interests, passions and feelings instead of a checklist of symptoms from the DSM.  Too often, I feel that the autistic characters in most movies and television shows are portrayed in a way in which their deficits are highlighted which evokes a sense of pity and disdain from the viewer.  In the characterization of Wendy, there was a nice delicate balance between showing the real challenges that autistic people have along with their capabilities. 

As an autistic female who is also in her 20's as well, I relate so much to Wendy.  We both have to struggle to work hard to navigate a world not built for us, we're both passionate about our special interests (for me it's characters such as Disney or Hello kitty while for Wendy it's Star Trek) and that we both have stubborn and determined personalities.   We're both at similar levels in terms of how autism impacts us meaning that we have normal speaking abilities and self care skills and can easily pass as "normal."  Yet, we still struggle with certain things in our daily lives and we still need supports to manage effectively.  In that sense, I liked how the movie shows Wendy as capable and independent (she is able to navigate the bus system and hold a job at Cinnabon but can't live on her own) but does not overlook or "gloss over" her support needs.  This is unusual because autistic people who are able to "pass" in society are often portrayed as having no support needs at all.  Another aspect that I can relate to Wendy is that we are both good writers.  Wendy spends most of her leisure time writing Star Trek scripts.  I also spend part of my leisure time writing blog posts and articles.  Writing is a way for us to really express our inner thoughts and beliefs and reveal how we process the world.

Although I enjoyed the film, there are a few caveats or things that particularly made me feel uncomfortable as a viewer as well as an autistic person.  The first thing was Wendy's living situation.  Wendy lives in a  group home with four or five other residents.  I felt the portrayal of the group home was not realistic.  The home she lived in was very nice and spacious (big lounging areas, nice big rooms for each resident) and had the euphemistic name "Bay Area Assisted Living Facility."  While there maybe a few homes like that, the reality is that most group homes are not as luxurous and "posh" as the one in the film.  In fact, I hear stories of people who are unhappy with their group homes and the limited control they have as well as stories of abuse and neglect.   Even Wendy herself is resentful of the limited choices she has in her home like the fact that she has to "have pizza on Thursdays even when she doesn't want to" or that she "can't watch t.v. when she wants to."    It would be nice if Wendy  had a supported living situation in which she lived in her own apartment but have support staff to come assist her with daily living activities.  She would have a little more freedom and feel more integrated into her community.  Not all autistic people live or want to live in  congregate living facilities.  To glorify such living arrangements overlooks the fact that autistic people who need help to live in the community can still live independently.

Another aspect  of the film that  made me uncomfortable was how people mistreat and took advantage of Wendy.   Don't get me wrong, this is the reality for a lot of autistic individuals in terms of people can be mean, hostile and apathetic.  But it was the fact that Wendy came across one mean person after another along her journey from the bus driver who talks down at her for not knowing that she had to purchase a ticket before boarding the bus to the receptionist at Paramount studios who refused to let her turn in her Star Trek script because it was not mailed in despite being before the submission deadline.  We all come across people who don't understand or who are downright hostile to our differences, but realistically we don't come across that many mean people every hour in a short period of time. 
The part that was the most uncomfortable for me to watch  is that everyday strangers were not willing to take time out of their day to assist her and expect Wendy to "figure it out" on her own.  The only nice person was the elderly lady who chastized the cashier of a liquor store for ripping her off over a bag of candy and offered her a place to stay when she found out Wendy was traveling by herself.   The fact that only one person was nice to her reflects a very sad truth about how self absorbed and apathetic people are in 21st century American society.

Perhaps the biggest person in Wendy's life who mistreats and undermines her was her sister, Audrey.  I felt it was awful that her sister viewed her as  dangerous and that she was afraid to let Wendy near her baby daughter.  In the film, Wendy demonstrates no such destructive behaviors  besides having a meltdown and in which she self injures herself for the very reason of  Audrey refusing to let her live with her family.  There was no justification for Audrey to view Wendy as "dangerous" just because she has meltdowns.  On the positive side, at least her sister changes her attitude about Wendy in the end and eventually lets her see her niece.

Overall, I really enjoyed the film.  Not only because it was a film about an autistic female, but also because it was one of the few that didn't rely on stereotypes about autism like many films about it.  I like how Wendy proves the misconceptions that her sister as well as her therapist/house manager Scottie wrong by showing how resourceful she was in navigating her journey from San Francisco to L.A.  in order to submit her Star Trek script before the deadline.  In an interview with the site Geek club books, director Michael Golamco took great care in making Wendy as "fully human" as possible.    When watching this film, this was evident throughout the plot and was a theme throughout the whole movie.  He was able to keep the audience entertained while portraying an authentic and genuine narrative about autism.   If you haven't seen the movie yet, I recommend you watch it.  You can view it on-demand on Amazon or Itunes.