• The Importance of Context in Our Dialogue about Mental Health and Addiction Treatment
    By Rob Simpson
    Commentary | March 16,2014
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    With increasing public awareness of tragic deaths in Vermont and across the nation due to both suicide and drug overdose, it has never been more important to frame our dialogue about the treatment of mental illness and addiction in ways that accurately reflect the nature of these diseases and the commitment of those who are dedicated to helping people overcome them.

    Mental illness can be devastating, particularly when we realize that someone in this country commits suicide every 14 minutes leading to 38,000 deaths a year. In recent years our nation has also been traumatized by multiple high-profile gun deaths along with a growing number of suicides and accidental deaths associated with mental illness and drug addiction.

    The rate of overdose deaths due to addiction has increased dramatically to nearly 40,000 deaths a year, with more than half of those deaths due to opiate use including heroin and abuse of prescribed opioid analgesics like OxyContin and Vicodin. Drug overdose death rates have been rising steadily since 1992 with a 102 percent increase from 1999 to 2010 alone according to the Centers for Disease Control.

    Whether it’s a tragedy on the evening news, or an account of someone we may or may not have known in our own community, the decision by an individual in profound personal pain to inflict fatal harm on themselves or others affects us in deep and complex ways, as does the death of a person from worsening addiction.

    While statistics alone cannot fully underscore the need for timely, quality mental health and addiction treatment, they can help us frame our understanding of the issue. The Vermont Department of Mental Health reports that up to 20 percent of Vermont’s teenagers disclose having had thoughts about suicide or have experienced long periods of profound sadness.

    Our perceptions of these trends and events, and the words we use to describe them, can be equally if not more powerful than the raw numbers. As such, they require the kind of compassionate contextual discourse that fosters hope and encourages people to continue to seek treatment, while honoring and supporting the caregivers who have dedicated their lives to treating these sometimes fatal illnesses.

    Those of us in the profession of treating mental illness and addiction know that the work involves a complex blend of science, psychology, biology, sociology, and compassion. It means helping our patients to look toward hope and away from despair by supporting positive steps forward while safeguarding against the potential for regression and failure. It means knowing how to decipher when an individual cannot care for him or herself, how to intuit danger, and when to take steps to protect a person from harming themselves or others. It means constantly assessing when an individual is ready to leave the hospital and safely re-engage in life. Ultimately, it’s about never giving up on someone struggling for relief from unbearable pain.

    This work also requires us to understand that the absolute prevention of suicide would necessitate removing privacy and personal freedoms, and that this must be balanced against the goals of fostering independence and recovery. We must be diligent in our efforts to keep people safe, but, as is true in every field of healthcare, we cannot eliminate risk entirely.

    Research confirms that psychiatric and addiction treatment saves many lives under challenging circumstances. Yet all too often the success stories in our field are left out of the larger discussion. And when I use the word “success,” I refer not just to patients who are able to take astounding steps toward healthier lives, but also to the countless small steps patients take on the path to recovery: a renewed sense of joy to someone who has been joyless, a feeling of safety to someone who has been traumatized and threatened, a positive human connection to someone who has lived with profound loneliness.

    Our national discussion about mental illness and addiction treatment must be accurately framed by the realization that finding a perfect path in the realm of human behavior is impossible.

    Rather, we seek transformation out of pain and back to a healthy relationship with oneself and one’s loved ones.

    In each person we must honor the profoundly courageous act of choosing to reach out for assistance. And let us not forget that most of the people who make the choice to seek care are better off for the decision. Nonetheless, our grief is profound when we experience the magnitude of the loss of even one person from suicide or drug overdose. Such is the power of mental illness and addiction to take lives.

    Dr. Rob Simpson is the president and chief executive officer of the Brattleboro Retreat.
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