Mental health “services” involve much more than prescribing pills


Barnard began hearing voices when he was 17. 
“It scared me because I didn’t know what they were,” he said. “I didn’t know,” said Barnard, who is highly intelligent and has been teaching himself about computers for a long time, “if the voices were there to hurt me or help me.”

Eventually, Barnard, who is now 24 and living with his parents on Portland Avenue in South Minneapolis, got his answer—the voices told him to kill himself and he tried twice.

According to 2004 data compiled by the National Institute of Mental Health (NIMH), suicide was the third leading cause of death of young people from ages 10 to 24. The highest suicide rate was among young adults ages 20 to 24, with 12.5 per 100,000 dying by their own hand. More than six times as many males as females ages 20 to 24 died by suicide and the highest rates were among Non-Hispanic Whites—12.9 of every 100,000 people. An estimated eight to 25 nonfatal suicide attempts occur per every suicide death.

Barnard was so young when he began to get sick that he never entered the workforce. His age prevented him from being covered by his parent’s health insurance, so after his second suicide attempt he ended up at Hennepin County Medical Center.

“Most folks who have mental illness are poor because they’ve never been able to get or hold down a job,” said Martha Lantz, executive director at Touchstone Mental Health. “Mental health services have very fragmented funding. You really have to fail before you can get help,” Lantz said.

“One of the biggest challenges for those with mental health problems is accessing services,” said Ed Eide, executive director of the Mental Health Association of Minnesota. “The Mental Health Initiative, passed during the 2007 Legislature, was an important step for getting resources to the people that need them,” Eide said.

According to information available through the state, approximately $34 million approved for the initiative was aimed at improving the accessibility, quality and accountability of publicly funded mental health services. Based on recommendations of the Minnesota Mental Health Action Group, services like community treatment teams, residential treatment services and adult mental health rehabilitation services were added to general assistance medical care, MinnesotaCare and the prepaid medical assistance program. This was a big step in integrating mental health care with the rest of health care services. Before the change, these services were provided only to the extent that county grant funds were available. 

“I had one instance of working with a 17-year-old foster child diagnosed with PTSD and depression where there was a constant conversation about whether county services were going to be cut,” said Judith Hoy, a clinical social worker in South Minneapolis. “It gave someone who was struggling with issues of abuse and neglect further questions about who to decide to trust and work with. Someone already suffering from depression was made to feel abandoned by the system,” Hoy said.

“We have a state funded, county operated system,” Lantz said. “That’s the way mental health dollars flow. Beginning in July of last year, the state began shifting mental health care to a more privatized system,” Lantz said.

According to the state, the 2007 Mental Health Initiative “implements reforms in the delivery and financing of public mental health services for persons enrolled in the state’s health care programs through development of public/private partnerships to assure that all aspects of the mental health system are working to serve consumer and families.”

“Down the road we’re looking at every county in the state having its own integrated system for caring for their constituents with mental health issues,” Eide said.

These developments have helped to put Minnesota on par with the rest of the country in caring for its mentally ill. Besides the changes in funding and infrastructure investments made by the mental health initiative, there was also the creation of a training and certification program for mental health peer specialists. 

“Right now, there’s a lack of psychologists and it’s very, very hard to get people booked,” said Minneapolis psychologist Dr. Ann Estes. “I’ve practically given up, in some cases, trying to find people help,” Estes said. According to Estes, the shortage is probably due to a lack of compensation—mental health practitioners are at the low end of health care compensation, and beyond the disparity between providers and patients, there may also be a gap in properly trained professionals.

“I’ve heard some real horror stories about inappropriate behavior by practitioners—people with horrendous patient skills,” said Estes. Regardless of their numbers or skill levels, state mental health workers, along with mental health facilities, are seriously over-booked. According to a story done in March by MPR, HCMC treats 700 to 900 mental health patients a month and its psychiatric ward beds are constantly full. By and large, these are people with serious mental health issues.

Barnard is one of those people—HCMC doctors diagnosed Barnard with paranoid schizophrenia.

According to current findings published in the journal Schizophrenia Research, the disease may be a disorder of both brain structure and brain function. The standard treatment for schizophrenia remains the prescription of powerful drugs. “The first meds I got made me very tired and listless,” said Barnard. “I tried a lot of different medications,” he said. “I had a hard time communicating with my family and friends.”

“There’s a debate going on right now between using medication and a more holistic approach to some mental illness,” said Kate Walthour, director of admissions for the University of Minnesota’s School of Social Work.
“I think drugs are useful. Drugs can bump an individual up into a level of coping,” Hoy said. “I have concerns about over-prescribing and about prescribing drugs to little children … Prescribing drugs should be a careful, thoughtful process,” she said.

“After a few months, I got more used to the meds and started to make friends at the hospital,” Barnard said. “But I still found it hard to trust people. At the time, I saw life arranged as a conspiracy against me—that everything was in some way connected against me. After I went home and I began talking with friends, the realization that all these ideas meant nothing made me depressed. So I was prescribed with antidepressants,” Barnard said.

“My own approach is to treat people with depression without using drugs,” said Minneapolis psychologist Dr. Michael Browne. “What isn’t widely known—and I say this from my own thorough research—is that antidepressants are not very helpful,” Browne said. “Human life is a lot more complicated than just taking a pill that will cure your troubles.” 

“Drug companies are certainly a very significant factor in the large numbers of people who are prescribed antidepressants,” said Browne, who added that drugs may give at least short-term relief from symptoms. “Family practitioners are under a lot of pressure to make their patients feel better.” 

For now at least, Barnard is feeling better.

“I know now that the voices are just voices—they can’t hurt me unless I take them seriously,” he said. And he’s training with a mentor so he can find work as a computer tech.