Compassion or Barriers?

Which is compassionate: indicating a desire to increase access to mental health treatment for those in need of help, or raising barriers that will make people think twice before committing to treatment?

Over the past few years, President Obama has stated he has compassion for those with mental health problems. For example, in 2013 he said,

We all know somebody—a family member, a friend, a neighbor—who has struggled or will struggle with mental health issues at some point in their lives… We know that recovery is possible, we know help is available, and yet, as a society, we often think about mental health differently than other forms of health… [T]here should be no shame in discussing or seeking help for treatable illnesses that affect too many people that we love.  We’ve got to get rid of that embarrassment; we’ve got to get rid of that stigma.

The problem is, his actions—especially his recent actions to remove Health Insurance Portability and Accountability Act protections for mental health records for gun purchases—demonstrate a lack of compassion by increasing the stigma associated with mental health problems. This increased stigma will erect barriers for those seeking help, and for those who might otherwise seek involuntary treatment for a family member with mental health problems. As the President erects more barriers, fewer people will seek and receive treatment. As fewer people seek treatment, the number of other symptoms of mental health problems, such as suicide, will increase.

According to a number of studies, the stigma associated with psychological treatment is a primary reason those with mental health problems avoid professional help. A stigma is a negative belief a society has about someone or something. Interestingly, its Greek root means “tattoo” while the Latin root means to “brand.” A stigma, therefore, is a permanent mark on a person causing others to view him or her with disdain.

A mental health record, especially when the record is created as part of a court-ordered involuntary treatment, is permanent. This permanency has drastic consequences, even if the episode giving rise to an involuntary treatment was temporary and the citizen has not returned for treatment since “recovery.”

Individuals can be committed for a number of reasons. Where a court is involved, the court will likely defer to an expert psychiatrist. The psychiatrist may recommend commitment on the basis of an eating disorder, or a particular personality disorder. Another psychiatrist, though, might not commit the same individual. Ultimately, because a court tends to defer to psychiatrists, the court will likely sign off on most commitments if a psychiatrist determines the individual represents a “significant danger” to him or herself.

The experts also acknowledge that family members, ex-spouses or partners and others could abuse the involuntary commitment system.

Juveniles in need of mental health treatment may be most impacted by the President’s unilateral actions removing HIPAA protections for mental health records. In the criminal justice arena, juveniles occupy a unique space. They have the ability to clear, or expunge, their criminal records after the age of 21 or 22.

In some states, the opportunity for juveniles to clear their criminal records does not extend to certain mental health records, such as, “judicial” or “extended” involuntary commitments. In other words, if a teenager commits the equivalent of a felony in a state like Pennsylvania, his record, after age 18 or 21, could be expunged and his ability to purchase a gun restored. That same teenager could be subject to an extended involuntarily committed because he threatened a parent.  Unlike the criminal record, the record of the teenager’s involuntary commitment cannot be expunged.

Admittedly, there are individuals who will struggle with significant mental health problems for their entire lives. There are also other individuals, as the President acknowledged, for whom “recovery is possible.”

But why does the President assume a “one size fits all” approach to HIPAA protections for mental health reporting is acceptable and compassionate? Why should those with mental health problems be permanently branded, especially when the President himself acknowledged that “recovery is possible”?

The President’s unilateral actions will harm, not protect, Americans in desperate need of mental health treatment. While his words may express compassion for those in need of treatment, his actions demonstrate the exact opposite by further stigmatizing those suffering from mental health problems. Real solutions aimed at aiding the mental health crisis will tear down barriers, encouraging individuals to seek needed treatment.