Sometimes, the threads of your own narrative conspire to take you down unexpected avenues. Mental Health issues, both personally and as a matter of public policy, were never at the forefront of my concerns, though they should have been, on both fronts. And chance sprinkled bread crumbs along the path that led me to that realization.
First, as a (surprisingly recent) law school student more interested in public policy than litigation or transactional law, I sought out appropriate venues to do internships. During my 2L year (after having momentarily forgotten why I went to law school, and, while interviewing with big firms during the early fall “on-campus interview” process, remembering again), I heard about a small policy LLC called “Center for Systems Integration,” looking for one or two summer interns. I told the career counselor who mentioned it, “if they’re anything like their name, they’re perfect for me!” I interned with CSI that summer, researching legal and fiscal issues surrounding trying to implement mental health screening and services in and through the public schools. Almost instantly, I realized how logical that was, and how needed. After all, adolescence is a time when emotional and mental stability issues are heightened, and many, if not most, need far more assistance navigating those roiling currents than they currently receive. Like the shoulder strap on seat belts, back in the day when cars were equipped only with lap belts, the instant you hear the suggestion or independently think of the idea, you slap your forehead and say, “doh! Of course!” I’ve since done far more research on the subject.
This morning, a renewed reminder of the importance of mental health care appeared on the Today Show, as I was getting ready to leave for a legislative breakfast with Mental Health America of Colorado. The father of the girl with cerebral palsy who boarded her school bus to threaten the kids who had been bullying her was on, with his daughter, clearly a descent guy who loved his daughter and was just driven into a rage at what she was suffering. This story is laden with implications: The bullies, the father, and the daughter all needed their own mental health hygiene (what is sometimes called “behavioral health”) better attended to. And the failure to attend to it has a negative rippling effect throughout our social landscape, reinforcing the bad behaviors of the bullies, leaving the girl to suffer without learning how to cope, and letting the understandable frustration of the father percolate into rage. Unattended mental health issues are seeds of destruction and despair, germinating in the soil of our individual and shared existence, and forming the root of many of our individual and social systemic woes.
Mental health is implicated in virtually all aspects of our lives, in how well we do in school, in how well we address the normal challenges and tragedies of life, in how well we choose our course and pursue our ambitions, in how well we contribute to the production of material and immaterial wealth upon which we all depend, in how well we avoid being sucked into predatory and destructive behaviors. Mental health is the foundation of social health, of prosperity and domestic tranquility, of human happiness.
Public investment in the provision of extensive, universal mental health services is a cost-effective one, paying proactively to nip problems in the bud, problems that, unaddressed, fester into bigger problems, requiring less effective reactive “solutions”, imposing costs that are far, far greater, both materially and immaterially, than the relatively modest costs of addressing these issues early and affirmatively. Our failure to make mental health care more of a priority, a more normal aspect of our routine maintenance of our own well-being, results in poorer academic performance by more children, more juvenile delinquency and subsequent adult criminality, more people incarcerated (we have the largest absolute and per capita rate of incarceration of any nation on Earth, bar none, costing society while producing nothing in return, and screaming of a social failure that we insist on denying), more drug abuse and homelessness and domestic violence and child abuse and neglect, all creating ever-more fertile soil for ever-more profound and widespread mental health problems, escalating in a feedback loop of spiritually and materially costly dysfunctionality. Investing in mental health services, from birth to death, is just about the biggest bang for the buck we can get.
Personally, and not at all uniquely, I’ve always struggled with my own inner-demons, my own internal emotional turmoil (for which I unfortunately never sought help), manifested, as it often is, as character flaws. For a person who takes pride in his accomplishments, in his sincere commitment to our shared enterprise, these failings have always been a source of deep shame. But they shouldn’t be. They are not extraordinary failings, nor extraordinary character flaws, but they are gravel in the gears of both my own personal efforts in life, and the social interactions necessary to our collective efforts. And it is their very normalcy, their very commonness, which is so poignant, because they are not inevitable, they are not mere functions of the cards we are dealt over which we have no control. Nor do they have to be purely individual burdens, borne well or poorly but with only that informal assistance that those same cards we were dealt happen to bestow.
Not only do I as an individual have a responsibility, and the ability, to confront those challenges and address them, but so do we as a people. Because the successes and failures of each of us are the successes and failures of us all. The relative inability of numerous individuals to most effectively and cooperatively participate in our shared enterprise as a society is an integral aspect of the shared challenge we face, of how we collectively play the cards we are dealt, when we face the challenge of improving the quality of our lives by being responsible, rational, and compassionate members of a society. Just as the gods help those who help themselves, society should as well. We should be in a partnership, the individual doing his or her part, and the rest of us offering our support.
Instead of the anger and rejection we indulge in when we confront someone who has problems that manifest in unattractive ways, we should strive to offer a helping hand. What we perceive as character flaws in others are often, if not always, unaddressed mental health issues. That may sound like an exaggeration, or an excuse, but it is neither. What are character flaws but internal problems, imbalances, sometimes even biochemical in nature, that have not been diagnosed and addressed? To those who insist that some people are just “bad” and some are just “good”, why is it that the numbers vary from culture to culture, that some cultures have far less or far more violent crime, or far less or far more “friendliness,” or far less or far more “humility,” or far less or far more “arrogance”? And, even if conceptualizing character flaws as mental health problems is unpalatable to some, the realization that we can help one another to be better people should not be so hard to swallow.
Of course, we are still all each responsible for our own actions and choices, but that does not mean that our actions and choices have no causes, and can’t be collectively improved upon through better understanding and better intervention. And, of course, it is impossible for us to “cure” all such problems merely through improved mental health care services, but, like many such problems, we can do better at addressing and mitigating them, and can benefit enormously by doing so.
Mental Health America of Colorado, along with many other organizations and agencies, has made enormous strides in improving our ability to provide mental health services to those who need them. Throughout the human services community, a movement called “systems of care” is increasing both efficiency and quality of services provided, by creating more integration among different agencies and organizations providing complementary, supplementary, and overlapping services, so that individuals receiving these various services, receive them in a coordinated way, that reduces costly redundancy, reduces the fracturing of interrelated services into mutually isolated compartments, and increases the synthesis of services into more effective packages designed to best meet the needs of those being served.
Research is improving our knowledge, such as the importance of using peers in mental health care regimens, and that those who have been sufferers of specific mental health problems are often the most useful counselors to others who are suffering them as well. Our knowledge of the unity of physical and mental health issues, each affecting the other, both being aspects of a single whole, improves our ability to address the systemic needs of individuals and society as a whole.
But the political challenge of working on how, rather than whether, to best address these very real needs, is just one more incarnation of the deeper political challenge in which we are embroiled: The dogmatic commitment to extreme individualism on the one hand, leaving each to fend for himself (which costs us all, because we are in fact interdependent whether we want to realize it or not); and, on the other, a commitment to working together as reasonable people of goodwill to do the best we can to address the challenges and opportunities of a complex and subtle world. It’s a no-brainer. But, unfortunately, sometimes even no-brainers are not no-brainers enough for reason to prevail. Not surprisingly, Colorado, the land of rugged individualism, has the 18th highest rate of depression in the country, the sixth highest rate of suicide, and the second highest rate of juvenile suicide. On the flip side, Denmark, one of the countries most committed to the collective welfare of its people, has the highest rating of self-reported happiness of any nation on Earth.
Some argue that such talk is an assault on individual liberty. But individual liberty is a function of being members of a society, based on the material, cultural, and spiritual wealth we create together. We are each free to think and say what we want, using a language and concepts that we have collectively produced over generations. We are each free to pursue our fortunes, within an economy in which we collectively participate, and relying on a material and immaterial infrastructure publicly provided. We are free to explore the wonders of the world, traveling on vehicles, reading books, engaging in entertainments, all produced through a collective enterprise, an enterprise which both requires and benefits from intelligently designed public policies. The question we face is not how much government we should have, but rather how best to use our government to provide the most opportunity to the most people to exercise and enjoy our individual liberty, to celebrate our freedom by living healthy and productive lives. We all benefit by addressing that challenge as wisely as possible. It’s time to stop shirking that challenge. Investing in the mental health care of our citizens is one important component of “getting it right.”