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By Lisa A. Burton


Guyana Journal, August 2014




IDENTIFY THE ISSUE: FRAMING THE QUESTION

Around the world the issue of mental health is one that all cultures share, shun and struggle to understand. Globally people are faced daily with the impact of untreated mental health disorders amidst their respective communities; however, most countries have not yet adopted an effective policy and/or practice for addressing, treating or preventing serious mental health illnesses. Subsequently, the ineffectiveness of accessible public mental health care has critically impacted the global prison population and homelessness. It has also been a contributing factor to some of United States homegrown terrorists. If there can be a global conversation that removes the stigma attached to mental illness, coupled with international research, can a proactive approach that improves global security be taken?

BACKGROUND INFORMATION

There is a direct link between mental health and some domestic terrorists that have committed random acts of terrorism. The fact that terrorist acts have been committed by some veterans implies that the Department of Veterans Administration should help lead the cause, as one of the major stakeholders, in an effort to underscore the need to institute effective policies and programs. These proposals will emphasize the importance of prevention in defending homeland territory, and properly treating mental disorders worldwide, as many veterans are deployed around the globe.

In 2009 at Fort Hood Texas 13 people died when Major Nidal Malik Hasan went on a shooting rampage that is now an unfortunate part of United States history. In 2013 at the Washington District of Columbia (D.C.) Navy Yard, yet another former military man terrorized and murdered innocent American citizens. Investigations show that the shooter, Aaron Alexis, was notably delusional but not receiving the intervention needed. Although not a veteran, Miriam Carey, briefly terrorized the nation's capital, unintentionally, due to a mental illness that caused her to have delusions. Carey's acts were initially perceived as terrorist acts and certainly paralyzed Washington D.C. temporarily. It was later determined that she was not connected to any terrorist group, but was contending with a mental disorder. There are statistics that show an increase in violence by the hand of veterans who return from war. These veterans are diagnosed with post-traumatic stress disorder (PTSD). On January 1, 2012, Veteran Benjamin Colton Barnes shot and killed Park Ranger Margaret Anderson in Mount Rainier National Park located in the state of Washington. In a separate incident, a former Marine Corporal Itzcoati Campo went on a violent rampage in which he allegedly stabbed and killed four homeless men. Both men in the aforementioned examples were deployed overseas to the war in Iraq. Some experts are comparing the shift in the behavior of Iraq war veterans to that of veterans that returned from the Vietnam War. Both sets of veterans returned with similar symptoms and challenges, to include aggression and/or depression. Currently, homicides by former veterans are not being effectively tracked or addressed, but the Army has indicated a significant increase in veterans' suicides since 2011. (See Experts: Vets PTSD, violence a growing problem by Ashley Haynes.) This may represent a small percentage of individuals, but every aspect of combating terrorist acts and preventing them need to be considered and rectified to the fullest. This is a critical global issue that requires swift, sensible, and workable solutions. Those solutions will remove stigmatization and fear for those in need of mental health assistance. The trickledown effect of the untreated or undertreated people with a mental illness is the displacement of these same individuals into jails instead of treatment facilities. If not in jails, these same people end up living on streets. Homelessness and mental disorders do not recognize any borders, nor do the consequences of managing them belong to any one nation exclusively. The mismanagement and unconscious evading of mental health disorders has impacted the veteran population, homelessness and prisons worldwide. In March 2014, a homeless man in New York City died in Riker's Island jail. He had been arrested for sleeping on a rooftop, placed in jail due to his homelessness and subsequently died there as a result of his mental disorder. He “baked to death” in his cell. (See: There are 10 times More Mentally Ill People behind Bars than In State Hospitals by Stephanie Mencimer/New Society Publishers.)

The United States makes up approximately 5% or the world's population; however, the U.S. imprisoned population makes up 25% of the world's inmate population. This statistic illustrates that there are a half million more people in jail within the U.S. than in China. China's population is five times that of the U.S. (See Global research -- “The Prison Industry in the United States: Big Business or a New Form of Slavery” by Vicky Peleaz.) This is the essence of a foundational reason to partner globally with other nation states to adopt and institute effective public mental health regulations.

ARGUMENTS FOR

World Mental Health surveys support that mental disorders are common in several countries across the globe. (See NIH-The global burden of mental health disorders: An update from the WHO World Mental Health (WMH) surveys.) The U.S. is not isolated with the unfortunate impact unresolved mental disorders have on societies.

Naturally, identifying suspected or known terrorists is a necessary part of the nation's mission toward securing the homeland but it cannot be the only facet in which one becomes consumed. It is critical that the U.S. becomes more innovative and proactive. To minimize areas of vulnerability government must proactively identify mental health issues and provide proper care to those in need. Global partnerships must be formulated to aggressively fund research as an effective and vital first step. Decisiveness rooted in preparedness and planning is the nation's best chance of developing and maintaining a resilient posture. Most recently a study showed that 42% of patients that required emergency psychiatric care were not receiving preventative treatment at the time of their mental crisis. (The Washington Post: “VA Panel Promises”, 2014.) A recent survey of the Cook County Jail in Chicago Illinois showed that a disproportionate amount of arriving inmates report having a mental illness. The percentage is staggering and ranges from 36% to 54% depending upon the day of the week. (The Washington Post: “Jails Struggle with” ~2014.) Some of these inmates are also veterans. The prison industry is rapidly growing due to investors on Wall Street and other stakeholders profiting from the imprisoned!

Globally, “treatment gaps” for people suffering from mental disorders can range from 50% -90% depending upon the development of the country, or lack thereof. (See TEDGLOBAL 2012 by Vikram Patel.) According to the World Health Organization over 450 million people worldwide suffer from mental illnesses, and 90% of people who commit suicide have a “diagnosable mental disorder”. (National Institute of Health) Countries like India and Zimbabwe are seriously understaffed to treat people suffering from mental disorders. In Zimbabwe the population of approximately 3 million people only has access to about a dozen psychiatrists. (Vikram Patel Research)

AGRUMENTS AGAINST

The main argument against governmental managing of global mental health seems to suggest that a sick mind is a direct result of a sick society. The critics believe that cultural differences, inequality and social injustices are fundamental causes of mental disorders. Some references even refer to poverty as a contributing factor to mental illness. (Campbell & Burgess 2012) The underlying belief is that mental health is a local community issue that is guided by cultural norms. Additionally the belief is that communities' mental health cannot be effectively managed from the global stage due to the endless list of differing mitigating factors for each nation state.

One highlighted disadvantage is that global expansion, research and treatment may be too expensive for all parties involved. The employers may not be agreeable to absorb the costs associated with policies, and society as a whole is not prepared to finance the mission of global treatments. The obvious shortage of mental healthcare professionals, especially psychiatrists, makes it impractical to try and regulate mental health from the global stage, according to the critics. In developed countries cost are already astronomical as related to health care; therefore, to implement the requirement for developing countries to participate would create more hardships as it relates to funding and resources.

CONTRADICTIONS

All people suffering from mental illness are not necessarily violent, nor will they commit violent acts. However, many are being diagnosed after deployments to war-torn areas and return with the inability to adapt to civilian life. The government on one hand can enlist their help for the purpose of war, but then refuse to be accountable for post-war consequences. To add insult to injury, some are arguing that the causes are linked only to local community inequalities despite pre-war conditions. The violent acts committed across the globe are not all committed by people with mental illnesses; however, many of our prisons, both nationally and internationally, are filled with people suffering from an untreated mental illness. To say that our cultural differences are an obstacle to developing a proactive policy to aid and treat those suffering from a mental health crisis is counterproductive and simply misguided.

The global statistics of homelessness, and the prison populations, clearly indicate there is a correlation to mismanaged mental disorders. The WHO reports that mental disorders are rampant and worldwide. Consequently, that makes it a global concern that cannot just be delegated to localities when the impact clearly stretches beyond all borders. NIH also reports that the leading cause of disabilities around the world is due to people suffering from mental disorders. The leadership cannot straddle the fence on the accountability of the global impact and still refuse to proactively revamp the guidelines and policies. That, in and of itself, is a contradiction.

PERSONAL OPINION

Undeniable international partnerships centered on true wellness have the capacity to proactively treat and remove stigmatization associated with mental health. Global unity on research and development could positively impact accessibility to necessary healthcare. A global consensus could set guidelines and minimum requirements for what is considered “quality mental health care”. It also could address the seemingly misguided priority of the pharmaceutical companies. The incentives in place need to emphasize awards and notoriety for cures, and proactive wellness plans, which educate the masses on how to manage mental health. To date the misplaced emphasis on prescribed medications only, as a solution, has led to an unhealthy dependency that merely cripples the suffering while increasing the profits of the pharmaceutical industries and the prison industries. Statistics across the international borders show that prisons are disproportionately filled with people suffering with a mental disorder. Currently, there are 2 million prisoners in the U.S. and 16% of the inmates suffer from mental illness. Globally there is an urgent need to design and implement a workable policy that puts humanity and one's wellbeing as the top priority. This will require all citizens within communities, from the local neighbor to the ultimate healthcare professional, to contribute to the process of finding local-global solutions that will be applied to developed countries, as well as the developing countries. The ideal remedy is to reach a worldwide consensus that demands a local-global approach which places humanity and wellness at the forefront of human consciousness. The statistics already illustrate that the percentage of people requiring mental health treatment far exceeds the current resources of available healthcare professionals. This corroborates the need for innovative approaches and local-global institutions to train and “empower” all people to contribute to “Health for All”.

An overhaul of the appropriation of funding could redirect the resources into building and equipping communities-in-crisis intervention training. The lobbying needs to be centered around wellness, public health and local-global solutions, not measures that benefit corporate stockholders and investors on Wall Street.

The statistics show military personnel around the globe often return from war battling some form of mental illness. The majority of these veterans did not have preexisting conditions. This implies that their military service may be the root cause to their mental illness. Sadly, recent terroristic shootings around the United States involving veterans show they were not receiving proper mental health care prior to their rampages, even if it had been previously documented. Other shooting around the U.S. have also been linked to individuals suffering from a mental health crisis. The fact that jails around the world are filled with people suffering from mental disorders is a clear indicator that local-global partnerships need to highlight the disproportionate percentages of jailed inmates who are suffering from mental disorders. This underscored information could catapult global mental health to the proper podium to propose new policies.

POLICY RECOMMENDATION

Reducing vulnerabilities and promoting science and technology programs, while ensuring that our emergency services, medical supplies and public health are protected, can be a huge step in the right direction of securing the nation. There are six critical mission areas according to The National Strategy for Homeland Security. (“National Strategy for Homeland Security”, 2002) While each mission area is important only two focus on reducing the nation's vulnerabilities. Those two are protecting critical infrastructure and key assets and defending against catastrophic threats. The challenge in protecting the infrastructure, in part, is because approximately 85% of the country's infrastructure is privately owned. This requires a unified effort to communicate and share information with the private sector and our international neighbors. Any system or asset vital to the nation that could cripple or negatively impact security, economy, public health or overall safety is a part of the nation's critical infrastructure.
Policy recommendation should emphasize, revamp and mobilize local-global efforts to defend against catastrophic threats linked to mental health.

Veterans Health Administration for Veteran's Affairs

The Veterans Health Administration's current policies need to be reevaluated and reworked to make health care accessible for all veterans, especially those known to suffer from a mental illness. The emphasis on mental healthcare is to prevent the deterioration of the condition, especially since the natural progression of some mental disorders lead to violent behavior.

Current Mental Health Gap Action Programme (mhGAP)

Additionally, the Current Mental Health Gap Action Programme established four major objectives during the creation of the Comprehensive Mental Health Action Plan 2013-2020. (mhGAP Newsletter, June 2013) These objectives were adopted by the 66th World Assembly and the World Health Organization to include various stakeholders of non-government organizations and their health care experts. This four prong agenda should be used as the basis of the policy that will provide the guidelines for all nation states. The four major points highlighted in this proposal are strengthening leadership for mental health, accessible social services within the affected communities, focus on prevention of mental health disorders and the sharing of information through research. These are excellent platforms to build upon within each institution affected by the crisis of unmanaged mental health disorders.

Crisis Intervention Training

The Department of Defense, the Veterans Administration, the World Health Organization, National Institute of Health, along with any of our international counterparts around the world, can implement the aforementioned four objectives into their respective communities as the agreed upon global incentive to combat mental health disorders. Crisis intervention training in local-global communities needs to educate and train people how to recognize mental disorders. Once trained these people could render assistance to those in need. This would automatically decrease the percentages of those who remain untreated. This will undoubtedly improve our mental health crisis within our local-global communities. Secondarily, in some cases, it may also contribute to the decrease of violent terroristic acts. Based on the WHO statistics and the current global impact of the untreated mental disorders, there is everything to gain globally, and absolutely nothing to lose by spotlighting the necessity of managing public mental health worldwide.


REEFERNCES

The National Strategy for Homeland Security 2002, Office of Homeland Security
http://articles.washingtonpost.com/2013-08-28/world/41525767_1_nidal-hasan-death-sentence-2009-shooting-rampage

http://www.globalmentalhealth.org/untreated-mental-health-issues-global-reality

Global mental health and its discontents: An inquiry into the making of global and local scale
http://tps.sagepub.com/content/early/2014/06/30/1363461514539830.abstract

Communities and Global Mental Health: A Special Section of Transcultural society by Eugene Raikhel
http://somatosphere.net/2012/09/communities-and-global-mental-health-a-special-section-of-transcultural-psychiatry.html

Virginia Panel Promises Changes in Mental Health System
http://www.washingtonpost.com/local/new-va-mental-health-panel-has-first-meeting/2014/07/21/ccd3f6a4-1109-11e4-ac56-773e54a65906_story.html

Jails Struggle to Deal with Flood of Mentally Ill
http://www.washingtonpost.com/national/health-science/us-jails-struggle-with-role-as-makeshift-asylums/2014/07/10/e5eaa0fc-085d-11e4-8615-4eddc1f1cffa_story.html

There Are 10 Times More Mentally Ill People Behind Bars than in State Hospitals
http://www.motherjones.com/mojo/2014/04/record-numbers-mentally-ill-prisons-and-jails

Some stats on the devastating impact of mental illness worldwide, followed by some reasons for hope.
http://blog.ted.com/2012/09/11/some-stats-on-the-devastating-impact-of-mental-illness-worldwide-followed-by-some-reasons-for-hope/

Word Health Organization-WHO

National Institute of Health-NIH

The Prison Industry in the United States: Big Business or a New Form of Slavery?
http://www.globalresearch.ca/the-prison-industry-in-the-united-states-big-business-or-a-new-form-of-slavery/8289



Lisa Burton is a graduate student at the University of the District of Columbia. This paper was submitted to Prof. Paul Nehru Tennassee as a course requirement Global Security and International Institutions for the Master’s program in Homeland Security.

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