Opinion: Watching out for signs of mental illness

Publisher’s note: The following column is the first of a two-part series that looks at the availability and impact of mental health services in Northern Nevada and across the nation.

By Kristin Hestdalen

As Nevada and the Lake Tahoe Basin greet 2013 with a mix of optimism and concern, we have great issues facing our nation, including looming debates on the state of mental health services, gun control, and protecting Second Amendment rights.

We continue to collectively mourn the devastating loss of life in Connecticut, as 27 people were killed (mostly first-graders). As unbelievable as this tragedy was (and many recently like it), we still face multiple questions: What are we as a nation prepared to change? How can we prevent this from happening again? And what exactly are the possible causes of these horrific acts?

Many commentators and politicians, say it is our “broken mental health system” that needs to be fixed. I am certain that something needs to be fixed, particularly our access to mental health services. But to declare there is a system, broken or otherwise, is naïve. In Nevada, the legislative body has cut 38.1 percent from the total general fund mental health budget over the past three years, making it the state with the fifth highest cut to mental health funding in the U.S. (Statistic from the National Alliance on Mental Health.)

And while legislators and mental health professionals continue to debate next steps, the question remains, “What leads a person to commit such a horrendous act?” I’m not sure there is an easy answer to this question.

Given that hurdle, we do have some ideas about what might predispose someone to consider mass homicide. In a detailed case study done on five mass murderers it was found they all shared some common characteristics and background history. First, the individuals in the study were all bullied as children and often experienced painful loneliness, leading to despair and feelings of social alienation. These were loners who eventually developed extreme anger at their perceived injustice by others, externalized blame, became suspicious and paranoid of others’ intentions and lacked the capacity to look inward in order to create real change. Instead they tended to be rigid, inflexible and narcissistic, unable to see the world except through their narrow lens. Addition of a mental illness (i.e. schizophrenia) exacerbates all of this and further distorts already flawed perceptions of others and their world.

Here are some possible signs that someone needs urgent mental health treatment:

1. An increase in isolative behaviors, such as staying in one’s room, not wanting to interact with family or friends.

2. Changes in mood or personality, especially development of hostility and anger.

3. Changes in interests, particularly an unusual and obsessive interest in guns and violence.

4. Onset of paranoia or suspiciousness.

5. Development of unusual thoughts or ideas and other distortions of reality.

6. Development of frank delusions or hallucinations.

These behavior changes often occur in adolescence or early adulthood and are sometimes the warning signs of very serious mental illness, such as bipolar disorder or schizophrenia. Families or the educational system (high schools, colleges and universities) are often left with the responsibility of finding help for someone who doesn’t want it.

In the next article we will discuss where this help may come from, and look at some examples of how residential treatment, counseling or medications can make a positive impact. So, as debate continues on many fronts and we see continuing acts of seemingly random and unexplained violence, perhaps real change, advocacy, and prevention can come from each of us as we bring the issue of adequate mental health services to the forefront.

Kristin Hestdalen is a board certified child and adolescent psychiatrist for Tahoe Family Solutions in Incline Village where she is a staff psychiatrist as well as chief psychiatrist for Sierra Mental Health Associates.