CT shooting devastating, sadly not surprising to nation’s RNs

Registered nurses across the country mourn the loss of life marked by the shooting of innocents in Connecticut and say it is time for the White House, Congress, and state and local legislators to take action to address causes of the violence, including restoring the devastating cuts that have occurred to mental health services across the United States.
 
“This is a massive tragedy that is being played out on a smaller scale every day in emergency rooms, in mental health facilities, and on the streets across our country, where, with sometimes devastating consequences, mental health is underfunded to a shocking, and sometimes deadly degree,” said Deborah Burger, RN, co-president of National Nurses United, the largest U.S. organization of nurses.
 
Time to Act
 
NNU supports both short-term and long-term responses, including as a minimum:
 
Demanding private healthcare systems reverse the pervasive cuts to mental health services, especially by profit-focused institutions which view mental health as an easy target for cuts because it is less profitable and has fewer public advocates.
Increasing federal, state, and local funding of public mental health programs and public health clinics, which play a crucial role in identifying persons with potentially violent mental health problems.
Requiring health insurance companies to provide full coverage for mental health services, and requiring parity in mental health coverage with other health services.
Restoring the positions of school nurses and counselors who are frequently a first target of school budget cuts.
Challenging the stigma of mental health that undermines mental health programs and stigmatizes people needing mental healthcare, the overwhelming majority of whom are not violent.
Guaranteeing healthcare for everyone, including mental health services, based on patient need, not ability to pay, as in improving and expanding Medicare to cover everyone.
 
“Sadly, it comes as no surprise to America’s nurses who are on the front line of our nation’s mental health crisis,” said Burger. “Why must it take such a catastrophe to convene a serious dialogue about the state of our nation’s mental health system? In communities from Maine to California, nurses must deal with the fallout that comes from hospitals, schools, and clinics, who have cut their mental health services to the bone. “
 
Evidence is in on the mental health crisis
Budget cuts for safety net programs and fundamental care services, from schools to health facilities, have a crucial impact on communities. In 2011, The National Alliance on Mental Illness, NAMI, released a report documenting deep cuts to mental health services that led to significant reductions in both hospital and community services for vulnerable individuals with serious mental illness.
 
In Connecticut, NAMI has reported, the public mental health system currently provides coverage for less than one in five Connecticut residents with a serious mental health problem. The other four may not be able to afford to pay for those services on their own, particularly since mental health issues tend to disproportionately affect poor people.
 
A 2010 National Institute for Mental Health study asserted that one in every three to four children suffers from a mental disorder and that about one in 10 has a serious emotional disturbance, with few affected youth receiving adequate mental healthcare. It emphasized that common mental disorders among adults first emerge in childhood and adolescence, further stressing the need for early intervention and prevention.
 
The National Health Council for Community Behavioral Healthcare reports that 60 percent of juvenile detention inmates have at least one mental disorder. Although home- and community-based services are more cost effective than warehousing youth in the juvenile justice system while they await treatment, the Council notes that these home and community services are “inadequately supported.”
 
According to the National Survey on Drug Use and Health, the Think Progress website reported that after the Connecticut shooting, just 7.1 percent of U.S. adults receive mental health services. Out-of-pocket costs for inpatient and outpatient mental health services are staggeringly high.
 
Nurses speak out
 
“While there is a national focus, rightly so, on the tragedy in Newtown today,” said Burger, “millions of people and their families in our country continue to suffer from mental illness and post- traumatic stress from domestic and sexual violence who do not receive support or counseling.”
 
“These millions are the hidden face of mental trauma in the U.S., and the disgrace of a healthcare industry in particular that is focused on short-term profit rather than therapeutic healing. Nurses will continue to advocate for the support and early intervention patients and all Americans deserve,” she said.
 
“My first reaction when I heard the news was that he sounded like someone with an untreated mental illness,” said Adelena Marshall, RN who has worked in the mental health unit of the Chicago Veterans Affairs Hospital for the last 20 years and has become the voice of veterans and the expert on mental health matters at the VA.
 
Last May, Chicago VA RNs with the support of NNU had to threaten to hold an informational picket with the group Iraq Veterans against the War (IVAW) to decry the appalling staffing conditions on the mental health unit. A couple of weeks later, 20 positions were posted.  
Nurses are witnesses to the dramatic increase and effect of untreated mental health patients in every part of our healthcare system and must have a voice in the public policy discussion as it moves forward.
 
“Nurses are on the front line of this issue and need to part of the policy conversation,” said Michigan RN Jeanette Hokett, who works in a 14-bed child and adolescent psychiatric inpatient unit at the University of Michigan Health System. “They spend the most time at the bedside with the patients and families, and offer a perspective others, such as doctors, don’t have.”
 
Earlier this year, nurses' concerns about access to mental health prompted NNU to convene a roundtable on mental health.  “Often, the emergency room is where desperate people end up,” said one participant, Diane Fagan, a Kaiser Permanente ER RN in Oakland, Calif. “In the eight years I have worked there, I have seen more and more untreated mental health patients coming into the emergency department and spending long hours waiting to see a psychiatrist because so many of our outpatient services have closed.”
 
Hokett, the Michigan RN,  hears frustration from patients and families on a daily basis. “There’s not enough for these families to get the support they need,” said Hokett. “I have seen patients come in sicker and stay shorter times. There are no beds. We have waiting lists for people who are trying to get a patient into our facility. While they wait, healthcare staff works with families to come up with a safe plan for them at home. It may mean a parent has to remove sharp knives from the house and sit with the child 24 hours until a bed becomes available.
 
“The reality is there are not enough treatment options and they are not always available for families because of financial constraints. If there was better access to mental healthcare, we would be able to improve the outcome for these patients and improve their lives,” she said.
 
Ultimately, said Burger, “effectively challenging the mental health crisis is an integral part of solving our overall, ongoing healthcare emergency in the U.S. That problem is far from fixed, which is why nurses will continue our efforts to enact a comprehensive solution, as in improving and expanding Medicare to cover everyone, with the services needed, including mental healthcare. And we will also continue to press for a tax on Wall Street speculation, as embodied in HR 6411, the Robin Hood tax, as a critical way to help pay for it.”