Mental Health Services Still Difficult To Get In King County

May 30, 2013

One year ago, Ian Stawicki killed four people at Cafe Racer, a popular and eclectic coffee shop and bar in Seattle's University District. Later that day he killed another woman, and then himself. Like other mass shootings without apparent motive, the case galvanized discussion about mental illness and violence.

KUOW's Sara Lerner spoke with Amnon Shoenfeld, director of King County’s Mental Health, Chemical Abuse and Dependency Services Division about why it's so difficult for many families to get help for loved ones who have mental illnesses.

Shoenfeld says it's still unclear whether Ian Stawicki had a mental illness because he never had a formal evaluation by county mental health professionals.

We don’t really know whether he had a mental illness or not. We don’t know whether if he had been referred for mental health treatment that he would have accepted or that he would have qualified in any way to receive that treatment.  So there’s a lot of questions. I think the one thing we do know is that there have been a lot of budget cuts for mental health treatment over the last four or five years and that has had an impact and it has restricted availability of services for people who are in need.

Stawicki's father has spoken publicly about his son's resistance to getting help. That's a common scenario families face when trying to get treatment for someone who is displaying symptoms of mental illness. Shoenfeld explains the options families have.

First, if someone really doesn’t want to go to treatment there is really no way to force them into treatment except through the involuntary commitment law, and that would require calling our office. Designated mental health professionals ... have the authority to involuntarily commit someone for 72 hours of evaluation and treatment  if the person has a mental illness and as a result of that mental illness they’re presenting a danger to themselves or others or are gravely disabled under the law, meaning they can’t take care of their basic needs of health and safety.

A lot of people think it’s very, very difficult to meet that standard. We actually involuntarily commit well over 3,000 people a year. So it’s certainly not impossible. It is, however, something we take very seriously. It is a restriction of someone’s liberty. And so they do have to meet a legal standard before we involuntarily detain someone.

That's the commitment process for someone when they are not voluntarily seeking help. If someone is willing to get help, families also face hurdles.

The second part really is, well, what if they are voluntary, how can they get treatment? And that is also a problem because if they don’t have the funding, if they don’t have someone who can pay for them, if they don’t have health insurance, if they’re not on Medicaid, then it’s very, very difficult to get into those services. And I don’t know the financial status of Mr. Stawicki or whether he was on Medicaid or whether he had insurance or anything, but that can be a real issue for a lot of people.

Access to services remains a problem because so many of them have faced deep budget cuts.

Well where we stand is we’ve received millions of dollars in cuts over the last four years. I think the legislature really does want to do more for mental health and treatment this session. And there is some extra money for additional services. However that’s really linked to speeding up the implementation of a change in the Involuntary Treatment Act from 2015 up to 2014. And they know that making it easier to get people committed will cost a lot of money so they are putting some resources into that. But that doesn’t nearly make up for all the cuts we’ve lost over the last four years. So we still have a long ways to go in order to have sufficient funding to help people who are in need in this state.

Another issue  facing people with mental illness is the stigma attached to these disorders.

Stigma is a major problem. It really is something that keeps people from seeking services. It keeps people from being full members of our community.

It can have major impact on whether or not people can get jobs or can get housing. There was a recent survey done that showed that the majority of people in this country wouldn’t want to work with someone who had a mental illness and wouldn’t want to live near someone who had a mental illness.

So when we have that kind of stigma  - people who really are afraid of people who have mental illness, don’t want to be with people who have mental illness --  that’s the kind of thing that isolates people more and probably increases the fairly small risk that people with mental illness have.

What we know is that people with mental illness are not more dangerous than the general population except under very specific circumstances -- when they’re not treated, when they’re homeless, when they’re also using drugs or alcohol. And of course when they’re unemployed,  when they’re not able to find housing –all those are risk factors and increase the risk of violence on that very small number of people who may have an inclination towards violence.

Though the risk is small, it is a large contributor to the stigma surrounding mental illness. Shoenfeld explains why:

Well. I’m afraid the media is partially to blame for this. Some of the horrendous things that we’ve seen over the last several years – the shootings in Colorado, the shootings in Arizona, Sandy Hook and Café Racer –are all examples that have been –media has paid a lot of attention to and they’ve really emphasized the possible mental disorder that people have had, sometimes with actually no real evidence.

The Sandy Hook shooting for example –there’s an incredible amount of discussion across this country about mental illness as a result of that shooting. Now obviously when someone does something as horrific as that, no one can understand that kind of activity, no one can understand why someone would do such a thing and there’s an assumption that they had to be deeply disturbed, that they had to be mentally ill.  But we don’t really know what was going on with that individual.

And there are people who do horrible things, who don’t have any mental illness and we don’t question that. People who are racist, people go in and shoot people because they’re a different color. People hijack airplanes and crash them into buildings because they have political beliefs.

All of those things we don’t question the mental illness part, but these kind of activities where someone does something to children, where someone just walks into a cafe and shoots people, I think there’s just an assumption there’s mental illness that’s driving that and so we associate mental illness with unpredictable violence and we’re afraid of it.

Statistics don't bear out that fear, however.

There’s been a lot of research about the connections between mental illness and violence. Most of the studies indicate that about 4 percent of all the violent acts in our society can be attributed to people with a known mental disorder so it’s a very small percentage.

The problem with these kinds of misconceptions about mental illness is that they prevent some people from getting help.

I think the message we want to send is first of all about 25% of all the people in this country will have a diagnosable mental disorder at some point in their lives. So that’s a fair number of people. And what we don’t want to do is create a perception that they need to deny it, that they need to hide it because of the stigma that’s associated with it. They need to go out and get the treatment the help that they need to deal with their mental disorder.

Most mental illness can be treated and so if we can get people to accept the fact that it’s an illness like any other illness and they need to take care of it just like they’d go to a doctor if they had a regular medical problem, a kidney problem or a heart problem.