Skip to main content

Get serious about mental health care

By Aaron E. Carroll, Special to CNN
updated 11:37 AM EST, Tue December 18, 2012
STORY HIGHLIGHTS
  • Aaron Carrroll: We might be able to prevent tragedies if we did better job treating mental illness
  • Carroll says more than 10% of kids should have mental health care, but few get it
  • He says emergency rooms treat acute instances, but system ill-equipped for long-term treatment
  • At checkups, he asks parents if guns are in house, but recent laws have tried to stop even this

Editor's note: Aaron E. Carroll is an associate professor of pediatrics at the Indiana University School of Medicine and the director of the university's Center for Health Policy and Professionalism Research. He blogs about health policy at The Incidental Economist and tweets at @aaronecarroll.

(CNN) -- In the wake of last week's tragedy in Newtown, I have been asked a million questions about gun control. I've seen pictures of the weapon the killer used. I've heard stories about the number of bullets in the clip and the number of guns in his mother's home. I've even heard politicians argue that school officials should be armed with semiautomatic weapons.

I've also heard about mental health.

Aaron E. Carroll
Aaron E. Carroll

We should be careful not to blame the mentally ill for all crimes. But we should also be prepared to accept that we might be able to prevent some tragedies if we did a better job of caring for them.

I've seen mental health illness in children, and our system is ill-equipped to handle it. I've seen families struggle with it. One of my greatest frustrations with clinical practice is that there are far too many times when I lack the tools necessary to care for children who need help. It's relatively easy to cure an infection or an acute physical ailment. It's so much harder to take a mental health issue. There are rarely pills that will do the job. Even when they are, they almost never work perfectly to eradicate the problem.

Opinion: On gun control, two places to start

Become a fan of CNNOpinion
Stay up to date on the latest opinion, analysis and conversations through social media. Join us at Facebook/CNNOpinion and follow us @CNNOpinion on Twitter. We welcome your ideas and comments.



Studies show that more than 10% of children in the United States might benefit from some sort of mental health treatment. Most don't get it. We often don't have the research to tell us how best to care for these problems. Even when we do, we often lack the capacity. There is a shortage of resources and services available to serve children. Furthermore, even when those resources exist, a lack of coordination often prevents they're being used effectively.

It doesn't help that the upcoming fiscal cliff will likely cut National Institutes of Health research funding by $2.4 billion. That would mean 2,300 fewer grants in the coming year, which represents about 25% of grants that might otherwise be offered. It doesn't help that we keep talking about cuts to services such as Medicaid and the Children's Health Insurance Program, which cover the health care for about one in every three children in the United States.

Gupta: Mental illness for 1 in 5 kids
Community coping with shooting tragedy
How do we stop the violence?

If a child is actively suicidal or homicidal, an emergency room can spring into action and admit him or her for inpatient care. But that's often all inpatient care will do. Once a child is no longer actively threatening harm to himself or others, he or she will be released. That's what the hospital system does. It cares for the acute problem, leaving the long term, and often much harder, work to a system ill-equipped to handle it.

Opinion: Mourn ... and take action on guns

It's natural to try and blame poor parenting when kids don't turn out as well as we'd hope. And, certainly, in many instances such parenting can lead to a misbehaving child, or even a child we don't necessarily like. But mental illness really does exist, and a lot of it can't be cured by good parenting and isn't caused by bad parenting. We don't have a good system for dealing with it.

I want to stress that I don't think that all violence is associated with mental illness. In fact, it's quite the opposite. But the problems with guns and injuries go so far beyond school shootings, and a lot of that is amenable to a more focused health care system.

Opinion: Predicting mass killings impossible

One of the things I do as a pediatrician is "anticipatory guidance." We ask questions about issues that have not yet occurred but might occur in the future. A lot of anticipatory guidance focuses on injury prevention. We might ask about bike helmets, or swimming, or fire alarms in the house. I even ask about guns in the home.

I don't ask this question because I'm eager to lecture patients or parents on the morality of owning guns, or the rights of individuals under the Second Amendment. I'm asking because I'm trying to prevent injury or death. The No. 3 killer of children age 10-14 is suicide; the fourth is homicide. The No. 2 killer of children age 15-19 is homicide; No. 3 is suicide.

Opinion: In school shootings, patterns and warning signs

I have been trained to ask parents if they have a gun in the home. If they do, I ask how it's stored. I strongly recommend that they keep it unloaded, locked up, and that they store the bullets separately. I do this because guns are part of almost 85% of homicides and more than 45% of suicides in kids 5 to 19 years old. This doesn't even account for injuries not resulting in death.

Yet recent laws have attempted to stop pediatricians from doing even this.

I don't know what the best outcome is from a tragedy like this. I imagine much of the focus will be on banning the weapon used or on limiting the number of bullets that could be fired without reloading. I think that's somewhat missing the point. The vast majority of injuries or deaths due to guns are carried out on a small scale.

While what happened in Newtown is a horrific occurrence, it represents the exception, not the norm, with respect to gun violence in the United States. While I welcome the opportunity for us to address the problem, I hope we focus on how we might best help all our children, not just those who make the national news.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Aaron E. Carroll.

ADVERTISEMENT
Part of complete coverage on
updated 12:53 PM EDT, Tue September 30, 2014
Jeff Yang calls Ello a wakeup call to Facebook and Twitter, and a sign of hope for fast-rising upstarts Pinterest and Snapchat.
updated 6:48 PM EDT, Tue September 30, 2014
Paul Waldman says the Secret Service should examine its procedures to make sure there are no threats to the White House--but without losing the openness so valuable to democracy
updated 4:49 PM EDT, Tue September 30, 2014
Jesse Williams says the videotape and 911 call that resulted in police gunning down John Crawford at a Walmart reveals the fatal injustice of racial assumptions
updated 7:03 PM EDT, Tue September 30, 2014
Mel Robbins says officials should drop the P.C. pose: The beheading in Oklahoma was not workplace violence. Plenty of evidence shows Alton Nolen was an admirer of ISIS.
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, William Piekos says..
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, writes William Piekos.
updated 10:13 AM EDT, Tue September 30, 2014
As Prime Minister Narendra Modi visits America, Madeleine Albright says a world roiled by conflict needs these two great democracies to commit to moving their partnership forward
updated 10:04 AM EDT, Tue September 30, 2014
John Sutter: Lake Providence, Louisiana, is the parish seat of the "most unequal place in America." And until somewhat recently, the poor side of town was invisible on Google Street View.
updated 9:11 AM EDT, Mon September 29, 2014
Julian Zelizer says in the run up to the 2016 election the party faces divisions on its approach to the U.S.'s place in the world
updated 10:19 AM EDT, Mon September 29, 2014
Ruben Navarrette says Common Core supporters can't devise a new set of standards and then fail to effectively sell it.
updated 9:29 AM EDT, Tue September 30, 2014
Earlier this month, Kenyans commemorated the heinous attack on the Westgate Mall in Nairobi.
updated 2:59 PM EDT, Tue September 30, 2014
David Wheeler says Colorado students are right to protest curriculum changes that downplays civil disobedience.
updated 9:58 PM EDT, Fri September 26, 2014
Sally Kohn says when people click on hacked celebrity photos or ISIS videos, they are encouraging the bad guys.
updated 7:55 AM EDT, Fri September 26, 2014
Loren Bunche says she walked by a homeless man every day and felt bad about it -- until one day she paused to get to know him
updated 9:32 AM EDT, Tue September 30, 2014
ISIS grabs headlines on social media, but hateful speech is no match for moderate voices, says Nadia Oweidat.
updated 8:33 AM EDT, Mon September 29, 2014
A new report counts jihadists fighting globally. The verdict? The threat isn't that big, says Peter Bergen.
updated 5:37 PM EDT, Tue September 23, 2014
Ebola could become the biggest humanitarian disaster in a generation, writes former British Prime Minister Tony Blair
updated 12:58 PM EDT, Fri September 26, 2014
ISIS has shocked the world. But will releasing videos of executions backfire? Four experts give their take.
updated 10:39 AM EDT, Fri September 26, 2014
Eric Holder kicked off his stormy tenure as attorney general with a challenge to the public that set tone for six turbulent years as top law-enforcement officer.
updated 9:09 AM EDT, Fri September 26, 2014
LZ Granderson says Obama was elected as a war-ending change agent, not a leader who would leave behind for his successor new engagement in Iraq and Syria. Is he as disappointed as the rest of us?
updated 5:10 AM EDT, Wed September 24, 2014
Gayle Lemmon says the question now is how to translate all the high-profile feminizing into real gains for women
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT