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 7:34 PM EDT, Fri October 17, 2014
The world's response to Ebola is its own sort of tragedy, writes John Sutter
updated 4:33 PM EDT, Fri October 17, 2014
Hidden away in Russian orphanages are thousands of children with disabilities who aren't orphans, whose harmful treatment has long been hidden from public view, writes Andrea Mazzarino
updated 1:22 PM EDT, Sat October 18, 2014
When you hear "trick or treat" this year, think "nudge," writes John Bare
updated 12:42 AM EDT, Sat October 18, 2014
The more than 200 kidnapped Nigerian schoolgirls have become pawns in a larger drama, writes Richard Joseph.
updated 9:45 AM EDT, Fri October 17, 2014
Peggy Drexler said Amal Alamuddin was accused of buying into the patriarchy when she changed her name to Clooney. But that was her choice.
updated 4:43 PM EDT, Thu October 16, 2014
Ford Vox says the CDC's Thomas Frieden is a good man with a stellar resume who has shown he lacks the unique talents and vision needed to confront the Ebola crisis
updated 4:58 AM EDT, Sat October 18, 2014
How can such a numerically small force as ISIS take control of vast swathes of Syria and Iraq?
updated 9:42 AM EDT, Fri October 17, 2014
How big a threat do foreign fighters in Syria and Iraq pose to the West? It's a question that has been much on the mind of policymakers and commentators.
updated 8:21 AM EDT, Fri October 17, 2014
More than a quarter-million American women served honorably in the Iraq and Afghanistan wars. Now they are home, we have an obligation to help them transition back to civilian life.
updated 4:27 PM EDT, Thu October 16, 2014
Paul Begala says Rick Scott's deeply weird refusal to begin a debate because rival Charlie Crist had a fan under his podium spells disaster for the Florida governor--delighting Crist
updated 12:07 AM EDT, Thu October 16, 2014
The longer we wait to engage on Ebola, the more limited our options will become, says Marco Rubio.
updated 7:53 AM EDT, Wed October 15, 2014
Democratic candidates who run from President Obama in red states where he is unpopular are making a big mistake, says Donna Brazile
updated 12:29 AM EDT, Thu October 16, 2014
At some 7 billion people, the world can sometimes seem like a crowded place. But if the latest estimates are to be believed, then in less than a century it is going to feel even more so -- about 50% more crowded, says Evan Fraser
updated 3:38 PM EDT, Thu October 16, 2014
Paul Callan says the Ebola situation is pointing up the need for better leadership
updated 6:45 PM EDT, Wed October 15, 2014
Nurses are the unsung heroes of the Ebola outbreak. Yet, there are troubling signs we're failing them, says John Sutter
updated 1:00 PM EDT, Wed October 15, 2014
Dean Obeidallah says it's a mistake to give up a business name you've invested energy in, just because of a new terrorist group
updated 7:01 PM EDT, Wed October 15, 2014
Fear of Ebola is contagious, writes Mel Robbins; but it's time to put the disease in perspective
updated 1:44 PM EDT, Tue October 14, 2014
Oliver Kershaw says that if Big Tobacco is given monopoly of e-cigarette products, public health will suffer.
updated 9:35 AM EDT, Sat October 18, 2014
Stop thinking your job will make you happy.
updated 10:08 PM EDT, Tue October 14, 2014
Ruben Navarrette says it's time to deal with another scandal involving the Secret Service — one that leads directly into the White House.
updated 7:25 AM EDT, Tue October 14, 2014
Americans who choose to fight for militant groups or support them are young and likely to be active in jihadist social media, says Peter Bergen
updated 9:03 AM EDT, Mon October 13, 2014
Stephanie Coontz says 11 years ago only one state allowed same sex marriage. Soon, some 60% of Americans will live where gays can marry. How did attitudes change so quickly?
updated 4:04 PM EDT, Tue October 14, 2014
Legalizing assisted suicide seems acceptable when focusing on individuals. But such laws would put many at risk of immense harm, writes Marilyn Golden.
updated 9:07 AM EDT, Mon October 13, 2014
Julian Zelizer says the issues are huge, but both parties are wrestling with problems that alienate voters
updated 6:50 PM EDT, Mon October 13, 2014
Mel Robbins says the town's school chief was right to cancel the season, but that's just the beginning of what needs to be done
updated 11:43 AM EDT, Sat October 11, 2014
He didn't discover that the world was round, David Perry writes. So what did he do?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT