November 1st, 2013

Former DMH chief reflects on issues

On October 8, Ken Duckworth, M.D., medical director of the National Alliance on Mental Illness, discussed his thoughts on a variety of mental health issues in an informal event sponsored by the Association of Health Care Journalists. He touched upon some current issues that have an impact on the mental well-being of individuals in Massachusetts and across the country.

As former commissioner at the Department of Mental Health (DMH), Duckworth is intimately familiar with the Commonwealth and its efforts to help those who have a mental illness. He applauds the state for being a pioneer in this field, although he says there is always room for improvement.

For the most part, Massachusetts has done a good job of addressing the mental health needs of its citizens, according to Duckworth. But he believes the current DMH leadership has been too aggressive in closing beds across the state. “Emergency room wait times are posing another crisis because accessing psychiatric inpatient care can be tough,” he says. “The Department of Corrections is looking to build more mental health units. This represents trans-institutionalization, moving care from hospitals to prisons.”

Of great concern is the legalization of medical marijuana in the state. “The medical marijuana law in Massachusetts is worrisome. What do we know about increased access?” he asks. “We should keep 14 to 16-year-olds away from marijuana, particularly those with a history of psychosis. Earlier and heavier use raises the risk of developing psychosis between ten and 30 percent.”

However, one of the most notable, and favorable, pieces of legislation to come out of Massachusetts is the Rosie D. law, says Duckworth. He emphasizes that this case has helped not only the children who were involved in the original lawsuit, but also every child who sees a pediatrician. “This is driving mental health. The doctors give the questionnaires to all children now,” he says. “Rosie D. is the most emulated law across the country. People want early intervention, prevention, screening and treatment. This has been a major public health triumph. More kids are getting cared for at home and in the community.”

Since this event attracted journalists, Duckworth pointed out the importance of treating certain subjects diplomatically in the media. For instance, suicide “epidemics” should be reported circumspectly, he says. “When the media published stories some years ago about several youth in Austria committing suicide by jumping off bridges, it created a cult that said this is okay,” he says. “The World Health Organization created guidelines for the media when it comes to reporting on suicide. It shouldn’t be glamorized. Additionally, the APA released a guide in April 2013 for the media on how to talk about mental health.”

Duckworth admits that no one has all the answers and that with the implementation of the Affordable Care Act, there will be more questions and confusion when it comes to treating those with mental illness. He says that anyone working in the field of mental health must be comfortable with ambiguity, but must be accountable. He asks, “Who is responsible for these people? All of us.”

By Phyllis Hanlon

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