creative solutions and mental health

In her response to the shootings at Sandy Hook, titled, "There's Little We Can Do To Prevent Another Massacre," Megan McArdle took a fatalistic approach.  She stopped short of the Ecclesiastes approach, that “meaningless, meaningless, everything is meaningless under the sun.”  “Pointless, pointless,” would be a better summary.

She addressed the major areas of reform that have been discussed in the aftermath of Newtown:  gun control, civic religion, mental health, and media coverage.  She decides that, from a policy standpoint, there was nothing in these areas that we could have done that would have changed the outcome, short of banning all guns, which she points out will never happen.

She has received criticism for her ending--that the best thing would have been to teach the children to ignore their flight instinct and rush the shooter.  Perhaps that could be an effective approach from an older crowd.  

I mostly found her discussion to be interesting and engaging.  More than anything else I've read, she grasps the overall complexity of the ills that lead to an incident like this.  I was taking Sociology 100 when Heath High School shooting happened.  My professor warned us that the media would take a monocausal approach--that there would be a rush to reduce the incident to a single cause.

Still, while McArdle was able to grasp that there are a lot of issues, and that they aren't easy to solve, that difficulty took her to a place where she decided not to even try.  I think her discussion on mental health is a good illustration of how she got to that point.  She says:  

An affluent resident of an upper middle class town, Lanza had exactly the kind of resources that you would want for taking care of a kid with these kinds of problems.  His parents had all the money he needed to get him help, and his school did everything they could to help him cope, according to the Wall Stret Journal: "Not long into his freshman year, Adam Lanza caught the attention of Newtown High School staff members, who assigned him a high-school psychologist, while teachers, counselors and security officers helped monitor the skinny, socially awkward teen, according to a former school official. 

The problem in her analysis of the issue is that there are only two choices:  the school psychologist or institutionalization.  The school psychologist didn’t work, and nobody likes to be institutionalized, so that leaves us with no possibilities. 

The problem is this:  while these may be the two most obvious choices, they are not the only choices. 

If the two options don’t work, we don’t give up.  We seek out a third.

The obvious choices are, of course, the easiest.  Coming up with options in between can take some time, effort, creativity, and dialogue.  Put another way, problem solving takes some effort.  But, it’s possible.

I’m reminded of an essay written by Malcolm Gladwell for the New Yorker that was published in his book of essays, “What the Dog Saw.”  The essay is called "Million DollarMurray."  Murray was a homeless man in Reno, NV.  Studies of homeless shelters have found that most people stay only one or two nights.  People who stay on the streets longer than that tend to have mental illness or addiction issues. 

Murray fit into that category.  His struggles with alcohol kept him on the streets and in bad health.  However, when he was in a supervised treatment program, he did very well.  He was able to hold a job as a cook.  But, when he would graduate from the programs and was unsupervised, he would relapse, and soon be back on the street.  All to a great cost to society:

The first of those people was Murray Barr, and Johns and O'Bryan realized that if you totted up all his hospital bills for the ten years that he had been on the streets—as well as substance-abuse-treatment costs, doctors' fees, and other expenses—Murray Barr probably ran up a medical bill as large as anyone in the state of Nevada."It cost us one million dollars not to do something about Murray," O'Bryan said.

So, to keep Murray on the street, it cost a million dollars.  What if we paid for an apartment and a staff to treat him? 

The cost of services comes to about ten thousand dollars per homeless client per year. An efficiency apartment in Denver averages $376 a month, or just over forty-five hundred a year, which means that you can house and care for a chronically homeless person for at most fifteen thousand dollars, or about a third of what he or she would cost on the street. The idea is that once the people in the program get stabilized they will find jobs, and start to pick up more and more of their own rent, which would bring someone's annual cost to the program closer to six thousand dollars.

In essence, it’s cheaper to rent him an apartment and hire a nurse or social worker to keep track of him than it is to leave him on the street.  Of course, this isn’t a perfect solution, as Gladwell points out:

The reality, of course, is hardly that neat and tidy. The idea that the very sickest and most troubled of the homeless can be stabilized and eventually employed is only a hope. Some of them plainly won't be able to get there: these are, after all, hard cases.

He lists some other issues with the program.  It’s not perfect, but it has been effective in some of the cities that have tried it out.  Now, this is about helping the homeless, but could it have a broader application.

I’m not saying this is the solution, but it is a third option.  It’s more intensive than session with a therapist, but with more freedom than institutionalization.  More to the point though, is that if there is a third option, then there is likely a fourth option, a fifth, perhaps even many possible solutions.  And each one individually may be imperfect, but perhaps one solution can fill in the gaps of another.