America's Mental Health Challenge

Aurora victims this October are participating in activism and sharing their insights from the horrific shooting spree in Colorado. Several have come forward to take public stances on the trial of the accused, the way charity funds have been dispersed, and most notably, gun control reform. By and large, Americans are joining these brave souls in revitalizing large-scale conversations around these critical cultural issues. Unfortunately, mental health remains in the margins. As we have done for several decades now, Americans are again eschewing an opportunity to discuss the role that mental illness played in the making of this and other massacres.

After three months, mental health has been little more than a footnote in the biography of the accused, James Holmes. A few details of the struggles he faced in receiving consistent therapy at and after school have become available, but otherwise, his mental health has scarcely been a topic of discussion. Now a clearer picture is emerging to suggest that Mr. Holmes, like Jared Loughner and other aggressors like them, suffered from serious mentally illness.

The scale of this country's challenge with mental illness is formidable. One in four adults -- more than 57 million Americans -- experience a mental health disorder each year, and less than one third of them receive treatment in a given year. Even among people who have been diagnosed with serious mental illness, less than 40 percent receive treatment. And what is the most common reason Americans are not seeking treatment? Our 'rugged' individualism. A 2001 Harvard study by Ronald Kessler reported that "wanting to solve the problem on their own" was the most widespread motive for foregoing treatment among people suffering severe mental illness.

Details now coming to light in court regarding the history of Mr. Holmes' illness make the Aurora story particularly frustrating. Classmates, teachers, and family all have confessed that they knew this was a young man in distress. He had even sought and received some care from a psychiatrist at the University of Colorado, but the relationship was severed when Mr. Holmes withdrew from the University. Once he was no longer enrolled, it is unclear to what extent he sought or received further treatment.

This story belongs to a larger narrative about what it is to be mentally ill in America. Although rarely included in the public discourse regarding health reform, stories like Mr. Holmes' reflect the ways in which our faltering health care system is even more problematic when it comes to mental health. First, the stigma associated with pursuing mental health still compels people to hide their suffering from friends, family and medical professionals alike. Second, given the prevalence of mental health issues, needs often overwhelm the supply of practitioners and availability of insurance. Third, particularly for younger adults, continuity of care can be interrupted by changes in school and employment status. This fragmentation is a major problem as the National Institute of Medical Health estimates that about 8 percent of people 18-24 years old have a serious mental illness. Prison, ironically, may provide better mental health care for Mr. Holmes than he may have otherwise received, at no cost to him.

The mental illness Mr. Holmes was experiencing when he opened fire does not excuse his egregious crime. But it forces us to reconsider the questions that we typically ask about why such travesties happen. Too often, we look to one another and wonder, "How can evil like this exist in the world?" when the more appropriate question may be, "How can illness like this persist in our world?" Had Mr. Holmes been properly diagnosed and under close, continued care of a trained professional, the earlier signs of his mental illness may have catalyzed medical intervention. In order to make this hypothetical a reality, we must reinvigorate conversation about how we design and deliver mental health care in this country.