Skip to main content

Get serious about mental health care

By Aaron E. Carroll, Special to CNN
December 18, 2012 -- Updated 1637 GMT (0037 HKT)
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
August 21, 2014 -- Updated 1842 GMT (0242 HKT)
Retired Lt. Gen. Mark Hertling says he learned that the territory ISIS wants to control is amazingly complex.
August 21, 2014 -- Updated 1450 GMT (2250 HKT)
David Weinberger says Twitter and other social networks have been vested with a responsibility, and a trust, they did not ask for.
August 21, 2014 -- Updated 1410 GMT (2210 HKT)
John Inazu says the slogan "We are Ferguson" is meant to express empathy and solidarity. It's not true: Not all of us live in those circumstances. But we all made them.
August 20, 2014 -- Updated 1951 GMT (0351 HKT)
Cerue Garlo says Liberia is desperate for help amid a Ebola outbreak that has touched every aspect of life.
August 21, 2014 -- Updated 1742 GMT (0142 HKT)
Eric Liu says Republicans who want to restrict voting may win now, but the party will suffer in the long term.
August 21, 2014 -- Updated 1538 GMT (2338 HKT)
Jay Parini: Jesus, Pope and now researchers agree: Wealth decreases our ability to sympathize with the poor.
August 21, 2014 -- Updated 1200 GMT (2000 HKT)
Judy Melinek offers a medical examiner's perspective on what happens when police kill people like Michael Brown.
August 19, 2014 -- Updated 2203 GMT (0603 HKT)
It used to be billy clubs, fire hoses and snarling German shepherds. Now it's armored personnel carriers and flash-bang grenades, writes Kara Dansky.
August 20, 2014 -- Updated 1727 GMT (0127 HKT)
Maria Haberfeld: People who are unfamiliar with police work can reasonably ask, why was an unarmed man shot so many times, and why was deadly force used at all?
August 18, 2014 -- Updated 2152 GMT (0552 HKT)
Ruben Navarrette notes that this fall, minority students will outnumber white students at America's public schools.
August 19, 2014 -- Updated 2121 GMT (0521 HKT)
Humans have driven to extinction four marine mammal species in modern times. As you read this, we are on the brink of losing the fifth, write three experts.
August 19, 2014 -- Updated 1158 GMT (1958 HKT)
It's been ten days since Michael Brown was killed, and his family is still waiting for information from investigators about what happened to their young man, writes Mel Robbins
August 18, 2014 -- Updated 1242 GMT (2042 HKT)
The former U.K. prime minister and current U.N. envoy says there are 500 days left to fulfill the Millennium Goals' promise to children.
August 20, 2014 -- Updated 1738 GMT (0138 HKT)
Peter Bergen says the terror group is a huge threat in Iraq but only a potential one in the U.S.
August 18, 2014 -- Updated 2006 GMT (0406 HKT)
Pepper Schwartz asks why young women are so entranced with Kardashian, who's putting together a 352-page book of selfies
ADVERTISEMENT