
My son is schizophrenic. The ‘reforms’ that I worked for have worsened his life. - aaronbrethorst
http://www.washingtonpost.com/national/health-science/my-son-is-schizophrenic-the-reforms-that-i-worked-for-have-worsened-his-life/2012/10/15/87b74a98-eadd-11e1-b811-09036bcb182b_print.html
======
debacle
You can blame the schools for misdiagnosing ADHD, and you can blame them for a
poor IEP, but you can't blame them for a child not having a normal life due to
one of the most tragic diseases known to man.

Schizophrenia is not the kind of disease you can treat with an IEP, and it
sounds like the author's son fell out of the system from a very young age.
Trying to blame anything but genetics and development for his son's state is
disingenuous - treating schizophrenia is a complicated, involved, and
ultimately very stressful process for everyone involved, and in the end it can
only bring someone on the brink of homelessness or self-harm into a situation
where they can be stable most of the time, but never _all_ of the time, or
even almost always.

> The word “disability,” for instance, should have covered Tim and children
> like him.

ADHD or blindness are not even in the same room a schizophrenia. It's like
comparing having six toes on your left foot to being comatose.

> If I were a legislator today, I’d mandate — and provide funding to ensure —
> that every teacher receive training in recognizing symptoms of mental
> illnesses.

Teachers have enough on their plate, and more importantly, that's not what
teachers are for. It sounds like the author took his son to plenty of mental
health professionals, and he still wasn't properly diagnosed until he was
nearly an adult.

> I’d see that pediatricians are trained to make screening for mental health
> concerns a regular part of well-child exams.

Many mental health diseases don't manifest to the levels for proper diagnosis
until adulthood, and even then the process of diagnosis is not scientific.

> I’d put much more money into community mental health services...

All of that sounds great, but mental health services are one of the first
things cut into in a down economy.

> Tim is where he is today because of a host of public policy decisions we’ve
> made in this country.

No, he isn't. The author is wrong, and I'm sorry for that, but it's very
unlikely that his son would have ever been a contributing member of society.
Schizophrenia is a severe mental disease that cannot be treated like a
'special need.'

~~~
fusiongyro
This fatalistic attitude isn't wrong, but it is manifestly unhelpful and
surprisingly expensive. Being homeless is not a zero-cost alternative to real
treatment; in many cases, the cost of lavish treatment is far lower than the
cost of ER visits and criminal proceedings that would otherwise be incurred. I
believe Malcolm Gladwell wrote an article about chronic homelessness a few
years ago, about Denver rolling out a program to take some number of homeless
folks and set them up in an apartment free of charge with on-site nursing
24/7, and it was saving the city millions just by keeping them out of the ER.
I believe the program ultimately came under fire because of how essentially
un-American such a system is, even when it makes both ethical and financial
sense.

~~~
ArbitraryLimits
> when it makes both ethical and financial sense.

It saves money on a small scale because no one's trying to defraud it yet.

~~~
fusiongyro
The article I'm remembering actually addressed that. The program was limited
to a very small number of people--tens, or fewer. They actually had one that
wrecked his apartment every week, and still it was cheaper to fix it back up
than to let this guy back on the street, where he would incur about $1M a year
in ER bills. One of the big objections to this program came from the fact that
the scale was so limited.

~~~
philh
The fraud that jumps to my mind is a hypothetical person taking a free
apartment, when they are perfectly capable of supporting themselves and would
do so if the alternative was homelessness. That's certainly not cheaper.

I make no claims about how common this kind of fraud would actually be.

------
kyro
I just finished my Psychiatry rotation as part of my training and there are
three things, of many, that I learned: First, America has a _long_ way to go
in developing the best screening and management tools for people with mental
disabilities. Second, schizophrenia is an _incredibly_ complicated illness
that can take manifest in a whole host of unsuspecting symptoms, and is not
easily treatable. And third, diagnosing and treating a mental disorder in
children is _really hard_.

The last two points, I think, are very relevant to this article. While I
sympathize with you, understand that child development is a very, very
complicated thing. You have naturally hyper children, naturally withdrawn
children, etc, and physicians are very wary to label any child with an
illness, especially schizophrenia. When we're adults and have leveled out,
it's easier to discern what is "normal" from "abnormal." But children are
constantly changing, being molded by their environment, and so it's much
harder to outline a symptomatic threshold of what's considered normal.
Additionally, children exhibit mental disorders in very different ways than
adult do; there are different sets of symptoms to look out for. And these
symptoms can be anything from "pressured speech" (talking too fast. some kids
are just naturally fast talkers, right?) to auditory hallucinations (but the
child could have a vivid imagination, right?).

The treatment for schizophrenia is an entirely different beast. The goal is
usually to just suppress the symptoms and to restore the patient to a
functional baseline. In many cases, the disease progresses and the prognosis
worsens. In your case, your child had early-onset schizophrenia, which is
associated with a worse prognosis than late-onset cases.

Although there are studies that show that early detection and treatment of
schizophrenia can improve the course of the disease, chances are your kid
would have still developed much of the same symptoms and issues that he has
now. It really sucks, and I sympathize with you, but that's the nature of the
disorder. It's terrible, difficult to manage effectively, and can ruin lives.
I've seen it.

------
cletus
Things like this are easy to say:

> If I were a legislator today, I’d mandate — and provide funding to ensure —
> that every teacher receive training in recognizing symptoms of mental
> illnesses.

but teachers aren't psychiatrists or clinical psychologists and can't really
be expected to be.

I was recently watching a program talking about the somewhat controversial
theory that schizophrenia (and other mental disorders) are either parasitic in
origin or that parasites may simply contribute [1] [2].

The culprit in this case being toxoplasmosis. There's been research to show
that there is correlation between the incidence of schizophrenia and the
domestication of cats.

This kinda reminds me of how peptic ulcers were once thought to be caused by
stress until they were found to caused by a virus [3].

At the same time the elimination of parasites is arguably related to the rise
of autoimmune diseases in the developed world (the so-called "hygine
hypothesis" [4]). For example, hookworms may combat asthma and other allergies
[5].,

I wonder if the coming century will be a revolution in mental health as
parasties, viruses and bacteria (or even the _lack thereof_ ) may be far more
immportant than currently realized, possibly even causal in many cases.

[1]:
[http://www.sciencedaily.com/releases/2009/03/090311085151.ht...](http://www.sciencedaily.com/releases/2009/03/090311085151.htm)

[2]:
[http://www.stanleyresearch.org/dnn/LaboratoryofDevelopmental...](http://www.stanleyresearch.org/dnn/LaboratoryofDevelopmentalNeurovirology/ToxoplasmosisSchizophreniaResearch/tabid/172/Default.aspx)

[3]: [http://health.nytimes.com/health/guides/disease/peptic-
ulcer...](http://health.nytimes.com/health/guides/disease/peptic-
ulcer/causes.html)

[4]: <http://en.wikipedia.org/wiki/Hygiene_hypothesis>

[5]: [http://www.gizmag.com/hookworms-prevent-asthma-
allergies/129...](http://www.gizmag.com/hookworms-prevent-asthma-
allergies/12969/)

~~~
mst
> teachers aren't psychiatrists or clinical psychologists and can't really be
> expected to be.

True.

Equally: Programmers aren't operations staff.

But we can damn well learn how to call them in when we need them.

~~~
dromidas
Very good analogy.

------
tjic
Some problems just don't have good solutions.

We're so used to political debates where the Republicans say "less regulation
will solve X", the Democrats say "more spending will solve X", the
libertarians say "X is none of the government's business", and each suggests
that things will go swimmingly under their preferred way of attacking the
problem.

Some things, though, just suck.

Schizophrenia is one of those things. You can't cure it. You can't treat it
very well. There's not much to be done.

Sometimes bad things happen to good people, and no amount of "training
teachers" or "diagnosing diseases" or whatever will change that.

It's a tragedy.

~~~
wonderzombie
I think this is too fatalistic. This sets the bar far too low -- you could
substitute poverty or crime in here without substantially altering the
meaning. No, you cannot "cure" it or "fix" it, but the alternative isn't "do
nothing." That's a false dichotomy.

At a minimum you can look for ways mitigate the impact it has on our society.
See the pieces elsewhere in this thread which discuss the cost to our society
incurred by ER visits from the mentally ill and/or homeless. That's a trivial
example.

It might be worth discussing how other western industrialized nations approach
this; I suspect that those countries which have some kind of socialized health
infrastructure do more than the US than shrug their shoulders and avert their
eyes.

~~~
angersock
Not so much...the fatalism here is not unwarrented.

If I give a pauper a million dollars, they are no longer a pauper--foolish
noveau riche, perhaps, but not a pauper.

If I repeal laws pertaining to various things, drugs for example, a great many
criminals cease to be so.

Mental illness, unfortunately, tends to stay with the person.

:(

~~~
wonderzombie
That's true, but again, at least we ought to evaluate what the cost of doing
nothing is. What we're doing now is pretty close to nothing, and it _does_
have a cost, in money and in more intangible dimensions (e.g. humanitarian).

~~~
angersock
Oh, don't get me wrong--I'm very much for state-run healthcare and could be
considered a proponent of socialism. I think that any civilization with as
much resources as we do (we here being Americans, presumably) is criminal if
it does not work to support its citizens cradle-to-grave.

I was just disagreeing with your assessment that fatalism is unwarranted--we
do it (caring for mental illness) anyway, because it simply must be done, but
we ought not pretend that things will get better.

------
showerst
"Every year, one in every five children and one in every four adults has a
diagnosable mental illness. A quarter of all mental illnesses are considered
serious."

1/16 adults having a serious mental illness seemed awfully high to me, but I
went and looked it up and that may actually be low-balling it:
[http://www.nimh.nih.gov/health/publications/the-numbers-
coun...](http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-
disorders-in-america/index.shtml)

~~~
aes256
I don't really like the term 'mental illness', not so much because of the
stigma attached to it, but because the term implies there is some 'normal'
from which only a small subsection of the population deviates.

In reality, there is no 'normal'. There is no one person with perfect mental
health; perfect clarity of thought, perception, of feeling and action.
Everyone, to put things bluntly, is a little fucked up.

Thus, these figures don't really surprise me. As far as I'm concerned you can
end up with any percentage of the population suffering from mental illness, it
just depends where you set the thresholds.

~~~
lusr
There's a ridiculously vast difference between "a little fucked up" and
serious mental illnesses such as schizophrenia, rapid cycling bipolar disorder
or borderline personality disorder.

If you think serious mental illness isn't a real, debilitating reality, I
encourage you to spend some time with somebody in a truly psychotic state and
see how you feel afterwards. Then imagine living _as_ that person.

There may be no absolute "normal", but there are most certainly people who
live in a sad, terrible, frightening state of mental disturbance with no
simple treatment.

~~~
aes256
Don't get me wrong, I don't mean to belittle those with debilitating mental
illnesses.

I simply don't like the view many seem to hold that mental illness is black
and white; you have a mental illness or you don't.

------
dgavey
What a timely article. Just today received a call from the school that my
grade 3 son had thrown a girl to the ground threatening her. This was the
second incident in a week. A team of councilors and mental health workers were
called in as an emergency response team.

The similarities between the child in the article and my son are startling and
scary.

Although we are still at the beginning of our story, I do believe that in my
area in Canada, the system has gotten better. I can only hope that this
continues and the system does not let him down like it did to the child in the
article.

My son will be seeing a counselor and accessing services that were previously
unavailable to us starting in 2 days. Thanks Hacker News, you are always so
poignant.

~~~
tisme
I'd go easy on that counselling and do my best to figure out first _what
actually happened_.

It would not be the first time that the visible aggressor was in fact the
victim of a long drawn out teasing campaign by a group of bullies, and girls
can be bullies just as easy as boys.

One of the best bits of fun seems to be to goad someone until they snap and
then let them take the blame for it all.

Been there, done that, have the t-shirt.

~~~
dgavey
I know the useless tunnel that counseling can be all too well. I also know my
son. He is not like the rest of the kids. Exceptionally bright, exceptionally
short fuse. No energy, always tired and constant sleepwalking or night
terrors, and I do believe he may have already had auditory hallucinations.
There is a history of mental illness in his lineage.

That being said, I have seen the kids first hand pushing his buttons on the
school yard. There are so easy to push it's hard for them to resist. We are
working with both the school and some mental health workers to make the
situation more livable for all parties. I appreciate your concern, and I do
understand that play-yard aggression is often mis-construed. That is most
definitely part of this situation.

~~~
tisme
Ok, super to see you're on top of this and looking at all angles.

School can be hell if you are standing out in whatever way, and cause and
effect can be hard to separate sometimes. Night terrors could be causing
trouble in school, school trouble could be causing night terrors just the
same.

I wish you the very best of luck with this, and I hope that it will all come
to a good resolution.

------
jetti
One of the major problems that I've seen first hand with mental illness is
that the diagnosis is so subjective and often times relies on accounts of the
patient and family. If you have family who don't know what to look for or the
patient doesn't know how to explain it or is under the duress of the illness
at the time, you run the chance of misdiagnosis.

This happened to me. My senior year of high school I had a "breakdown" of
sorts. I was suspended from school until I saw a mental health professional.
After the first visit, I was diagnosed with Bipolar disorder and given meds to
treat it. After awhile, the diagnosis changed to Schizo-affective disorder and
more drugs were added to help. Finally, I was diagnosed with epilepsy and told
that the mental health diagnosis were wrong since epilepsy can cause both
depression and hallucinations if untreated.

I shared my story for a few reasons. One the brain is complex and there can be
many factors that causes symptoms. If mental health professionals can't get it
right, there is no way to expect teachers or school administrators to get it
right. I was lucky and had phenomenal insurance at the time that I went
through that ordeal. Because of that, I was able to get tests and scans that I
know others wouldn't not be able to afford. I fortunate enough to have a
parent who could afford for me to get a SPECT scan which is (or was)
considered cutting edge and would not be covered under insurance. That was
what helped the neuro-psychiatrist realize that I have epilepsy and not a
mental illness. Many people can't afford these things. Had I not had that
scan, I would still probably be taking 20 pills a day and having to wake up
early to take Adderall so that I'm able to physically wake up in time to be
functional and the worst part is, that would be all for naught. It wouldn't
help me since I don't have any problems.

There is so much wrong with the mental health system (at least in the US) that
it really makes me sad. You start at the education level (such as the article
talks about) but then when you move to insurance, so much isn't covered that
it becomes either pay out of pocket or just let the individual suffer.

~~~
lostlogin
Thanks for sharing that. It isn't just the US that is a bit average where
mental health is concerned.

------
tzs
My old eyes cannot handle very very long lines of very small type, and after
several tries I was not able to guess the URL for the story in human friendly
form.

Please submit links for humans, not machines. Add the machine link in a
comment if you wish.

PS: I'm aware of Readability and the ability to increase font sizes. There are
other problems in general with print links that those do not address:

• Print links generally do not include extras like comments. This particular
story had a large number of comments at the original site.

• Although not applicable in this particular case, stories often include
sidebar links to related stories, and these are often omitted from print
links.

• The non-print link usually includes a very easy way to get to the print
version. Typically, you just click a print icon and you are there. The print
link, on the other hand, usually does not include any link or other mechanism
to get to the non-print version (other than the "back" button if you happened
to have come from the non-print version).

Taking this all into account, particularly the last part about it being very
easy to get to the print link from the non-print link, and not easy to go the
other way, in almost all cases the link submitted should be the non-print
link.

PPS: there are some sites that offer an "all on one page" link, which is
distinct from the print link. The former simply does away with splitting the
article into pages, keeping the comments and sidebar links and human-friendly
formatting. Submitting "all on one page" links is great.

~~~
pan69
Press CTRL+PLUS a couple of times to increase the font size. CTRL-ZERO to go
back to 1:1.

~~~
lostlogin
Try that link from an iPhone. I love small type usually, but that's a little
small. Yes, Instapaper is what I should have done.

------
jnar
I'm out of words. Here everybody seem saying smart words about being mentally
disable/ill, about politics and so on but you all miss the pivot.

This (young) adult was diagnosed with schizophrenia. If the US wouldn't have
the health-care system it has, this guy would receive proper treatment without
hassles. Being hospitalized and so on. But he wasn't, and now he's just the
last of the leasts. Why he wasn't? Because he wasn't elegible according to the
insurance. Obviously he wasn't i'd say. Companies exist to make profit, this
is old story, no insurance want really to treat people who are going to
require life-long medications and care.

So, try to learn something from this story and realize how the US system is
broken when it comes to care about people who isn't Paris Hilton.

I heard Romney saying "nobody is dying in this country because of lacks in
terms of health-care, they jsut go to the first aid". He said this because
he's just evil. Anyone smart realizes that being stabilized and being treated
are 2 different things.

------
jrockway
It's pretty sad that the best way to get mental health treatment is to commit
a crime and go to jail. What an epic failure.

It really goes to show how our society thinks of people: if we're punishing
someone for a wrong, then spend as much money as necessary. But helping
someone before they do something wrong: that's socialism.

------
_delirium
This is often discussed among homeless advocates, because such a large
percentage of homeless have mental illnesses of various kinds.

I do think reform had quite a bit arguing for it: old-style "insane asylums"
were really not nice places, and involuntary commitment was used fairly
widely, at times even producing involuntary surgeries (like the notorious
period in which involuntary lobotomies were performed), which I think are
serious problems for civil liberties and easily abused. But the problem is
that we just closed the asylums and didn't replace them with much of anything
at all, in most states not even voluntary facilities that people can check
themselves in to.

~~~
barry-cotter
Mental hospitals suck. Some suck more, some less but if you visit people in
them you will be under no illusions but that they all suck.

~~~
jetti
Depending on what you mean by "Mental hospitals suck" I disagree. It isn't
supposed to be a place you go for happy fun time, but there are some really
nice ones. The problem is, the really nice ones are out of the reach for many
people who need them because they are super expensive.

------
emeraldd
I grew up around a situation similar to this. Thankfully, it hasn't turned out
that badly. People with that kind and depth of mental illness have to have
someone watching out for them. One little slip, one missed pill has the
potential to send them down a road that they will not be able to recover from
on their own. It can get bad fast and take a long time to bring back under
control.

------
zwieback
My cousin has (had?) schizophrenia. Despite the best efforts of his wealthy
family and a willing mental health system in Germany he disappeared and we
haven't heard anything in a very long time. He lived on the streets for a
number of years but it's very hard to get schizophrenics on the needed
medication and even harder to keep them on it.

I don't think there's a policy solution for this.

~~~
efa
But wait! I thought it was because the United States was evil. And all other
countries have it figured out!

------
brackin
This is quite a personal story and It's not near this level but I grew up with
a parent with Schizophrenia and still am.

I'm 18 and currently live alone with this parent and am moving out soon as I
work on my company. The situation is fine (for me) because there are few
things to set them off these days and I've just had to learn how to deal with
many of the disturbances. Like paranoia of me (What I talk about to others),
using certain words in relation to illness like saying something is "mental"
or even how are you. The illness only pops up at certain times. People
wouldn't know they are ill from speaking to them, most of the time. It's 10X
better than it was when I was much younger and lived with both of my parents.

I won't go into detail out of respect to my family but their illness has broke
up their marriage (Although sometimes couples don't work) and now they refuse
to take any medicine or see anyone. Because they aren't anymore at the level
that they are forced into treatment there's nothing that can be done.

What I've learned from this is most policy on mental illness is under the
assertion that if the person is at extreme harm to themselves or the public,
they require treatment. If this isn't the case and the person refuses to
believe they are ill or that they need treatment, little is done.

------
brownbat
In a former job, I was confronted with a heartbreaking string of cases of
individuals who are homeless, clearly suffering from mental illness, yet
repeatedly breaking into local businesses, often not to steal anything of
value.

The frustrating choice for those in the prosecutorial or defense systems, is
how to best perform your duty to the public and these individuals.

If you simply release them, the business owners continue to face
victimization. If you send them to jail, you put them in a completely
inappropriate community, and damn them to poor or nonexistent care for complex
problems.

It's not isolated cases, mental health issues took up a significant portion of
our resources in the criminal justice system (a system that, when
overburdened, suffers both Type I and Type II errors simultaneously, leading
to higher rates of hasty convictions while also letting more guilty
individuals walk free).

The best solution I heard, discussed only in chambers with heavy sighs as to
its political infeasibility, was some sort of mental health court, analogous
to a drug court.

Drug courts are designed to take a significant number of cases and prosecute
them more efficiently, while focusing on what reduces recidivism most, and
helps those "offenders" (treatment and monitoring is the general template,
though individual cases can be highly customized, rather than one size fits
all incarceration).

Drug courts don't always work, sometimes they can be systemically flawed. This
American Life presented just such a case a few years ago, describing a judge
who abused the process. But in most jurisdictions, drug courts lower costs to
the system while putting a lot of people in a far better place.

A similar institution, a "mental health court," might feed people from
courtrooms into community treatment facilities, with monitoring and care,
while putting them on probation instead of placing them in jail.

This would, of course, work best with significantly increased funding for
humane and competent mental treatment facilities. But at least some of those
costs would be offset by lower burdens on the justice system and systems of
incarceration.

Such a system would certainly help more people, and it deserves wider public
discussion.

------
lilsunnybee
It's really sad that this isn't a priority in the United States. Somehow we
have so little money for the government to pay for anything, that any possible
solutions are either underfunded or written off completely. Overloaded case
workers, run-down facilities, lack of facilities, lack of integrated programs,
are just a few of the consequences.

It's an odd sort of poverty where all sorts of gadgets and innovations are
commonplace, but where the marginalized in society still suffer through
neglect and lack of funding for any viable solutions.

~~~
efa
How much money would save this man? You going to build him a golden prison to
live in. Schizophrenics hate being medicated. They are miserable. So they go
off their medication and run away. It's not a question of money. Please stop
the "we are so horrible because we don't spend enough money." That's the lazy
minded answer to an extremely complex issue.

~~~
zanny
They are human beings though, so if they chose not to accept help or
medication you can't force it on them. You lose a lot more taking away
individual freedoms over what you deem abnormal or mentally ill than you do
from the suffering making potentially poor life choices.

------
agwa
This says so much about what's broken in our legislative system:

> Six weeks into my legislative career, I was the legislature’s reluctant new
> expert on mental health.

After six weeks, he was _not_ an expert. In nearly all cases, our legislators
are not experts in any of the things which they are legislating, yet that
never stops them from forming strong opinions and trying to "reform" or "fix"
things. On HN, we see this frequently with Internet and technology
legislation, but this article shows it's a problem with other areas, too.

~~~
showerst
I think he was using 'expert' in the sense of 'go-to guy', and maybe a bit
ironically.

~~~
mynameishere
Yeah, he was clearly being sarcastic. Sarcasm is generally a bad rhetorical
device.

------
tokenadult
This is a tough story of a state legislator who became an adoptive father
finding out that policies that he thought were humane reforms didn't end up
helping people in this generation like his adoptive son. Some of my
perspective on these issues comes from knowing Irving Gottesman,

<http://en.wikipedia.org/wiki/Irving_Gottesman>

who was credited as the main adviser on schizophrenia relied on by the author
of the book _A Beautiful Mind._ Gottesman has spent much of his career
researching schizophrenia and debunking former theories about the origin of
schizophrenia. Twin studies, especially studies of the unusual cases of
monozygotic twins reared apart, and adoption studies have consistently shown
that schizophrenia develops from an underlying genetic vulnerability (probably
varying greatly from patient to patient, according to the best evidence from
genome-wide association studies) that makes a patient all too likely to
develop full psychotic symptoms over the course of childhood without careful
treatment. Gottesman's research goal is to define "endophenotypes" that can be
reliably measured clinically to identify patients who need one kind of
preventive or supportive treatment rather than another. But we are nowhere
near identifying endophenotypes for any major mental illness.

"Self-medicating with marijuana, Tim’s drug of choice for lowering the volume
of the voices in his head, got him suspended from the first high school he
attended — a public, vocational-technical school in Middletown, Conn. — and
placed on court-ordered probation." We do know that young people whose family
history suggests genetic risk for major mental illness (which might not be
known for a particular adopted child) are playing with fire if they take
schedule I drugs without medical supervision. Many of the worst outcomes found
in families in which some relatives become mentally ill and some do not are
among the persons who "self-medicate" (that is, abuse drugs) rather than
reduce risk of perturbing their brain chemistry.

"If I were a legislator today, I’d mandate — and provide funding to ensure —
that every teacher receive training in recognizing symptoms of mental
illnesses."

Teacher who are credentialed to teach elementary school receive specific
training in how to teach reading, and receive specific training in how to
teach elementary mathematics, but mostly do a remarkably poor job in those
important tasks anyway. There are not today any reliable lists of early
symptoms of mental illnesses to guide an adult who sees young children as to
who will develop severe mental illness in adulthood. Diagnostic criteria for
psychology and psychiatry are not that well developed yet, and communicating
criteria for best practice to future teachers in schools of education or to
in-service teachers through in-service training programs is already a vexing
problem in reading instruction and mathematics instruction.

"I’d see that pediatricians are trained to make screening for mental health
concerns a regular part of well-child exams."

I think some of that is already done today. At least, my four children
certainly seemed to be asked routine questions in well-child pediatrician
visits that could raise red flags on the basis of certain answers to those
questions. Again, there simply aren't that many effective early screening
tools for mental illness today of any kind. One of the best tools for
identifying people at highest risk for developing mental illness is to know
the complete medical history of their nearest relatives--but that is the
hardest tool to use for some adopted children.

"I’d require school administrators to incorporate recommendations from
pediatricians and mental health professionals into students’ IEPs."

What I hear from parents whose children have IEPs (individual education plans,
under federal law about special education) is that it is often annoyingly
difficult to get a school to follow an IEP, even though that is mandatory by
law. It is the parents's responsibility, in the first instance, to make sure
that all relevant information is provided to the professionals who work with
the parents in drafting the IEP. The parents have to push back if the IEP
isn't drafted helpfully at first, and they have to keep an eye on whether or
not the school implements the IEP.

All in all, this sad story is a good reminder that EVERY parent, and maybe
especially an adoptive parent, needs to be cautious about reducing risk of
future harm for all children in the parent's care. The author's description of
his situation makes his situation sound very rough. He surely hoped that his
son would be living independently and thriving by the son's current adult age.
What I've learned about parenting after two decades is that parenting never
completely ends. Launching a child into self-sufficient adulthood is
wonderful. (I have done that once so far.) But there will always be scary
issues for parents to watch out for that they have to take care of themselves.

AFTER EDIT: Several comments below this comment talk about the risk of drug
abuse for persons who have underlying vulnerabilities to mental illness. I
agree with the suggestion that alcohol (legal for all adults) is surely
dangerous in such cases and perhaps tobacco (also legal for all adults) is
too. But I will remind all readers here that marijuana was specifically
mentioned as the now homeless person's "drug of choice" in the submitted
article, and marijuana alone, plus the genetic vulnerabilities, is enough to
turn some formerly productive young people out on the street unable to support
themselves. (It was probably observations of situations like this decades ago
that helped convince legislators to change marijuana's legal status from
permitted to largely banned. The article submitted here makes the correct
point that sometimes legislation has unintended consequences, and perhaps the
"drug war" is ineffective policy for reducing the harm that mind-altering
drugs cause individuals and society.) Richard Branson has argued that
Portugal's different pattern of regulating drugs has reduced drug use and has
reduced various social harms from drugs that are Schedule I drugs here in the
United States.

But that said, I will stand by my statement "We do know that young people
whose family history suggests genetic risk for major mental illness (which
might not be known for a particular adopted child) are playing with fire if
they take schedule I drugs without medical supervision. Many of the worst
outcomes found in families in which some relatives become mentally ill and
some do not are among the persons who "self-medicate" (that is, abuse drugs)
rather than reduce risk of perturbing their brain chemistry" because it is a
factually correct statement. I don't know of any physician who regularly
treats psychotic patients in emergency rooms who recommends that young people
with family history medical risk for psychosis use marijuana. That is a
distinctly bad idea.

ONE MORE EDIT:

I shared the article submitted here among my Facebook friends, and one
thoughtful friend suggested the article, from the same newspaper in 2005,
"Social Network's Healing Power Is Borne Out in Poorer Nations"

[http://www.washingtonpost.com/wp-
dyn/content/article/2005/06...](http://www.washingtonpost.com/wp-
dyn/content/article/2005/06/26/AR2005062601091.html)

as an interesting contrast to the situation described in today's article.
There is some good back and forth among experts on schizophrenia in different
countries in the previous article. Diseases influencing human behavior often
manifest differently in different cultures.

~~~
erichocean
_We do know that young people whose family history suggests genetic risk for
major mental illness (which might not be known for a particular adopted child)
are playing with fire if they take schedule I drugs without medical
supervision._

That marijuana is classified as a "schedule I drug" is, itself, obscene and a
result of politics, not science.

Therefore, the rest of your suggestion regarding them "playing with fire" does
not apply in this instance.

~~~
lysol
It's still a major mood and behavior alterer. A trained professional should be
directing the patient's use.

~~~
jlgreco
Certainly it, and _any_ other drug or medication, should be taken with care in
this particular situation. "Schedule I" has _nothing_ to do with it though.

------
acroyear
Author's first impulse is to look to the state for the care of his child.
WRONG!!!! YOU and your family are the primary folks responsible for this kid.
Your wife had about the same chance of success as any set of teachers or state
gov't goons but with much more incentives. What the hell was she doing?
(probably getting her 'career' on - woo hoo!)

Why are ppl so apt to think that state employees are miracle workers? Central
command/control and one-size-fits-all solutions (or any approximation thereof)
are bound to fail for most of us who have special needs.

~~~
jessaustin
I'd speculate that anyone "political" enough to be elected to the legislature
at the tender age of 25 will never be able to step outside the mentally-
crippling assumptions of the total-services state. Note the unrecognized
contradiction between "the state should provide this service and provide it
well" and "when I was in charge of things for the state, the LAST thing I or
any of my colleagues cared about was providing this service".

~~~
acroyear
exactly; he's just a bloke like you and I - not some super-helper-expert-
because-i-work-for-the-state guy.

I'm not saying we shouldn't expect any return for our tax dollars; but
certainly not as the primary source of help (read 'assistance'). also, perhaps
the problem shouldn't go after our tax dollars in the first place .. it's a
warm/fuzzy idea to 'help', but you're taking my dollars and supposing a
solution to which you have no idea what you're doing. stop it please ;)

------
SoftwareMaven
I have a very dear loved one who suffers from schizophrenia. I've seen
firsthand how useless the system is. Before a diagnosis, everybody (schools,
friends, etc) are judging the parents because their child doesn't fit into
"norms". After a diagnosis, they have no idea how to handle it, so things
don't get better.

We pushed everybody out of state hospitals (which were _horrible_ places) but
never really answered the question of where those people need to go.

Fortunately, my loved one's disease is being well treated at the moment. I
constantly fear the day that a serious psychotic event occurs, especially if
it occurs after she moves out of her parents house (which, like most
teenagers, she really wants to do).

------
cathar
As someone who was diagnosed with Schizophrenia, had several bouts of
psychosis, and settled into BiPolar disorder without the psychosis, I can
speak on this subject a bit. As a kid I exhibited the typical, thinking fast
and trying to talk just as fast. My first major manic episode I recall was
while studying for a midterm, where instead I had inspiration and handwrote a
8 page business plan. After my my first psychotic break, a year later I spent
all night down the rabbit hole of importing raincoats from China. I showed no
Schizophrenic symptoms until a major psychotic break that triggered my
underlying proclivity towards Schizophrenia, partially by roadtripping to a
new place and excessively smoking marijuana. I ended up in an out-of-state
hospital for several days before transferring to a local one. My family
thankfully had insurance, but the profit-driven company battled with us to
deny paying for that expensive out-of-state care and treatment, thankfully
they paid. I couldn't get non-group insurance until insurance companies could
not as easily deny you coverage for pre-existing conditions.

Before that event I had genuinely enjoying smoking for nearly 2 years in
college with no paranoia. Uncharacteristically, I got into minor legal trouble
thanks to a dumb, drunken night. The day my probation ended I lit it up again,
leading to a mild psychotic episode with friends who were freaked out. That
was the end of marijuana for me. Never tempted to touch it again as I know
that is seriously playing with fire given my tendencies. I've had one other
paranoia-fueled episode where I went off my medications because I didn't like
the side effects. I somehow got tangled with a local urban gang, after they
broke into my house and stole my roommate's golf clubs and spotted my
expensive studio equipment only to stake the place out for another burglary. I
avoided hospitalization with the help of close family this time.

 _The_ biggest thing for people with BiPolar or Schizophrenics is to stay on
their medication. It's a very tragic feedback loop, you feel good or normal so
you go off your meds. Then you are OK for a while, then you are nearing a
nervous breakdown, manic episodes (which are really fun for most people),
paranoia, or deep depressive episode (which is why so very many BiPolar people
commit suicide). Every time I went off my medication, a break down was near,
and you had to basically hit the "reset button" on your life again. Start a
new job, new location, try again. This time, you pledge to stay on your
medication, your family reminds you as well. Things can stabilize when you get
on the right medication with the lowest effective dosage, get regular sleep
and exercise. I am stable now, with the help of family, friends, low dosage
medication, and exercise. (In that order)

------
guylhem
Title "The ‘reforms’ that I worked for have worsened his life" - That's
interesting. Let's read further.

Extract : _The 1980s was the decade when many of the state’s large mental
hospitals were emptied (...) I jumped at the opportunity to move people out of
"those places" (...) to help manage the transition of people back into the
community

(...)

When he was in jail, with its regular routines and meals, Tim usually
stabilized. But when he was released (...) he destabilized right away_

Ok, we get your point.

But they why giving in conclusion the idea that more money thrown at a problem
that seems intractable could solve it??? [Extract: _I’d require school
administrators (..) I’d put much more money (...) I’d get rid of laws (...)_ ]

This begs the question : was it considered only once that maybe "humane
reforms" had been pushed too far, and that the best outcome would have been
reached in a place with " regular routines and meals" where stabilization
could have been provided- in other words a good old hospital.

Maybe in the past there were many people in that shouldn't have been there,
and the "humane reforms" were then a good idea. But maybe we overdid them and
now we make people worse, based on our own idea that people suffering from
schizophrenia would be better outside the hospital.

Extract again from the post : "His only furniture was a bare mattress on the
floor; a rat and flies were his companions. Sadly, he seemed content. This is
the mental health delivery system that I helped build".

Yes the author did, since he considered a patient own evaluation of his
situation to be perfectly valid and not in any way damaged by his disease.

It is usually better to respect a person will, self evaluation, etc. But
maybe, just like for suicide, when the best judgement seems to no longer work,
it is a good thing to ignore it until it can be fixed - if it can.

------
dennish00a
I don't believe that the author thought he was doing the right thing as a
legislator! I think he was trying to save the state some money, without
thinking carefully about how those savings would impact people's lives. As you
sow...

------
pessimizer
The word "reforms" in this article, and in recent political parlance, is being
used as a euphemism for "cuts."

It seems inevitable that euthanizing a long neglected mental health system
could lead to further difficulty amongst the mentally ill and the people who
have to live around them and/or love them. It must seem shocking that any bad
outcomes could ever come out of "reforms."

As a person who was alive in the US when all of the crazies were thrown out
into the street without a net in preparation for their future
jail/homeless/jail/homeless/dead therapeutic cycle, I'd like to add that more
than this guy's son was screwed by Reagan.

------
chris123
The path to hell is paged with good intentions, in this case by young, well-
meaning, but unqualified and overly-ambitious people who like the sound of
their own voices and think they know what is best for others, but come to
realize 25 years later that they really fucked things up for a lot of people
they were supposed to be helping (guys, you are supposed to be helping the
99%, not the 1%). Better late than never, but what's he going to do beyond
write an article to make himself feel better. Nothing, probably (that's a
challenge to the author, if he's even here).

------
woodchuck64
Timothy D. Wilson's "Redirect" is relevant here and shows that a significant
number of treatments for all manner of childhood and young adult issues skip
one crucial yet obvious step: simple scientific testing. Instead, "common
sense" often ends up the preferred approach to treating problem children,
usually making the problem worse.

[http://www.amazon.com/Redirect-Surprising-Science-
Psychologi...](http://www.amazon.com/Redirect-Surprising-Science-
Psychological-Change/dp/0316051888)

------
chernevik
The problem isn't the particular reforms, it is the idea that any reform could
evoke the needed individualization from centrally planned institutions.

My heart aches to think of the hell this man is in, and that his father is in
watching him. I have worked with people in this condition, it is
heartbreaking. I get the screaming urgency to do SOMETHING.

But if that something doesn't make sense it just isn't going to work.

------
zanny
Nobody brought this up (what?) but how is this relevant to.. _hacker_ news? I
get that someone on here might be schizophrenic, but is this really on topic
with startups, software, etc? If I want to get sad over incurable mental
illness I'll go read r/politics or atheism (oioioi).

~~~
ignignokt
Maybe it's useful because you might hire staff or have co-workers who happen
to have a mental illness and being informed about it is a good thing?

------
cwisecarver
It was a very interesting article and I really enjoyed reading it but why is
it on Hacker News?

~~~
DanBC
Ideally politics of healthcare are avoided, and then people can provide
information about how this stuff is handled in other countries, or discuss
better systems.

You have a flow of 'patients' through a system. You also have a flow of
information about those 'patients'. Some people need access to (some of) that
information (doctors, the patients, their carers) but the information needs to
be kept private from others.

Already there's an interesting problem that plays to the strength of many
people on HN.

Given that health care spending is so large - about £120bn in the UK[1], about
$800bn US[2] - it would seem that big money is available for a good solution
to these problems.

There are people doing interesting things in health care IT. But I don't know
what a minimum viable product looks like when you're aiming at over 60 million
records (UK population) or 300 million records (US population).

[1]
([http://www.ukpublicspending.co.uk/uk_health_care_budget_2009...](http://www.ukpublicspending.co.uk/uk_health_care_budget_2009_1.html))

[2] (<http://www.usfederalbudget.us/health_care_budget_2012_1.html>)

------
stretchwithme
My sympathies. My brother has this condition. His is manageable, thank
goodness, but he went through a lot early on.

Charlie Rose had an interesting program about this topic and its biological
causes:

    
    
      http://www.charlierose.com/view/interview/12269

------
frozenport
Why does he let his schizophrenic son lives as a homeless man on the street?

------
TeMPOraL
Thank you OP for linking to print version, it's much better for reading.

