What is the most important factor in treating mental illness? Competence.

It’s been nine years this week since my late husband David died by suicide. Everything about this time of year releases a cascade of emotion that is unbearable, the softening of the light, the gold and amber in the leaves, the heat during the day dissipating to cold nights. There is a vivid memory of David’s state of mind, a cold, agitated horror at his state of being. Even breathing seemed to be an effort that exhausted him.

At a time when we needed the very best care we could get, we experienced a system that retraumatized David to the point of hopelessness. An initial misdiagnosis, a prescription that pushed David over into a state of akathisia and suicidality, a lockup care center whose contracted doctors made money– not by helping people– but by admitting as many patients as they could squeeze into a bland and hopeless enclosure. We knew it was oppressive when we were in it, but, in insight, it was also a shameful failure of care.

Currently, there is no standard of education for a diagnosis. Many people treat depression, including family practitioners and social workers, and the varying degree of competence is maddening for families who are desperate for quality care. Families seeking help find professional camps divided between psychopharmacology and psychotherapy. And often, medications compound the suffering. Caught in the middle, patients are dying.

This year marks the tenth consecutive year our nation’s suicide rate has increased while outcomes for heart disease, diabetes, and cancer are improving. Half of those who died by suicide were under the care of a general practitioner. One-third of those who died by suicide were under the care of a psychiatrist. As one doctor told me, “It’s time to put the head back on the body.”

We demand excellent outcomes for every other major disease. We track success rates for heart surgeons. We compare and contrast survival rates for cancers. Why has the treatment of mental illness in our country been so lacking that many inpatient psychiatric centers don’t even bother tracking the outcome of their patients? David’s doctors didn’t realize he’d killed himself just one day after his release!

We could be saving lives by coordinating patient care- sharing essential treatment information, scheduling and tracking referrals, and providing proper follow-up care. With today’s technological advances, a fully coordinated system of care is possible, and is even being practices in some parts of the country with very good outcomes.

I’m just one survivor. But for every death by suicide, the National Institute for Mental Health suggests eight people are profoundly affected. Last year, 41,000 Americans died by suicide. The toll of grief, confusion and chaos impacts hundreds and thousands of people every year.

What is the most important factor in treating mental illness? Competence. We should demand it.

Dear Grandma, Here’s Why I Missed My Partner’s Mental Illness.

A reader of my book, ‘All The Things We Never Knew’  suggested it would be impossible to be married to someone for ten years and not realize that they had a mental illness:

Dear Grandma in Arizona,

I’d like to give you some insight into my experience of loving someone with a mental illness. Contrary to what Dr. Phil has said, most people who experience mental illness don’t  “howl at the moon.” The early behaviors of mental illness are elusive, intermittent and commonly misunderstood.

Have you ever felt rage and not understood it? Have you distanced yourself from others? Have you been sensitive to light and sound? Eaten too much or too little?  Have you felt as if you don’t belong? Have your thoughts been slow and depressed or fast and racy? Have you been uninterested or unable to complete a task you know you need to do? Have you ever lost hope?

Maybe you have a few weeks or a few months when you feel better. You try to reconnect, you promise you’ll be a better person. You laugh. And then, your brain goes dark again. You cheat and you lie, denying these recurring depressions are happening, even as the symptoms are occurring with more frequency and more severity.  Your family and friends are frightened, confused and unsure of  how to help. You blame your behaviors on your partner, or your job, or your parents.  As you self-stigmatize and withdraw, you are getting sicker and sicker.

Now, throw in a few traumas. The death of your father. The crumbling of your business. The pending separation of your life’s partner. Boom. All of those methods you used to compensate are gone. Then, a well-meaning doctor gives you an anti-depressant, and suddenly, you are thrown into mania and Akasithisa, an agitated, skin-crawling, can’t sleep state that induces suicidal thoughts.

Then, you find a gun.

Now, you are hospitalized against your will.  A nurse who doesn’t know your name takes your clothes and personal belongings. A doctor who has only fifteen minutes a day for you prescribes more drugs, and when those don’t work, different drugs to counteract the side-effects. You are a threat. And hopeless. You lie about your state of mind to get out of the hospital.  To be free of it all.

This is my experience of my partner’s illness, but in conversations with hundreds of other family members who have cared for someone with a brain illness, there is a shared sense of confusion, guilt, and even denial. It helped me immensely to hear from a primary care physician who shared just how difficult it is to detect and treat bipolar illness.

Recognizing the early signs of mental illness is difficult, but even trickier is getting good care. If our  mental health and medical systems are not changed to stop re-traumatizing people in crisis, our rate of mental illness will continue to climb. If we don’t do a better job of recognizing the sometimes elusive symptoms of mental illness (especially in high-functioning people), our rate of suicide will continue to climb.

That’s why I wrote, All The Things We Never Knew. I laid bare my mistakes in an effort to try to help others recognize mental illness and intervene earlier than I did.  I worked very hard to compile resources for others and investigate the programs and people who are giving people hope. We must believe in the tenants of recovery. It will take a tectonic shift in the way we deliver care.

Grandma, I hope this has given you a bit more understanding and empathy of my story and the stories of others. I wish you and your family only good health and happiness.

With kind regards,

Sheila Hamilton

All The Things We Never Knew is available here:



Mass Shootings: It is a mental health problem. And it’s a gun problem.

A reporter wrote me the other day asking for a quote in the wake of the Roseburg shooting. She wanted to talk about how mental illness is being stigmatized by the NRA.

“Is it a gun problem,”  she asked, “Or a mental health problem?”

“It’s not either, or.” I answered. “It’s both.”

In Roseburg, in Springfield, in Denver, in Newtown, in a dozen or so fill-in-the-blank shootings in our country, the male shooter also had a serious mental illness.  James Holmes, Adam Lanza, Kip Kinkel, Seung-Hui Cho, Jiverly Wong, Major Nidal Hasan, Jared Laughner-ALL of these shooters had a psychiatric disorder, many of them were under the care of a psychiatrist.

Christopher Harper-Mercer, who killed nine people and wounded nine others at a rural community college in Oregon had been discharged from the Army after attempting to commit suicide, according to the Wall Street Journal and law-enforcement officials familiar with the case.

Yet, the mental health community argues, “This is not our problem,” and the public is left shaking its head.

Instead, health providers could be saying, “Yes, there is a tiny fraction of seriously disturbed young males who commit mass violence. We’d be happy to take a portion of Homeland Security funding and attempt to help!”

The NRA loves the diversion. It doesn’t actually support more funding for mental health programs and neither do the politicians who point the finger of blame at mental health providers. So, let’s be blunt: These deeply troubled men would have remained unknown to most of us, except that, they got access to a weapon, or two, or fifteen.

Meanwhile, some common sense advice doesn’t get said: If you are aware that your son, brother, or father is one of the fraction of disturbed young men who might be capable of committing an act of mass violence, hide or take away their guns. If you don’t know what a mass killer looks like, here’s a sample of the most relevant risk factors from a 2001 study of 33 mass killers: a. loner status b. substance abuse problem c. preoccupations with weapons d. victim of bullying  and e., lastly, a psychiatric history.  These risk factors are heightened by violent or aggressive behavior.  If you just said, “check, check, check” to that list, and your kid or brother or dad has access to weapons and ammunition, you’ve got a responsibility to get involved NOW.

A reader wrote me recently to say, “My son is just like the other shooters. He’s on meds. He stays in the basement all day, complaining of having no friends. He is obsessed with his guns. He plays violent video games all day long. He’s verbally abusive. I’m scared of him. What do I do?” It’s as if people are waiting for the government to wave a magic wand and help them navigate the most precarious and potentially deadly territory.

First, take the guns out of your household. It’s your home. If a friend or young adult fits this category, talk to them about their reasons for stockpiling weapons. You may be able to detect a plan they are only now sharing with the darknet. You are, sadly, the front line of defense. Call it  “a temporary gun restraining program because I love you and you’ve shown intent.” Second, attempt to get some help. Your county mental health services is the best place to begin. And for support for yourself, please learn more about NAMI.

Mental health advocates are accurate. The vast majority of people with a mental health problem will not commit an act of violence, in fact, statistically, they are much more likely to become a victim of violence or hurt themselves than the general population. But, we cannot deny that a tiny fraction of people who also happen to have a mental illness are causing a ton of heartache in our country. Nor, can we deny that if those people hadn’t had access to guns, they would not have been capable of massive slaughters.

Nobody’s coming for your guns, but it’s time to re-evaluate how accessible they are to others.

Win a chance to have your book club meet with Sheila

Sheila Hamilton’s new book “All The Things We Never Knew” is launching at Powell’s on October 20th, and you could win a chance to have your book club meet with Sheila at the Skype Live Studio during the week of November 2nd.

Five winners and their entire book club will be chosen to visit with Sheila over the week of November 2nd. To enter, simply open your KINK app, available on Apple and Android. Coffee and pastries by Beaverton Bakery will be provided. Find out more →

Sponsored by Cascadia Behavioral Healthcare

The mission of Cascadia Behavioral Healthcare is to provide healing, homes and hope for people living with mental health and addiction challenges.

Buy “All the Things We Never Knew” on Amazon.

An Open Letter to Responsible Gun Owners

I was one of the television reporters on the scene of Oregon’s first mass shooting, May 21, 1998. When Kip Kinkel opened fire in a lunchroom full of his fellow classmates, many of the students thought the sounds of gunfire was a joke or they would have ducked for cover sooner.
I’ll never forget the ashen faces of young people standing in shocked silence outside the police line, dressed in the uniform of youth, jeans, t-shirts, hoodies. Two of the girls I interviewed still had blood spatters on their tops.

Kinkel, who’d also murdered his parents the night before, loaded and unloaded the three weapons he’d brought with him, a .22 caliber rifle, a .22 caliber handgun and a 9mm Glock automatic pistol. “He just kept shooting,” one of the girls said. “The sound is still ringing in my ears.”
By the time Kinkel was finished, two were dead, twenty-five students were seriously wounded. “Jake finally stopped him,” the student told me. “After Kip shot Jake, Jake must have thought, what the hell, we’re all going to die anyway.” The girl pushed her shoe in the mud.

I thought I’d witnessed the worst trauma our state could endure. Not even close. In October, nine  people were killed and seven more seriously wounded in another campus horror. It’s the 296th mass shooting in America in 274 days. Columbine followed Springfield, Virginia Tech followed Columbine, Sandy Hook followed the Colorado theater shooting. Keeping track of the horror is a mind-boggling exercise.

When you read the descriptions of the history of mass shooters in America, you recognize one thing immediately. They are all male. They are young when they shoot up schools and middle-aged when they shoot up their offices. They are obsessed by guns and in various states of psychological unraveling. They are described as loners, and they are often known to their friends and families as being “in trouble.”

Access to mental health treatment in America is like running the gauntlet of the worst kind of bureaucracy. Services are fractured. There are far too few psychologists and psychiatrists, especially in rural areas, where mass shootings tend to occur more frequently. Treatment is often prescribed in the form of anti-depressants, which can induce mania and ideation in young people.

And yet, access to guns is easy. It’s as simple as buying on the internet or buying from a gun show dealer who is exempted from conducting a private background check. Angry callers on talk radio shouted, “If only we allowed all students to be armed.” They maintain that the mass shooting problem will be solved with more guns. There are 310 million guns in America and 11. 1 million people carry a concealed weapon legally. Yet, the number of mass shootings stopped by an armed civilian in the past thirty years is one, a documented account of an Uber driver who stopped a passenger from opening fire on a crowd in Chicago. http://www.businessinsider.com/uber-driver-with-concealed-handgun-prevents-mass-shooting-in-chicago-2015-4

The other numerous events sent to me for review are not verifiable.

Owning a gun has been linked to higher risks of homicide, suicide and accidental death by gun. For every time a gun is used in self-defense, there are 7 assaults or murders, 11 suicide attempts, and 4 accidents involving guns in or around the home. These are not made up statistics. The Centers for Disease Control is non-biased, evidence-based and gathers data only from verified sources.

Responsible gun owners, what is your solution? You must look at these mass shootings with the same concern for your children that I have for mine. Can we have a real conversation about gun violence in America? Could we at least agree that the parents of deeply troubled young men shouldn’t be buying more guns to fuel the obsession? Could we agree on safer storage methods? No? What then? Is there a dialogue we can have and change we can make that doesn’t end in more violence?

Four years ago, my daughter and I were talking about terrorism and the various measures America had taken to make itself safer. “I’m not afraid of terrorism,” she said, looking out the window. “I’m afraid of being shot at school.”