Underlying Factor in Mental Health
CUOMO: Welcome back to NEW DAY. This morning, authorities are still piecing together what made an Army specialist open fire at Fort Hood on his fighting brothers. But, once again, mental health is being mentioned as a factor, and rightly so. Joining us now is Dr. Michael Welner. He's a forensic psychiatrist. He testified yesterday in front of Congress about Representative Tim Murphy's mental health overhaul. It's great to have you, doc, as always. We had the representative on making the case for the bill. He says now is the time. Even though there's no silver lining in a tragedy like this, the timing does come when you're holding the hearing for this bill. You say we need change. What change do we need and why?</s>DR. MICHAEL WELNER, FORENSIC PSYCHIATRIST: Sure. Sure. I think part of what's happening in - over the course of a number of months, and this really started and came into focus with the Newtown catastrophe, is that there's some element of psychiatry and mental health -- crisis mental health. It's independent of diagnosis because it may relate to someone who has a personality disorder, who's got a character disorder. What is a crisis? It's a person who contemplates violence, like the person at Fort Hood. But it's also the person who's a repeated batterer. If you're a battered woman, you know that if your husband were to go in front of a mental health professional, he could give the appearance of not being dangerous. He could give the appearance for which services would not be committed or put upon him, but he'll never get help. So when you have a batterer and you have an abuser and you have someone with a substance abuse problem who's dragging an entire family down the drain and you have someone with command hallucinations who keeps them silent and someone who's contemplating violence, our threshold in the law that says you have to be a danger to yourself or others, it binds mental health professionals. And it's not something that relates to people with psychiatric illness per say, but it relates to those who have no insight into their problems, who deny that they have a problem and who are so destructive to the people around them. So you can build it, you can have a great mental health system, but if you have people who reject it and who say psychiatry, stay away from me, I'm going to create a crack that I will crawl into, you have to have a system of crisis psychiatry. I think Congressman Murphy's bill is so groundbreaking and has such great foresight to tackle this kind of problem, which relates to Fort Hood because he saw what he was going to do and he made sure nobody found out about it until it was done.</s>CUOMO: So you're not surprised the review a month before by a psychiatrist revealed that he wasn't a danger to any -- you're not surprised to hear this psychiatrist interviewed him a month ago and said, he's not a threat?</s>WELNER: I'm not surprised. You know what's most compelling to me about this story, hearing it, is that his wife apparently didn't see it coming. We're used to talking about people who are isolated and not connected. So he - here he had a wife and he had a small child. He had the selfishness -- let's make this clear -- he had the selfishness to burden his little girl for the rest of her life with everybody knowing, your daddy killed all the people around him. And so he made an incredibly unusual and selfish choice, and yet his wife didn't see it coming. So he was able to keep his own counsel, it mattered that much to him, which to me goes to the heart of the motive and that will be a very important thing to get to because -- because for a person who's suffering and really declining with PTSD, with depression, what I'm picking up from what the military is saying is, his mental illness was ambiguous. Was it a character disorder, that he might have been on the cusp of being discharged and losing his military career? Because PTSD is so dramatic. And we have a legacy of many wars and PTSD. We don't see veterans cannibalizing each other. So what's different about this person's illness, whatever it is? And so the ambiguity of his illness relates very much to the privacy of his motive and his agenda for being destructive.</s>CUOMO: Now, unlike the situation that we hear now, if you take the wife at her word, is that ordinarily you have a family and they're like, oh, this -- this kid, this person, they're a problem, they're going to do something but we can't get them any help. There are no services. We can't force them to get help. And -- or you'll have an institution saying, well, we can't really tell anybody about the treatment we just gave this person because of the HIPAA laws, the privacy laws. You're saying, both of those situations need to change and this bill can do that. Why do they need to change?</s>WELNER: Absolutely. Absolutely.</s>CUOMO: Because the pushback is -- you're well aware of this but for you at home -- the pushback is, you can't force me to have treatment. First of all, it violates my rights and it will have a chilling effect on me wanting to seek treatment if I think I might be forced into it. And privacy is so important. You can't disclose my information, you may burden my job, you may burden my life. You say that it still needs to change.</s>WELNER: I think we need to see this as crisis psychiatry and not psychiatry. Crisis is different. National security crisis is different. A fire is different. A medical crisis is different and a psychiatric crisis is different. The idea that a person is not going to seek treatment if they're put in a situation where they're ordered by a court to say, you have to get treatment, the reason it got that place in the first -- the reason it got there in the first place is because we were dealing with someone who was never going to get treatment. And again I would ask you, if we had the ability to take a person who was sitting in his room all day and doing nothing but sitting on a computer and not bothering anybody and with a lot of violent fantasies but no violent history and not hallucinating, would we force that person into treatment? Maybe not. But if his mother came to us and said, I'm Nancy Lanza and I think that my son is very disturbed and I'm frightened and this is what I see, would a bill like this, like what Murphy is doing, enable us to say, look, you need to go into treatment because we see something coming. There's a crisis there. That is what this bill is meant to do.</s>CUOMO: And you believe it's ethical and fair?</s>WELNER: I think that when a crisis situation happens, we have to manage it exceptionally. And -- and, if family is expected to pick up the pieces when someone falls apart. When someone is in the hospital and they're discharged very quickly because of length of stay requirements, family deserves to get some guidance from the clinician, hey, here is what you can do to help keep your loved one stitched together. And for those who are concerned about your -- their privacy, hey, obviously I respect it. I'm a physician and I have to respect that as well. But, at the same time, if your caregivers support you, pay for you, pick up the pieces, you have responsibilities to your illness and denial is not one of them. Denial never solved substance abuse and those substance abuse specialists recognize that you have to massively confront the denial. And denial never solved cancer. Denial never solved medical illnesses. I think we have to look at psychiatry in the same way, but we look at it differently because sometimes a crisis generates into a public safety issue and that's what makes psychiatry different from other medical specialties. You can't let the illness run the treatment. When you let the illness run the treatment, you get Adam Lanzas. Maybe this person fits into that. You get the mother who drives her car into the ocean with the babies who was just discharged and the sister can't find out information and of course she cares and of course she's picking up the pieces. This is why absolutely rights, but public safety defines the barrier. We've already established that with terrorism. There is no reason why, when we lose more people in a Newtown than we do in a terrorist attack, that we should not look at crisis psychiatry as a homeland security issue. I think Congressman Murphy's bill is brilliant. I think your viewers should call their congressmen and say, you must support this bill, 3717, because we actually have a chance to change something and make it different so we can go back to talking about the budget on the morning news.</s>CUOMO: And you're not saying it as a politician, you're saying it as a clinician, a physician and a psychiatrist who understands the system and you're behind it. That's why we're covering it, because we want to make sure that we do everything we can to not keep repeating this cycle.</s>WELNER: Absolutely. I've read this bill. I've contributed to parts of it. I've been critical of how it needs to be refined. This is a bill that's been put together by someone who's not just a congressman, but a psychologist.</s>WELNER: And so it's had a tremendous amount of mental health sensitivity and patient centeredness. People need services. They're not always going to come to psychiatry to get them. We need to bring the services and integrate law enforcement and corrections because so many people who need mental health services are in jails.</s>CUOMO: We're going to watch the bill. We'll see what happens with the debate. Thank you so much, doctor.</s>WELNER: Thank you.</s>CUOMO: Appreciate it. And thank you for testifying.</s>WELNER: Thank you.</s>CUOMO: Kate.</s>BOLDUAN: Turn now to this week's CNN's hero. California's Chula County supplies some of the nation's largest grocery chains. But many of the people who work the crops can't always afford the food around them. Sarah Ramirez found a way to change that. Take a look.</s>SARAH RAMIREZ, CNN HERO OF THE WEEK: Pixley is a small community located in the central part of California. We are in this agriculturally rich area and yet people who live here and work here are hungry, are impoverished. Some are working in the fields that feed the entire country and then they don't have resources to put them in their homes. It's heartbreaking. What we do is we glean mostly from backyards. Today we're looking at a glean of about 6,400 pounds. That's incredible. Looking at these issues of poverty and obesity, we were trying to figure out how do we provide our resources for our community and our home? We also have a component in our garden that's a "you pick" area. If your household needs some fruits and vegetables. We really try to teach how to use what we're growing.</s>UNIDENTIFIED FEMALE: Wow.</s>RAMIREZ: I want to grow old and I want to grow old in a healthy way, and I want that for everybody.</s>UNIDENTIFIED FEMALE: Thank you.</s>BOLDUAN: Go to CNNheroes.com to nominate someone you think deserves to be recognized just like Sarah. Coming up next on NEW DAY, the late night landscape is about to undergo a seismic shift. David Letterman announcing he's retiring. How he broke the news. And of course the question, who's possibly going to replace him?