The entire mental health field continues to reel from the tragic, untimely death of Wayne Fenton, MD. Wayne was a very sought after psychiatrist in the Washington, D.C., area, with a national reputation as an accomplished schizophrenia researcher and clinician. He served as the associate director for clinical affairs for the National Institute of Mental Health, and he conducted a private practice nearby for consumers with schizophrenia for whom routine care did not work. He had a wonderful wife and four loving children just reaching adulthood. In his free time, he greatly enjoyed playing the guitar and attending movie openings. He always was willing to help anyone.
On September 3, Wayne was killed by a 19-year-old consumer, Vitali Davydov, whose family had brought him for care on a referral from another psychiatrist. According to reports, Vitali suffers from both schizophrenia and bipolar disorder. He was referred to Wayne so that he could begin a new medication regimen. Vitali is a twin. In high school, he was an avid ice hockey player. His family cares about him.
This tragic incident has caused me to think about all teenagers in the early stages of schizophrenia and/or bipolar disorder. My conclusion is that we don't do a very effective job addressing their problems. Schizophrenia is a very nasty disease that can be extremely difficult to treat. Sometimes the medications used to treat schizophrenia do not work as expected; other times, they can have unacceptable side effects. Bipolar disorder is frequently misdiagnosed.
Our difficulties are compounded further because we have not developed effective outreach to families, schools, workplaces, peer groups, and our own providers. Let me explain:
Families always are concerned, but they usually don't know what to do.
When confronted with a child just beginning to experience mental health difficulties, such as schizophrenia, most families have no idea how to address these problems. This lack of knowledge is not their fault. The National Alliance on Mental Illness (NAMI) has recognized this issue and has prepared training courses and materials for families. Some families have prepared materials based on their personal experiences to help others. However, I suspect that a family in the early phase of this crisis would not know about or be able to access these materials.
Teachers are reluctant to intervene.
Discussion with teachers indicates that although many have a good sense of the personal problems their students experience, they are often reluctant to intervene. This can be because they do not believe that the school has adequate resources to address the problem, or as a result of concern about the reaction of a principal or other faculty member if they bring a problem forward. As a result, most problems are not identified until they are very severe, usually in conjunction with some behavioral problem in the classroom. Clearly, we have not fostered an effective dynamic in schools for intervention in the early phases of a problem.
Workplaces are even more reluctant to intervene.
Most late teens or early adults have low-paying jobs in service industries. Because turnover is so great, most of these job sites prefer to have the person leave the job rather than to identify problems. If problems are identified, then the company can become liable for higher insurance or workers’ compensation payments.
Peers may discuss the problem, but they may be afraid to identify the problem to adults.
Teen peers are usually excellent barometers of the emotional tenor of their friends, but they usually don't discuss these topics with adults, especially their own parents or teachers. They actually may try to help their friends, but they generally lack the knowledge for effective advice.
Mental health systems are not configured for early intervention.
Most local mental health systems identify consumers through walk-ins and referrals. They usually do not reach out to identify early-onset consumers, and they now are just beginning to work with schools. They are also very ill equipped to help with advance directives or medical power of attorney, which could help address care problems in the transition from the teenage years to adulthood.
Having known Wayne for a very long time as both a colleague and friend, I am sure that he would want us to continue to solve the riddles of schizophrenia and bipolar disorder, and he would want us to address our difficulties with treatment and outreach. That is the kind of person Wayne was.
Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board.