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The Dangers of Stage 4 Thinking about Serious Mental Illnesses

By Paul Gionfriddo, President/CEO

During my first hundred days at Mental Health America, I have frequently made the case that mental health policymakers and practitioners are too often mired in “Stage 4” thinking when they think about serious mental illnesses.

Here’s what I mean – they use an “imminent danger to self or others” as a standard for determining who gets care.  That near-death time typically only comes during the latest stages of a chronic disease process, or Stage 4.

There are several dangers in using such a standard.  The first is that it furthers the myth that mental illness causes violence.  The second is that it leads to the over-incarceration of people with mental illnesses.  The third – and perhaps most dangerous – is that it deflects our attention away from intervening early in the disease process, when we can do the most good and get the best results.

We don’t treat any other chronic diseases this way.  Imagine the outcry if we waited until Stage 4 to treat cancers, cardiovascular diseases, or diabetes!

I haven’t come across anyone who thinks there’s a clinical basis for using the “imminent danger to self or others standard” to determine eligibility for care.  But this hasn’t stopped us from using it for decades.

Until we take a different approach and move upstream in the disease process, we’re going to continue to put our resources in all the wrong places, and we’re going to continue to fight about all the wrong things.  And people will still cycle between homelessness and hospitalization, outpatient treatment and incarceration, and crisis and stability.

At Mental Health America, we believe that it is past time for investing heavily in early identification and intervention.  That’s one of the reasons we launched a new mental health screening program this year, with screening tools available on our website or at www.mhascreening.org.

And we’re pretty sure that people agree with us.  After all, in just four months, the first 100,000 screens will have been taken, typically by people who are experiencing early symptoms of what may become over time severe depression, anxiety, or bipolar disorder.

They’re concerned about their mental health now, and so are we.

And they don’t want to wait ten years or more, and be forced to progress to Stage 4, for everyone else to take notice.

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Kubuś Puchatek (ang. Winnie-the-Pooh) – figura z
literatury dziecinnej stworzona poprzez brytyjskiego pisarza A.A.
Milne’a.

W pierwszej książce o Kubusiu Puchatku podkablowanej 14 października 1926 roku pojawiły się takie kreacje gdy:
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Książki Milne’a:

Kubuś Puchatek (Winnie-the-Pooh; pierwotne oddanie w 1926, 1938 w Polsce)
Chatka Puchatka (The House at Pooh Corner; zwierzchnie przekazanie w 1928, 1938 w Polsce)
Wiersze dla Krzysia (When We Were Very Young, Now We Are Six; dziewicze przekazania w 1924 oraz 1927, w Polsce 1957; publikacja w
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Pochodzenie imiona

Podobnie gdy oraz wiele innych form z publikacyj Milne’a, Kubuś Puchatek pozostawał wymieniony imieniem
jednej z zabawek Christophera Robina Milne’a (1920-1996), syna pisarza.
Z kolumn pluszowa zabawka Christophera zostawała nazwana
tak od imiona niedźwiedzicy Winnipeg będącej ostrą maskotką kanadyjskiego wojska z
Korpusu Weterynaryjnego Kanady. Została kupiona za 27 dolców
przez porucznika Iana Gary’ego w miasteczku White River w Ontario, dokąd dziś odkrywa się pomnik misia.
W październiku 1914 r. pozostawała przewieziona do Wielkiej Brytanii.
Postanowiono pozostawić ją w londyńskim ogrodzie zoologicznym.
Zdechła 12 maja 1934[1].

W 1924 roku Alan Milne główny cios nadszedł do zoo z czteroletnim synu Christopherem, jaki bardzo
polubił Winnie. Trzy lat wcześniej Milne
nabył w domem komercyjnym Harrods oraz sprezentował synowi na
jego dziewicze urodziny pluszaka firmy „Alfa Farnell”.

We wrześniu 1981 61-letni Christopher Robin Milne, partycypował w odsłonięciu pomnika niedźwiedzicy Winnie
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