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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

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.

Tina Hahn (not verified)

Fri, 03/13/2015 - 21:36

When I click in this blog and go to the screening page, I see sponsorship from Lilly and Astra-Zenica. Screening is important but I know that these drug company sponsored screening lead to increased diagnosis and primarily more pharmaceutical treatment. This has me greatly concerned. Trauma informed therapy is the correct approach (and psycho-education). Medications are last resort and for developmental trauma and toxic stress I do not see them being effective. Thanks Dr. Hahn

Ashley (not verified)

Wed, 06/17/2015 - 17:09

I have severe depression & anxiety & adhd, they diagnosed me as bipolar but they haven't told me much about all this & what to do. They got me takin medicine everyday & counseling once a month. I don't know what to do anymore seriously

Ashley, you have to become stable. Replace the thoughts with stable thoughts. Therapy 1 session per week or two to help with the thoughts and let it go.