On that Friday morning, Dec. 14, 2012, Dr. John Santopietro was working at Community Health Resources in Bloomfield, Conn., when one of his patients called to ask for more anti-anxiety medicine.
The patient said there had been a shooting. It was all over TV, and it was upsetting.
Santopietro was stunned to read about that mornings massacre at Sandy Hook Elementary in Newtown, about 50 miles away. As president of the Connecticut Psychiatric Society, Santopietro got to work quickly, emailing the societys 700 members to stand by. Their help would be needed.
More than 150 psychiatrists volunteered. And Santopietro ended up organizing daily shifts of doctors to be available for parents, children, teachers, townspeople, anyone who needed help coping with the unbearable reality that 20 children and six adult staff members had been shot and killed by Adam Lanza, 20. He had also shot and killed his mother, Nancy, earlier that morning. At the end of his 11-minute rampage, Lanza shot himself.
On the one-year anniversary of the Newtown shootings, Santopietro , is now working in Charlotte, where he took a new position in February as chief clinical officer for behavioral health at Carolinas HealthCare System.
He chokes up, taking a lengthy pause to keep from crying, as he recalls the stories he heard from psychiatrists who counseled grieving families in Newtown last year.
Santopietro compared the shooting to a psychological nuclear bomb that exploded in Newtown with shocks that rippled out across the country. He tried to help his fellow psychiatrists who had little experience with disaster psychiatry.
Its less formal, he said. Less about prescribing medicine, more about making appropriate referrals. He called it therapy by walking around because the doctors sometimes just milled about the town, stopping wherever people had gathered, offering a shoulder to cry on, someone to listen. We became, he said, human radiation absorbers.
Although Americans have become somewhat numbed to news of mass shootings, Santopietro said, Newtown was more horrific because the victims were first- and second-graders.
Coordinating psychiatric help, he worked from his kitchen table for 60 hours straight, making calls and arranging schedules. He didnt do any counseling himself and wasnt sure he could have. I have three kids, he said. His boys are 11, 7 and 4. As hard as it was to absorb the news of the shooting from a distance, he said, Can you imagine what its like for people who were families of victims?
If anything good has come from the Newtown tragedy, Santopietro said its the renewed national conversation about the need for better access to mental health care and for reducing the stigma that prevents more people from seeking the services that are available.
The most important thing is that weve kept the dialogue going, Santopietro said. He lauded Vice President Joe Bidens announcement this week of $100 million in funding for community-based mental health and substance abuse services.
Santopietro said the country hasnt had a similar focus on mental health since the 1960s when President John F. Kennedy signed a law that created community mental health centers, like the one Santopietro worked for in Connecticut, to replace overcrowded psychiatric hospitals.
In his new job in Charlotte, Santopietro said hes hoping to help transform the delivery of mental health services. Instead of operating in silos, the programs at Carolinas HealthCare hospitals are now operating under one umbrella, under the direction of Santopietro and Martha Whitecotton, senior vice president for behavioral health.
Carolinas HealthCare is building a behavioral health hospital in Davidson and operates the former county-owned behavioral health center on Billingsley Road. But Santopietro said buildings arent the only measure of the systems commitment to behavioral health.
It is also working to expand service and provide better access for patients. For example, he said all primary care doctors offices in Carolinas HealthCare will be adding mental health services. Teams of experts psychiatrists, psychologists, nurses, pharmacists will support primary care doctors by providing diagnosis and treatment on-site or through video-conferences. Carolinas HealthCare already provides 250 telepsychiatry visits a month.
Seventy percent of primary care visits have a behavioral health component, Santopietro said. And untreated mental illness drives higher (health care) costs.
Medicaid, the state-federal government health program for the poor, spends about $4,000 per patient on average, he said. But if a Medicaid patient is also diagnosed with substance abuse and a mental illness, that average increases to $35,000. For example, he said, someone with diabetes who also has untreated depression may not take insulin regularly, have a poor diet and fail to keep doctor appointments, all of which could lead to complications that drive up costs.
Get people to treatment
A recently released summary of the investigation into the Sandy Hook shooting revealed there had been many signs over the years that something was going wrong in (Lanzas) thinking, behavior and his brain, Santopietro said. The report also said medications were recommended and he didnt take them.
We really do have good treatments, Santopietro said. But we only treat about 40 percent of the people with mental illness. (When treated) 60 to 80 percent of people recover. Theyre just not getting it. We have to get the people to treatment.
Mental illness itself isnt necessarily associated with violence, Santopietro said. I wouldnt say theres no association, but it is overblown. Only 4 percent of violence is caused by people with mental illness, he said. More often, they are the victims of violence.
But untreated mental illness can be associated with violence, he said, which is why its important to reduce barriers to access.
If there were one thing I could fix, it would be (to reduce the) stigma, Santopietro said. Its the one thing that keeps us from getting treatment.
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