In 2009, the National Alliance on Mental Illness gave the United States a D in its overall efforts to provide care to people with mental illnesses. Things haven't improved much since then.
Suicide deaths in the military exceed combat deaths, but states continue to cut mental health services. More than half of the people in our jails have mental health issues. And although people with mental illnesses are not likely to harm others, if you give someone who can't reason ready access to guns, he or she is more likely to commit mayhem.
Still, "reform" efforts across the nation have eliminated hospital beds for people in crisis, Medicaid reimbursement rates are so low that most service providers can't afford to take on too many patients.
Starting in 2001, North Carolina began to "reform" its system "to offer consumers more choice." I cringe whenever I hear that phrase because it means privatization, and mental health care should never be left solely to the private sector.
People with severe and persistent mental illnesses need a lot of care, and they're not easy patients. If their illness is not well controlled, they might not even show up for appointments; they might stop taking their medications, in which case the illness will get worse.
Our system in North Carolina imploded. People were dying on the streets -- literally. And the state General Assembly is still looking to make more cuts. 
The system is changing from a fee-for-service to block grants, which will total less than what was being spent. The money just isn't adequate, as our local management agency here in Asheville learned from experience.
So now, instead of reviewing cases every year, it is done every three months, which means four times the paperwork and four times the likelihood that a person's care will be reduced or terminated. Fewer care providers are willing to do this increased and unpaid work.
Instead of being an hour, sessions are now 45 minutes. You can still bill for an hour, but you will be reimbursed for only 45 minutes of your time.
More people are falling through the cracks and then turning up in jail or dead.
When NAMI revisited its national report card in 2011, the advocacy nonprofit found more cutbacks in states' systems.
The Affordable Care Act contains some strong advocacy for people with mental illnesses, including a mandate that insurance companies cover psychiatric care at the same level they do every other specialty. You can't charge a $50 copay for an endocrinologist and $75 for a psychiatrist. You can't allow 52 visits to a gastroenterologist but only 12 to a psychiatrist.
That's great for people who have insurance, but people with severe and persistent mental illness aren't likely to be able to hold down a job, and our health insurance in this country is tied to employment. Even after the Affordable Care Act takes full effect in 2014, most of us still will get our health insurance through our employers.
So, people with mental illnesses are left to fend for themselves. Some will have access to disability, but if they have been able to work for any length of time, they will only be eligible for SSD, which means they might lose Medicaid and not have access to Medicare for two years.
Some have sporadic employment and so will not be eligible for Medicaid, especially in states that refuse to expand Medicaid.
None of this makes any sense to me. It's so much more cost effective -- not to mention humane -- to treat this chronic illness properly.
But there still are people who believe we can all control our own brain chemistry and that someone with a mental illness is somehow morally deficient.
Many evangelical Christians believe people can and should pray the illness away, even though they would never say the same thing about asthma.
We as a society are punishing people for an illness over which they have no control, and it's costing us billions in lost productivity, in criminal justice dollars and

These aren't the names of children; they are the names of people our society didn't care enough about to save.
Some struggled with mental health issues or addiction, others lost jobs or became ill and then lost their homes.
These 20 names don't mean much to most people. Only about 100 people attended a memorial service for them this morning.
Whatever you might think, these lives were as precious as yours or mine in the eyes of God, and except for better luck than they had, you or I might have been in their shoes. This year there were 20 names of people who were homeless who died; there were more who were not named.
On this, the shortest day of the year, people gathered in the chapel of First Baptist Church here in Asheville, as we do every year, to honor the lives lost from among our homeless.
I used to cover this service when I was a reporter and I continue to attend each year as a health care advocate and as a person who believes everyone deserves a safe place to sleep at night.
I go because four years ago, when we learned Mike was dying and raced to be with him in Raleigh, another man I never met was dying.
Tommy McMahon had gone to the emergency room the night before with a respiratory infection. He had been there before; the staff knew him. The doctors there gave him antibiotics and an inhaler and discharged him.
But Tommy knew he was too sick to go back out into the cold and wind and he refused to leave. Someone called the police and Tommy was offered the chance to go to jail for the night. He was arrested.
Sometime during the night, Tommy died, and an editor called me in Raleigh to ask who a reporter might interview for a story. As I gave the names and telephone numbers of a few people, I knew my precious son would die surrounded by love, and he did just six weeks later.
Tommy, on the other hand, died alone in a jail cell.
This season always brings Tommy to mind as much as it does a baby born in a stable and placed in a manger. I wonder if anyone loved Tommy, whether he had family and if they had given up on him. That happens a lot with homeless people -- they burn through all their family members before they're turned out onto the street. Did he have a mental illness that should have been treated? Was he addicted to drugs or alcohol and not able to get the help he needed to sober up? Did he become homeless because of an illness or a lost job? 
I wonder whether anyone grieved him as I do my son and I grieve for him just in case. I pray for his soul to be at peace. I do that for each of the homeless people who die every year, but especially for Tommy McMahan because he is forever connected to my son in my heart.
Tommy's death made me understand that we are all connected, that we are responsible for each other. I got to say goodbye to my son; Tommy's mother didn't. Both men died because of injustice. They died because no one who could save them cared enough to do so.
This year, as the names of the dead were read, a little about each one of them was shared -- at least something about the people that someone knew and could speak about.
  • Fred Blevins, who perfected the sport-coat-over-a-bare-chest look.
  • Paula Jean Gump Chrishawn, a mother of five whose battles with mental illness and addiction caused her to lose all of them because she couldn't care for them. She loved the color purple, and she finally won her battles. She was one week away from moving into her own apartment when she died in September.
  • Douglas Dillingham
  • Dennis Gillette, an outgoing "gentle giant."
  • Floyd Hill, an accomplished storyteller with a deep mountain drawl and a veteran.
  • David Isles, a veteran who smiled often.
  • Herman Lee, a veteran known as "Buffalo."
  • Andrew Marsh, called Sammy, was known for his generosity.
  • Dan Mason, who fancied himself a bodybuilder, even as he became increasingly weakened by illness.
  • Joseph Metcalf, a soft-spoken native of West Asheville.
  • Kenneth Myrick
  • Rebecca Plemmons, a mother who was just rekindling her relationship with her daughter.
  • David Pounders, a kind man who divided his time between his beloved mountains and the coast of Florida.
  • Donna Ray, a woman of kind and gentle spirit.
  • Jeff Reynolds, a young man still struggling to navigate the world.
  • Delois K. Smith, a kind and gentle soul with a great sense of humor.
  • Jackie Todd Stipes, a former carnival worker who bragged that he often let the rides go longer than they were supposed to because he enjoyed the looks on the children's faces.
  • Grace Teague, who adored cats.
  • Luzella Whittemore, who was firercely independent.
  • Ivie Ward Yearns, called by his middle name, was a large man and quiet.
If you have time for a prayer today, please include these 20 souls and the people who loved them.
Let me start by saying I'm tired of the politicization of life-and-death issues in this country. Twenty children and seven adults are dead in Newtown, Conn., and people are screaming about politics. 
It's political because lobbyists pay billions to make it so.
We can't talk about gun safety without being political. I noticed the same thing during the health reform debate. 
I know what it is to lose a child who shouldn't have died and I'm trying to wrap my heart around all of those families in Connecticut. I at least got to say goodbye to my child. 
This is a tragedy beyond my ability to even comprehend. I have spent much of the time since hearing the news praying for healing that I know will never really come completely. Losing a child is not something you ever get over.
This is about people's lives, and gun manufacturers have made it Republican vs. Democrat. They have many of us believing that guns are perfectly safe; it's people who are dangerous.
Well, it's people with guns who are dangerous. Not all of them, mind you, but enough of them to cause havoc every few weeks.
This is not a simple problem with a simple solution. This is not just about guns, although guns certainly play a huge part.
I see this as a three-pronged problem:
  • The ease with which people can get guns and ammunition;
  • The lack of diagnosis and treatment for mental illnesses;
  • Our country's love affair with violence.
This is a public health issue and an education issue. The gun lobby has too much power and it has billions of dollars driving that power. A lot of the talking points I'm hearing come from those dollars.
  • We shouldn't regulate guns because then only criminals will have them.
  • We should put guns in the hands of more people so they can shoot back.
  • We should honor the victims by not discussing gun laws.
  • Guns don't kill; people do.
  • Only crazy people go on rampages so we all need guns to protect ourselves from them.
  • People will find other ways to kill if we take away their guns.

And on and on ...
Without going into all the anti-gun rhetoric, let me just say 20 children and seven adults were killed yesterday. Three people died in a mall in Oregon less than a week ago. The bodies are piling up and we're still arguing instead of talking.
We as a nation regulate cars more than we do guns -- we require a licence that has to be renewed periodically. We have more laws regulating the manufacture of teddy bears than we do guns.
It's well past time to have some sensible regulation of guns, including banning of assault weapons and background checks of everyone who wants to buy a gun -- even at a gun show.
The reason so many "nut cases" go on killing sprees is because they have a chronic illness that gets worse when it isn't treated, and we keep cutting funds for mental health. People with serious mental illnesses don't often have insurance because they can't hold a job and our access to care is tied to employment. In addition, most insurance policies don't cover much mental health care, although that will change in 2014, thanks to the Affordable Care Act.
I have watched as our mental health system in North Carolina has imploded because of state "reform," which privatized much of the system. Add to that the defunding of the system in recent years and you have a disaster. 
So, people with severe and persistent mental illnesses don't get the treatment they need, and their illnesses get worse, just like any untreated chronic illness.
Until we address this problem, we will continue to see "nut cases" with guns going on shooting rampages -- unless, of course, we make it more difficult for them to get guns.
We can demand improvement in our mental health system, and we will see it if enough of us demand it. Call your legislators and let them know you won't back down.
Finally, we have a love affair with violence in this country. We adore it. It's in our movies, on TV and in the games we play. The military uses violent video games as a recruiting tool -- go to the Army's web site and play for free.
Every year, the special effects in our entertainment get more grisly and realistic and the violence more graphic because it takes more to shock us. We've become desensitized to it, and there's some good scientific research to back that up.
I do not advocate censorship, but I do think parents should try to protect their children from it. If we don't buy the violent video games or go to the grisly movies, they won't be profitable so they won't be made. 
We are the ones who drive the market.
We are the ones who can make change.
Now is the time -- before the pain of this loss of innocent life diminishes.
While our hearts are still broken, let's honor the victims by being the force of change needed to prevent another massacre.

Yes, I'm very happy President Obama won. I think we stand the best chance of improving our health care system under his guidance.
That said, I want to add that I will try not to post anything obnoxious on Facebook or Twitter today. I've seen a few things that are amusing to me, but I have friends who are upset this morning and I see no need to antagonize them. I did share something about Donald Trump, but he's fair game as far as I'm concerned.
Most of all, I am relieved that Obamacare is safe. By the time the next presidential election rolls around it will be fully in place. It is not everything we need, but 30 million people will gain access to health care, and that, as Joe Biden said, is a "big deal."
My own state of North Carolina went completely red last night, and that disappoints me because I foresee more cuts to health care, especially mental health care, and more cuts to the social safety net.
On Sunday, I listened to The Rev. Dr. Tony Campolo preach at my church. Dr. Campolo is a founder of Red Letter Christians -- people who look to the words of Jesus for their values. The red print contains a lot of talk about mercy, about helping the poor and marginalized. 
Jesus never said, "I got mine, get your own!"
What he did say was, "Whatever you do for the least of these, you do also for me."
So, when a young man asked me yesterday which candidate I thought best embodied Christian values, I told him to look for the person who embraces the poor. 
There aren't a lot of candidates even talking about the poor and the sick and how we can help them, so it's up to us to start that conversation and keep it going. 
Let's leave gloating and hard feelings aside and work together to make life better.
Until a couple of weeks ago, I had never heard of ACE, which stands for Adverse Childhood Experiences, a long-term study being conducted by the Center for Disease Control. (Read more about the study at
It turns out some of us "resilient" children were less resilient than we thought and that experiences we don't even remember could affect our lifelong health.
  • I grew up in a house with a depressed mother. That's one. 
  • If she became frustrated, which she did often, she would yell at us, blaming us for her frustrations and berating us. That's two. 
  • She believed in corporal punishment and she used a strap that left marks. That's three. 
  • She never knew what to do with me because I wouldn't be the "sweet young lady" she wanted, so she ignored me or discouraged me from trying new things because I would only fail. That's four.
  • I was molested from the time I was 3 until I was 11 by someone both my parents trusted. That's five.
That's also a pretty high score, and according to the study, predictive of my being overweight, having chronic depression and even asthma.
I don't blame my parents. My mother had an abysmal childhood, and my father worked a whole lot of hours to keep food on the table and a roof over our heads.
And it's not just family situations. Things as seemingly innocuous as surgery in infancy or the use of forceps during birth can cause lifelong changes in body chemistry. Babies who were premature and had to undergo a barrage of tests and be separated from their mothers also have high levels of stress hormones and a lifelong higher sensitivity to pain than babies born at full term.
I used to marvel at how sensitive my son, Mike, was to pain, but now I realize it probably was all the medical procedures he endured as an infant and toddler.
We have known for a long time that children who are beaten often continue they cycle of violence with their own children. They suffer from depression, low self-esteem and often enter into abusive relationships themselves.
We have known that children who are molested face a litany of problems including low self-esteem, depression, promiscuous behavior, alcohol and drug abuse, obesity ...
But the reasons aren't just psychological; they are physical too. It has to do with cortisol, the substance produced in the "fight or flight" response, and whether our bodies produce too much of it. Childhood adversity is a good predictor of the levels of the stress hormone cortisol in adults.
People with ACE sores of 4 and above usually have increased levels of corti face lifelong health problems and even early death.
It might sound depressing, but to me it's a bit of a relief to know the root of the illnesses and emotions I have had during my adult life. I can work with this.
Want to know your ACE score? You can find out at