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Possible signs that someone you love needs urgent mental health treatment


The following article is the first of a two- part series by Kristin Hestdalen, M.D., that looks at the availability and impact of mental health services both here in Northern Nevada and across the nation. Within the information is a list of   some possible signs that someone needs urgent mental health treatment.

As Nevada and the Tahoe Basin greet 2013 with a mix of optimism and concern we have great issues facing our nation, including looming debates on the state of mental health services, gun control, and protecting Second Amendment rights.  We continue to collectively mourn the devastating loss of life in Connecticut, as 27 people were killed (mostly first graders).  As unbelievable as this tragedy was (and many recently like it), we still face multiple questions: What are we as a nation prepared to change?  How can we prevent this from happening again? And what exactly are the possible causes of these horrific acts?  Many commentators and politicians, say it is our “broken Mental Health System” that needs to be fixed.  I am certain that something needs to be fixed, particularly our access to mental health services, but to declare there is a system, broken or otherwise, is naive. In our own state of Nevada, the legislative body has cut 38.1% from the total general fund mental health budget over the past three years, making it the state with the 5th highest cut to mental health funding in the US. (Statistic from the National Alliance on Mental Health).

And, while legislators and mental health professionals continue to debate next steps, the question remains, “What leads a person to commit such a horrendous act?”  I’m not sure there is an easy answer to this question. Given that hurdle, we do have some ideas about what might predispose someone to consider mass homicide.  In a detailed case study done on 5 mass murderers it was found they all shared some common characteristics and background history. First, the individuals in the study were all bullied as children and often experienced painful loneliness, leading to despair and feelings of social alienation. These were loners who eventually developed extreme anger at their perceived injustice by others, externalized blame, became suspicious and paranoid of others’ intentions and lacked the capacity to look inward in order to create real change.  Instead they tended to be rigid, inflexible and narcissistic, unable to see the world except through their narrow lens. Addition of a mental illness (i.e. Schizophrenia) exacerbates all of this and further distorts already flawed perceptions of others and their world.

Here are some possible signs that someone needs urgent mental health treatment:

  1. An increase in isolative behaviors, such as staying in one’s room, not wanting to interact with family or friends.
  2. Changes in mood or personality, especially development of hostility and anger.
  3. Changes in interests, particularly an unusual and obsessive interest in guns and violence.
  4. Onset of paranoia.
  5.  Development of unusual thoughts or ideas and other distortions of reality.
  6.  Development of frank delusions or hallucinations.

These behavior changes often occur in adolescence or early adulthood and are sometimes the warning signs of very serious mental illness, such as Bipolar Disorder or Schizophrenia.  Families or the educational system (high schools, colleges and universities) are often left with the responsibility of finding help for someone who doesn’t want it. In the next article we can discuss where this help may come from, and look at some examples of how residential treatment, counseling or medications can make a positive impact.  So as debate continues on many fronts and we see continuing acts of seemingly random and unexplained violence, perhaps real change, advocacy, and prevention can come from each of us as we bring the issue of adequate mental health services to the forefront.

Kristin Hestdalen, M.D., Board Certified Child and Adolescent Psychiatrist for Tahoe Family Solutions where she is a Staff Psychiatrist as well as  Chief Psychiatrist for Sierra Mental Health Associates.

Tahoe Family Solutions or “TFS” is a private, non-profit 501(c)(3) organization, providing low/no cost services to children and families living along the North Shore of Lake Tahoe.  Originally a satellite of Children’s Cabinet-Reno, TFS began providing services to the Incline Village/Crystal Bay areas in 1991.  With the expansion of TFS’s services in this area, TFS became an autonomous agency in September of 1994.  Our mission is “Building Hope for Children and Families.”


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