The Toll of Dissolving the Nation’s Mental Illness Treatment Facilities

  

The “mental illness” factor is at the heart of so many issues today. For rightwing supporters of ubiquitous gun ownership, they adhere fiercely to the mythology that “guns don’t kill people, people do.” The only form of gun control that they embrace is to deny those with violent felony convictions, diagnosed mental illness and maybe, perhaps, those under court orders regarding domestic abuse. But our prisons are filled with individuals suffering from mental illness:

On February 20, 2020, the government’s National Institute of Mental Health reported: “According to a 2017 report by the Bureau of Justice Statistics, approximately two-thirds of female inmates in prisons and jails and around a third of men in prisons and jails report having been diagnosed as having mental health disorder by a mental health professional. Of those who enter jail each year with a serious mental illness, an estimated three quarters have a co-occurring substance use problem.” The compares with roughly a fifth of the general population that has diagnoseable mental problems.

A large proportion (estimated at over half) of the homeless are incapacitated by mental illness. There are rehab facilities, albeit far from sufficient to handle the problem, for substance abuse addicts, from alcohol to illicit narcotics, but the number of facilities dedicated to mental illness is so small, that our thoroughly unprepared prison system has become the de factor primary care system for that serious issue. It should be noted that the vast majority of those with serious mental health issues are also major consumers of banned narcotics.

The failure to deal with mental illness has catastrophic consequences. For example, as reported by Alisa Roth in The Atlantic (May 25, 2021), “When the justice system steps into mental-health care, the results are often deadly. According to a Washington Post database, nearly one-quarter of fatal police shootings involve a person with mental illness. Once inside a jail or prison, the mental-health care a person receives generally ranges from inadequate to abusive; suicide rates are disturbingly high.” The mental health issue permeates contemporary life.

From rising military suicides to athletes – even major Olympians – taking a mental health break, concerns for a lack of treatment alternatives is rising. We’ve even instituted a telephone shortcut – dialing the 988 Suicide & Crisis Lifeline – to try and save lives. Suicide among teens is a rising rapidly. The older designated mental hospitals were notoriously cruel (above photo shows the forced use of electroshock treatment), yet according to The Atlantic, “by the height of institutionalization in 1955, roughly half a million people were living in state-run psychiatric facilities.” Attitudes about the treatment of mental illness began to change. Mental hospitals closed, as will be noted below, and treatment moved from total “care” to lightweight outpatient treatment, where it is/was available at all. The harsh reality is that we began dismantling mental hospitals a long time ago.

The advent of a Thorazine in 1954, the first anti-psychotic drug widely used to treat the symptoms of mental illness and then approved by the Food and Drug Administration, brought hope that most patients could live among the community. Full-time care of mental patients was assumed to be an expensive and unnecessary alterative. In 1963, President John F. Kennedy signed the Community Mental Health Act, to create a network of community mental health centers where mentally ill people could live in the community while receiving care. The emphasis went from state to federal. But Thorazine and outpatient treatment were hardly the solution.

Republican Governor and then President Ronald Reagan embraced community outpatient treatment for mental patients, initially cutting California’s budget for state hospitals while fostering the rights of mental patients to challenge government ordered forced full-time treatment in mental institutions. In 1967, he signed the Lanterman-Petris-Short Act to this effect. But by the time he was President, Reagan’s obsession with austerity resulted in the 1981 Omnibus Budget Reconciliation Act that pushed most of the cost of handling mental illness back to the states. Later, when federal social programs like Medicaid rose in relevance, financial restrictions kicked in as well: “Medicaid, now the largest payer of mental-health-care services in the country, has severely limited the number of inpatients that hospitals and other facilities can serve. The dream of community-based care turned out to be largely a failure.” The Atlantic.

But few states have stepped up to address the treatment of serious mental health issue. It is easier to sell a “get tough on crime” public for more prisons than to address mental issue separately. The state most notorious for leading the charge to cut back the number of full-time mental health hospitals, California, is perhaps attempting to address a new direction: “Gov. Gavin Newsom is asking lawmakers and voters to approve sweeping mental health reforms that would commit billions of dollars in state funding for behavioral health-based housing and treatment facilities throughout California.

“The Democratic governor’s proposal, unveiled Sunday [3/19] in San Diego, would raise at least $3 billion through a bond measure to fund the construction of new mental health campuses, residential settings and permanent supportive housing. Newsom wants to redirect another $1 billion in funds annually from an existing income tax on top earners to operate the facilities, his office said… ‘It’s unacceptable what we’re dealing with, at scale now, in the state of California,’ Newsom said during an event at Alvarado Hospital Medical Center to announce his plan. ‘We have to address and come to grips with the reality of mental health in this state and our nation.’

“The governor’s aides billed his effort to rework the state’s mental health system as an opportunity to turn the page on decades of failure to build an effective community-based system in California.” Hannah Wiley and Taryn Luna writing for the March 20th Los Angeles Times. There are so many underlying issues, from a lack of affordable housing to the sheer stress of living in a complex, polarized and unstable society. But one thing is absolutely clear: what we have been doing for decades in addressing mental health issues most certainly has failed… dramatically.

I’m Peter Dekom, and perhaps our abandonment of meaningful treatment options for mental illness has created financial burdens, in hard dollars, than what a viable treatment program is likely to cost.