Thursday, November 27, 2014

Where Should We Be Treating Mental Illness?

Tis the season to be jolly and to shop for presents, stuff ourselves with too much food and dream of an America where everyone is out caroling nightly. This is the America we'd like to imagine exists in our country because it's comforting and we do so need comfort right now. Despite our fervent wishes, there's another, very real upsetting spectre here. No, it's not the Ghost of Christmas Past, but the condition of the incarcerated.

The mentally ill are becoming an inordinate burden to communities in the US as ever more persons with these illnesses are arrested and placed in jails and sent on to prisons. Of course, they also add to the bottom line of corporations that manage prisons and we need to consider this, too. A huge incentive exists here and we've seen examples of corrupt judges working at odds with the law.

However, the question in your mind might revolve around how this sorry state of affairs has materialized. Are mentally ill persons more likely to be criminals? Certainly, urban myths swirl around the image of the mentally deranged person wielding a brick or a hatchet and attacking innocent people on the street. The brutal murder of a New York City Central Park West psychologist remains in my mind. Details of the case can only lead to a conclusion of severe mental illness unchecked.

This particular image of the crazed person appears to be popping up more often and even in places like China, too, where school children have been the victims of men with hatches and knives lashing out and slaughtering them in their classrooms. So, the myth grows and it would appear it's not confined to the United States. But is it truly grounded in fact or are isolated instances being exploited for inordinate media attention? And, in the end, who will suffer because of this injustice? My answer would be that everyone suffers when we fail to appropriately attend to the ills of a society.

Working in mental health for three decades, I've seen how the current flood of the mentally ill population is beginning to swell prison populations. Several things add to the mix, not the least of which are crimes committed by persons with mental illness who have received little or no treatment or who have refused to continue their treatment.

The mentally ill were poorly served by the deinstitutionalization plans to empty psychiatric hospitals in the early 1970s.  The plans were ill-formed with incredibly inept follow-through and the scoundrels came in to scoop up the bewildered patients.

Those persons who fell through the cracks of an overburdened, poorly supported and managed social structure, with a constantly revolving cadre of inexperienced, green counselors, roam free, sleep on the streets and mingle among shoppers at malls where they seek warmth in winter, coolness in summer. The result of the latter has been architectural change where seating areas have been removed much like spikes are installed on window ledges to discourage roosting birds. No seats=no homeless hanging around. And the mentally ill are most certainly homeless. Shelters are places of violence to be avoided.

Add to this swelling population the fact that many prisoners are now in their senescence and require not prison but nursing home care. Are nursing home prisoners to become a new cash cow for a burgeoning industry aimed at our seniors? Who is offering Disneyesque plans for them?

One of our major cities, Los Angeles, California, is facing a major mentally ill inmate problem in its jail. Should they spend $1.7B to build a new jail or is there another solution to housing and helping the mentally ill? No easy solutions for LA or anywhere else.

Mental health professionals have led us to believe that patients can be managed in the community and that's where they belong. No one would disagree that, if there were truly what had been initially intended, it would be more acceptable than prisons where solitary confinement is often the management method. But the devil is in the details. The mentally ill are just one more opportunity for too many interests and even the well-meaning professionals are overwhelmed by the politics, the financial aspects and the commitment of communities.

Families are fiercely committed, but even they are no match for the forces that push for containment in prisons and supervised housing where staff leave at 6PM or earlier. Oh, yes, the mental health centers promise adequate supervision, but do they truly provide it and are they really up to the task? I think not.

The holidays are not a very happy time for too many people with mental illness.