Posted on 08/21/2008 7:59:15 AM PDT by Chickensoup
Our insane mental health system Faith-based finalists: The poorest among us are those who’ve lost their minds, according to psychiatrist E. Fuller Torrey | Marvin Olasky
I first heard E. Fuller Torrey critique America's mental health non-system nearly two decades ago—and the evidence of breakdown has only increased since then. The mentally ill now form probably half of the homeless and prison populations. Exploited and victimized by others, and often terrorized by their own phobias, they are a threat to themselves and to others, causing one-tenth of the homicides in the United States.
Torrey, a psychiatrist who specializes in helping schizophrenic and bipolar patients, founded the Treatment Advocacy Center (www.treatment advocacycenter.org), a national nonprofit trying to improve treatment of those with severe mental illnesses. He has persevered in helping men and women who are truly the poorest among us in that they don't even own their own brains any more.
WORLD: How many seriously mentally ill individuals are homeless or incarcerated in the United States at any given time?
TORREY: Conservatively it is estimated that there are about 175,000 seriously mentally ill persons who are homeless and another 220,000 who are in jails and prisons. By "seriously mentally ill" I mean individuals with schizophrenia, bipolar disorder, and severe depression with psychosis. This definition does not include individuals who only have alcohol and drug abuse problems. Thus, individuals with serious mental illnesses make up at least one-third of the homeless population and at least 10 percent of the jail and prison population. Both numbers have been, and still are, increasing.
WORLD: What was the trendsetting California legislation during the Reagan years, and who were the strange bedfellows pushing it?
TORREY: In the late 1960s California set the standard for emptying its state mental hospitals and other states then followed its lead. In 1969 it implemented a law, widely known as the Lanterman-Petris-Short (LPS) Act after its sponsors, which made it exceptionally difficult to involuntarily hospitalize psychiatric patients. Once in the hospital, patients could only be held for 17 days unless they met very strict criteria for dangerousness. The new law resulted in a major exodus of patients from the hospitals, a movement known as deinstitutionalization.
WORLD: Which strange bedfellows pushed for that law?
TORREY: A very odd coalition: politically left-leaning civil libertarians, who believed that nobody should ever be involuntarily hospitalized, and politically right-leaning fiscal conservatives who saw closing the hospitals as a way to reduce state expenditures and thus reduce taxes.
WORLD: Who was Herb Mullin and why did you write about him?
TORREY: Herb Mullin was a young man with untreated schizophrenia who, because of his delusions, killed 13 people in Santa Cruz, Calif., in 1972 and 1973. As is typical for schizophrenia, Herb had been a promising young man until his disease began after he completed high school. I used Herb as a case example because he is typical of the individuals with untreated schizophrenia and bipolar disorder who account for about 10 percent of all homicides in the United States. Most of those homicides could be prevented if the people were being treated.
I also used Herb because his untreated illness was at least partially a product of the new LPS legislation which had just been implemented in California. In 2005 I visited Herb, who is serving a life sentence in a California state prison. He still has schizophrenia. So far his incarceration has cost California taxpayers over $1 million. The cost of the antipsychotic medication needed to treat his illness in 1972, and thus prevent the homicides, would have been a few dollars.
WORLD: What effect did Wisconsin's mental health reforms have?
TORREY: Wisconsin, like California, passed legislation in 1972 that made it very difficult to treat people with serious mental illnesses. Following the passage of the new legislation Wisconsin witnessed an immediate increase in mentally ill persons who were homeless, in jails and prisons, and committing violent acts, including homicides.
WORLD: With mental hospitals closed, which public officials are now the front-line screeners of mentally ill individuals?
TORREY: In the past, psychiatrists, psychologists, and social workers were the screeners; now, it's police and sheriffs. They are the ones called when mentally ill persons become disturbed. For example, in New York City in 1976 the police responded to approximately 1,000 mental illness calls each year. By 1998 this had increased to over 25,000 such calls each year. Police and sheriffs are not recruited or trained to be mental health screening officials and it of course takes time from other law enforcement duties that they should be performing.
WORLD: What is "dying with one's rights on"?
TORREY: Dr. Darold Treffert, a psychiatrist in Wisconsin, originally used the term. He kept track of the increasing number of deaths of individuals with serious mental illnesses who died from accidents, suicides, starvation, etc., because of the new laws making it difficult to treat them. Dr. Treffert wanted to emphasize the fact that the new laws were effective in protecting the person's civil liberties and their right to refuse treatment, but in doing so the laws put the person in danger. Dr. Treffert is one of only a few American psychiatrists who have spoken out forcefully regarding the abysmal job we are doing in providing appropriate care for individuals with severe mental illnesses.
WORLD: Why don't more patients who need medication take it?
TORREY: The single biggest reason why individuals with mental illnesses do not take medication is because they do not believe they are sick. Schizophrenia and bipolar disorder are diseases of the brain and the disease often affects the part of the brain we use to think about ourselves. We see this also in other patients with brain disease, especially in Alzheimer's disease, and in neurological terms it is called anosognosia. It is seen in approximately half of all patients with schizophrenia and bipolar disorder. Such patients, no matter how sick they are, deny that they are sick and refuse to take medication. Other reasons why some patients do not take medication include side effects and cost of the medication.
WORLD: What are the consequences of our failure to treat people with serious mental illnesses who need treatment?
TORREY: Horrendous. Beyond the problems of becoming homeless, incarcerated in jail or prison, and becoming violent, mentally ill people who are not being treated often become confused and thus easily victimized. Their judgment is impaired, leading them into potentially dangerous situations. A study of seriously mentally ill individuals in Los Angeles reported that two-thirds of them had been robbed or assaulted in the previous year. Suicide also occurs frequently among mentally ill persons who are not treated.There are additional consequences: For example, hospital emergency rooms are often crowded with mentally ill persons waiting for hospital beds. Many public libraries have become de facto centers for mentally ill persons who have nowhere else to go. Many public parks have been taken over by homeless mentally ill individuals.
WORLD: Are any religious groups helping?
TORREY: I volunteered in homeless shelters for 16 years and have visited shelters in many states. I have been consistently impressed by the quantity and quality of services for the homeless that are being provided by religious organizations. If not for them, we would be much worse off than we are.
WORLD: How do we fix the system?
TORREY: The system can be fixed but the first thing required will be leadership from federal, state, and local officials. Such leadership has been in very short supply. I do not know of a single governor, for example, who has made the treatment of individuals with serious mental illnesses a priority. At the federal level the Center for Mental Health Services, which theoretically should be providing leadership, is one of the least effective agencies in all of Washington, and that is saying a lot!
We need to focus on the sickest patients. Of the 4 million seriously mentally ill individuals in the United States, about 10 percent of them, or 400,000 patients, are homeless, in jails and prisons, and causing most of the problems. And about 10 percent of those, or 40,000 individuals, are overtly dangerous and need to be on mandated medication for the safety of themselves and others.
Copyright © 2008 WORLD Magazine August 23, 2008, Vol. 23, No. 17
Why isn't family REQUIRED to care for them?
It's too easy to load up government with this.
Our country didn't start out this way ... families and churches cared for this - not the government. Yes, I know, it might be an inconvenience to the family ... we are a narcissistic society and irresponsible as well.
Just a few dollars? Apparently Doc. Fuller is pimping for the drug companies. There is no shortage of teachers who aren't out there helping him to rope hyper boys onto Ritalin and Girls onto anti depressants.
Our country didn’t start out this way ... families and churches cared for this - not the government. Yes, I know, it might be an inconvenience to the family ... we are a narcissistic society and irresponsible as well
Are you kidding? Have you ever had a severely mentally ill person in your family? In the past they were killed or tortured or like today in prison. Our compassionate forefathers saw a need and developed Town Farms and Insane asylems to help these poor souls live so that they would not molest general society or be molested.
The current system is much more expensive with the patients either being ignored OR the have 24 hour personal care attendents sometimes even two at a time. Mental health care for the seriously ill is a tragic and growing industy.
My wife is a case manager for a mental health clinic in the county we live in. She is overloaded in her work as she has in excess of 60 cases she has to deal with each week. That means she has to see to it that those who need to go to the halfway house do so, that those who need to get back to the state hospital do so and those who need medical attention do so and those who need to be gottten out of jail-do so, and those who need to be counciled get there and those who havent had called in over a week be contacted..on and on.
In the last month, one got shot by the police-he hadnt been taking his meds at home and went over the edge. One got killed by her husband. One robbed a bank and got caught after taking the taxi back to his apartment (LOL) and a couple tried commiting suicied. Not to mention those who needed to be sent to the “unit” to get their “Tune Ups” didnt show.
She works over 12 hours a day and gets just over 32 grand a year for her job. A lot of these people should be in an managed care situtation much like old folks homes where they can come and go yet are watched so they take their happy meds or whatever...at least thats what she says. Yet the state wont cough up enough money to cover the costs of these people and they expect outfits like where my wife works to handle it for nothing.
For those of you on here that will scoff at handing out money to take care of these in a responsible way..would you let your three year old take care of him/herselves and not provide for them?
BTW. My wife has a BS in Business Administration and will quit this job ASAP as she is sick and tired of working the Chinese overtime. Thats doing overtime on salery for those of you that dont know. A PERSON WITH A DEGREE WORKING FOR a lousy 32 grand a year. But the cheap F^$#ers in this state will fall over themselves to fund a G&%dam hiking trail to nowhere for a bajillion dollars...AND HALF THE STATE IS DESERT..you can take off and walk straight cross country for the petes sake.
“The cost of the antipsychotic medication needed to treat his illness in 1972, and thus prevent the homicides, would have been a few dollars.” psychiatrist E. Fuller Torrey
He is talking about haldol, thorazine and the like. they are the mainstays of the practice. This is not drug company pimping. This is the reality. Diabetics need insulin and psychotics need anti-psychotic medications. Prior to antipsychotics we tied them into straitjackets and let them scream.
YOu need to learn about this issue because it is in every community
Because they're nuts.
What happens when the family doesnt want anything to do with them? Then what? Leave em out on the street to cause havoc? Is that the way to do it?
That's an entirely different issue. This article is about severely dangerous, mentally ill people
In the long run it is less expensive to fund asylums and get this Communtiy based mental health off the streets. The costs in police, homelessness and different street programs would be eliminated. Having the mentally ill run around homeless is expensive. Not to mention the risk for them and the general publicn.
Why don’t more patients who need medication take it?
Because they’re nuts.
They are mentally ill. That means that they have POOR JUDGEMENT>
Why don’t more patients who need medication take it?
Because they’re nuts.
They are mentally ill. That means that they have POOR JUDGEMENT>
As someone who's family with such a member WHAT EXACTLY do you suggest we do in the case of a mentally disturbed family member who can't understand that they are ill, given that the state makes it virtually impossible to have them involuntarily committed for treatment?
That's what I said-they're nuts.
For the same reason my friend who has breast cancer feels that everyone else should pay for her treatments. Basically, "It's expensive."
People don't want to give up their creature comforts, by and large, and want other people to shoulder the cost. It's easier to imagine some greedy evil corporate bazillionaire than some regular joe who's got his own problems. It amazes me how people have become less and less self-reliant over the years.
It can be best summed up by a Simpsons quote, "Get someone else to do it."
The problem with someone who has schizophrenia and is not being treated with medication is that they are often impossible to help or even control. The patient does have rights as a human being, families cannot force-feed them their medications. Families cannot stop them from slipping into psychosis. If you are dealing with an adult with a mental illness who refuses to be treated with medications, the family can do very little about it... unless it can be proven that they are a possible danger to themselves or others. And that is a very difficult thing for a family to prove. It is generally only proven after the fact, after the patient has harmed himself or someone else.
Thank you!!!
The SMI people cant help it as they have an illness..and some are a danger to society sadly.
Maybe somebody here would care to tell me if they’d like to let a woman out on the streets who killed her baby and cut it up and flushed in down the toilet in a hotel room and not have anyplace where she could be watched and made sure she took her meds.
And believe me..there is just such a case in the USA..I’d get myself in trouble if I told you where. My wife took care of her. Its not in AZ.
nmh, I know that you speak sincerely. But you have, obviously, never faced this problem personally.
The families, despite their best efforts, CANNOT care for the severely mentally ill. These people will not accept help. They don’t think they need it.
We currently have a family member who feels on top of the world. He’s manic. He’s paranoid. He’s carrying a gun. We know it, and law enforcement knows it. He calls, but he doesn’t stay in one place for long.
Why is he out, you ask?
Because he’s just sane enough to fool the system. He told the last mental health pro who evaluated him that the gun was to shoot squirrels. He can calm himself enough to make minimal sense for a few minutes at a time. He’s learned to keep his mouth shut.
He won’t go for voluntary treatment. He gets violent and profane when it’s suggested.
He can’t be involuntarily committed till he’s judged a threat to himself or others. By that time, it may be too late.
And we, the family, will be blamed. Meanwhile, I keep my doors locked.
Careful judging till you’ve walked in the moccasins.
RepoGirl, you are wrong.
It’s not about money.
Please see my last post.
There’s insurance, and there’s family willing to pay. The severely mentally ill often will not accept treatment, voluntary or otherwise.
I would LOVE to see you work just one week in one of these places. You’d be eating your words in a second.
You’ve NO idea at all.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.