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
You keep on going. What they did is their problem and not yours. Someday they’ll come to you and you should rub it in their noses but good.
As for you. Keep up the fight and be the best you can be.
We all can learn from you.
>>But, is locking these people up the way to go?<<
Yes, it is.
If they are a danger to themselves or society, it is.
The idea of personal freedom for someone who is looking to suicide, kill or hurt others, is dangerous. The experiment has failed. Now is the time to return to “mental insitutions” but with better treatment.
And try to get someone on a Haldol or Prolixin depo to understand that the Friday night of fun, drinking with pals on the 7th, will cut the effectiveness of their med on the 30th. Those delusions are very real.
We had one like that.
That's okay. You can think I am wrong. I'm not going to vilify you but I don't agree with you.
I see no problem with a family paying to institutionalize their family member. No reason for the state to take on the burden. We care for our seniors, why not care for those who are ill.
Yes, it is a BURDEN. In the “old days” it stayed in the family. Your reasoning is why the “state” is dumped on. Yes, we neglect our sane senior citizens for the same reasons - it's inconvenient. We've quilted the old folks into believing they are a burden because they are old. When folks are old they actually want more familiarity and around those that genuinely care for them - not paid strangers and hope they are not abused.
The problem is that because the system is the way it is, there are NOT institutions to put them into. We fought to find one young man a group home to go into. Weeks and week while he ended up hospitalized for suicide attempts over and over (one was a Drano consumption that did damage that could not be undone). There was no where to put him.
You see, I just don't agree with more warehousing of the troubled or older folks. You accept this as the solution. I don't.
Understand, there were five children in this family. All grown and all taking care of him in shifts. They still couldn’t overcome his desire to punish himself for his imaginary transgressions.
So the “state” will do a better job?
LOL!
The “state” only makes things worse. They'll just speed up his demise in a sadistic way.
Nmh, you’re yearning for a society that never existed. Mad houses have been around since at least the Middle Ages...not exactly the Age of Convenience, back then.
Yes, families should take care of their own...but full-blown mental illness can literally destroy the most solid family unit, if only by stabbing everyone while they sleep.
A young woman I knew managed to kill herself while under suicide watch in a hospital with a nurse right outside the door and a doctor right down the hall...it only takes a moment for the illness to manifest.
Lots of frustration around this tangled issue...gal I know worked as a respiratory tech in one of those old mental institutions, said it was pretty depressing; they were so short-staffed they had pump the patients full of Thorazine to stop them from killing each other long enough to feed them.
Letting ‘em out on the streets, on the other hand, obviously has its downsides, which we see in the news and on our streetcorners everyday.
No easy answers.
Personally, I apply the Golden Rule thusly: I’d like to be left on my own unless such a time came as I became a danger to others...then, most reluctantly, I’d prefer to have the state lock me up than to learn I’d involuntarily hurt someone I loved, or a stranger.
Same as if I had an infectious disease, like TB...I wouldn’t WANT to wander the streets, making others miserable...even unwittingly.
Yes, it’s a burden on state budgets, but I think it’s squarely within government’s limited, necessary functions.
What about treatment?? And, who will be “the decider” of who is not “right”. Very, very slippery slope.
If freepers want to know how in the old days families took care of elderly parents or disabled family members, first parents had big families, and usually one of the daughters will be the designee to care for the imfirmed family member. She usually will not get a chance to marry and die a spinster. In today’s feminist and civil libertarian attitude of me first and my aspirations first, and why me (because I am a girl and its not fair) stuck with this sh#t detail, you better have good long term care insurance.
My guess is big money donations for the "homeless" are drying up. So liberals need job security - with benefits - so it's up to the "state" to take care of the problem. ( The "problem" being unemployed liberals.)
Conservatives usually back off on these issues mistakenly believing dems are the "caring" ones. But just like with welfare reform - where we spotted the perverse incentives, conservatives should craft the debate on this subject.
>>Yes, it is a BURDEN. In the “old days” it stayed in the family.<<
Okay, let’s go this way.
Can you give a reference to this fact?
Because “Insane Asylums” were actually the norm, my FRiend.
>>And, who will be “the decider” of who is not “right”.<<
There is a diagnostic book called the DSM. I think it is up to the “DSM-V” these days.
That book decides. One looks at a patient’s symptoms and the book guides you throught to a diagnosis. Certain diagnosis are “committed”. Plain and simple.
When you have a group home next door to you and people yelling at your kids and urinating in your driveway, then come and talk to me about the “very slippery slope”. We are at the bottom right now. Patients who need constant care are set adrift in the world because they have no where to go. Group homes are great if you can find them but institutions protect the patient who doesn’t want to take meds and the society who is put in danger by them.
I worked too long in Psych to listen to the “rights of the patient” argument. That hasn’t worked in the last 20 years.
Taking care of a seriously mentally ill people isn't like taking care of an aged parent who has lost their mental faculties. The aged parent, though difficult to take care of, is not likely to be dangerous (except maybe inadvertenly). But an adult paranoid schizophrenic, for example, can be a very dangerous person. It's unrealistic to expect a regular family (especially one with children in the house) to let such a dangerous person live with them.
You're assuming that families don't want to take care of mentally ill people because it's too much of a hassle, but in many cases it comes down to a safety issue.
I wonder though- given how much we have to pay for police, medical services and prisons to deal with the damage done by, and to, untreated mentally ill people, would it really cost more to pay for institutional care for such people? The startup costs might be high, if we had to build and staff the hospitals, but it wouldn't surprise me if we saw cost-savings in the long run.
insane or troubled people are not something that a typical person wants to be burdened with ... it interrupts their life and is an inconvenience
It is easy to say that it is a burden or an inconvenience when you are not faced with the mountain of coping with a psychotic inviduual
If you try to force them on their family, there won’t be any family to force them on to. Even the strongest of families can only take so much. They force out the insane member because it is either “them or us”, literally a life or death problem. This is not some casual “lifestyle choice.”
What would you have them do? Chain them up, or kill them?
Call up the police and have them chain them up, or kill them?
Even Bedlam hospital, whose name is still synonymous with the cruel treatment of the insane, and one of the first mental hospitals of Europe, was created because neither family nor society could deal with the insane in any other way than killing them.
Sorry, “one word solutions” don’t work, unless that word is “kill”.
“Sorry, “one word solutions” don’t work, unless that word is “kill”.”
I’m sorry to see that family is not a consideration.
I also don’t agree with your extreme rejection of family.
“You’re assuming that families don’t want to take care of mentally ill people because it’s too much of a hassle, but in many cases it comes down to a safety issue.”
In the majority of situations that is TRUE a burden that interrupts their normal lives.
Let’s atleast be honest about that fact.
The people you see on the street aren't people who have occasional issues with depression or mild forms of bi-polar disease.
They're people with serious mental illnesses, many of whom have a substance abuse problem, who can be very dangerous to their families. These families have had to make the difficult choice between trying to help the mentally ill person, or ensuring the safety of other family members. I'd hate to be in a position where I'd have to kick out an uncle or a sibling to protect my kids, but I can't blame people for doing so- unless you're talking about a rich family that can afford full-time, professional care for a dangerous mentally-ill relative, what choice do they have?
Didn't grandpa Kennedy lobotomize his daughter because she was an embarassment? A state institution would have been better.
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