The problem of mental health care has been a major dilemma for so long precisely because the public doesn’t even want to think about it, much less do much of anything.
It used to be seen as a state issue, like state prisons, but because of widespread abuse and nagging reformers, the states were forced by the courts to release the vast majority of insane people, keeping only the very worst. And states soon learned they saved a ton of money by doing so, so are not inclined to perform that task any more.
So, weirdly enough, it may be the *one* area that needs the involvement of the federal government.
As one idea, setting up federal mental institution regions in the US, for legal reasons associated with the United States Courts of Appeals and United States District Courts.
http://i.imgur.com/WpymuDM.png
The idea would be that it would be difficult to get into, or get out of, such an institution without local, state, and federal involvement.
The process would begin at the local or state level, in which a criminal court, based on the advice of one or more psychiatrists, recommended the individual for indefinite incarceration at the federal regional facility.
From there, it would go to that state’s federal district court, where a different psychiatrist would certify that indeed this individual represented a strong potential to harm himself or others.
From there, the individual would be referred to the federal facility, where a team of psychiatrists would both evaluate, diagnose and recommend treatment. Once they had done so, the individual would be under the care of the admitting psychiatrist, and get annual reviews to determine their status by a different psychiatrist.
To be released from that situation would be the reverse process, requiring approval at all levels to authorize their transfer or release to different circumstances.
Right now, many state mental hospitals are warehouses, where the mentally ill are given drugs so that they sleep for most of the day, then they are guided to eat, go to the restroom, bathe, change clothes and are given more drugs.
The idea of a federal district mental hospital is that it could provide them better care than that, and that at no point would the patients just become numbers.
Because there is such a multitude of spectrum mental illness in the US, relatively few people would be placed in the regional facilities, but it would be far better than putting them in prisons as is also done today.
Most mental health hospitals, strictly speaking, have nobody in them and are kept alive simply because they are the sole employer in their relatively remote parts of their states. NY State has a number of these staffed but empty hospitals. It’s virtually impossible to get a long-term involuntary commitment to anything but a prison facility, even though even providing secure housing, food and clean clothing for the mentally ill (many of whom now live on the streets) would be an improvement in their condition and would probably prevent some of the worse manifestations of their illnesses.
But the idea of having a several-tiered system is a good one, because this would probably prevent or at least make abuse of the power of the system much more difficult. Not impossible: we have to hope we someday get back a non-politicized and non-intrusive administrative system. Obama has corrupted the major agencies (IRS, DOJ, etc.) so thoroughly by now that it’s hard to say that’s ever going to be possible again.
