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
There’s another reason why patients don’t take their meds. A bipolar patient in a manic phase feels GOOD. He’s running high, king of the world.
The meds dull his senses, slow him down. Reality isn’t nearly as much fun.
Never underestimate the ability of an insane person to tear apart their own families. The reason that so many of the insane are wandering the streets is that their families had no choice but to kick them out.
It is not a free choice, they are near collapse, physically, emotionally, and financially. Often the mentally ill person is either nearly catatonic from drugs and depression, so must be cared for continually, fed, and cleaned, yet unable to respond. Or else they reject their drugs because of the painful side effects, and are incoherent, menacing, intensely paranoid and lash out unpredictably causing damage and injury to themselves and others.
When out on the street, they have nothing, and quickly fall victim to others or victimize some innocent person. If they are known to be mentally ill, or it is quickly determined, after arrest, at first they will be put in a County facility with a maximum stay of two weeks. Then they will be turned loose again.
Most State facilities operate at or above full capacity, so unless they are uncontrollable, they are arrested and put in prison. Only as a last resort are they put in a State asylum, where they are daily drugged so much that they sleep almost continually. After some months of this, they are so damaged and weak that they are just being held until they die.
This is why the courts eventually decided that even if they could live on the streets, it was a “better” life, though they were offensive to the population as a whole. This forced the States to release them, and they soon discovered it saved a lot of money, so they now support doing this as well.
The only significant improvement since then has been to take those who are not insane, but who just have “diminished mental function”, the retarded either naturally, chemically, or by accident, and put them in group homes, where just one or a few caregivers would be able to give them a reasonable life. Some of the earlier stage mentally ill are also in this situation, but it doesn’t last too long, because their minds deteriorate.
But the rest of the insane are boned. And despite periodic calls for society to do *something*, *anything* to improve the situation, the bottom line is that we want to, but just have no clue as to how.
Everybody wants to help them, but nobody has any ideas.
“There is no shortage of teachers who aren’t out there helping him to rope hyper boys onto Ritalin and Girls onto anti depressants.”
Maybe you should stick to the topic instead of sidetracking into some agenda.
Ya know..As my wife says. Some are comical-like the one who is a computer wiz and cleaned out several of his families accounts before they caught him, and some are harmless, but some of them are homocidal.
Ever wonder why the wild west was so like it was?
Never underestimate the ability of an insane person to tear apart their own families. The reason that so many of the insane are wandering the streets is that their families had no choice but to kick them out.
I don’t but I fail to see where it should be a taxpayer problem. They are REMOVED from any emotion towards the victim.
It is not a free choice, they are near collapse, physically, emotionally, and financially. Often the mentally ill person is either nearly catatonic from drugs and depression, so must be cared for continually, fed, and cleaned, yet unable to respond. Or else they reject their drugs because of the painful side effects, and are incoherent, menacing, intensely paranoid and lash out unpredictably causing damage and injury to themselves and others.
All the more reason to have FAMILY handle this.
...
Everybody wants to help them, but nobody has any ideas.
No. No one wants to be bothered. It should be FAMILY.
Obviously the government solution isn’t working either. This must be forced onto family or perhaps churches.
Laws need to be changed.
“Why is it ALWAYS up to the STATE to fix this problem?
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.”
Boy, it’s easy to tell when folks have absolutely no idea what they’re talking about.
Look into the history of what used to happen to the seriously mentally ill. It wasn’t nice lovable families and churches taking care of them and everybody living happily ever after.
But enough about the Democrats. . . .
Not evey bipolar patient experiences the illness in the same way. Many never even experience full-blown mania.
The reforms that emptied state mental hospitals didn't mean we actually stopped paying for the costs of taking care of people with mental illnesses.
In large part, we just ended up taking care of a lot of mentally ill people through the prison system- American prisons are perhaps the largest provider of mental health services in the country.
I'll leave it to the reader to figure out whether this approach has been an improvement when it comes to cost and treatment of the mentally ill.
Why isn't family REQUIRED to care for them?
Most families are wholly incapable, physically, economically and medically, to deal with a paranoid schizophrenic or someone with serious bi-polar disorder or other serious mental health issues.
The same people that made people with Mental Illness reliant on institutions had no plan when they were discharged to the streets.
The movie Sling Blade was a perfect example
http://www.imdb.com/title/tt0117666/
It has improved a little because of group homes but this statement about Dr. Treffert sums it up best.
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.
This still is a problem largely ignored by the media. The rights of people with mental illness also impede the progress of people with mental illness and society in general.
“This must be forced onto family or perhaps churches.”
So you think churches can take care of the seriously mentally ill? And they should be forced to do so?
Gimmee a break.
Laws need to be changed to protect society.
I do admit it is a tough and tragic situation. My suspicion is also that these are very troubled people and all the drugs in the world will only make them worse. That's where one can only hope and pray that someone that might actually CARE about the person, STEP UP.
It's too easy to shove the problem to government or someone else because they are an inconvenience. We’ve ad to deal with relatives alittle off - Alzheimer's. We didn't use drugs. It taxed us mentally but we had an OBLIGATION in the name of decency to deal with it. We loved the person. We didn't want the “state” to push them over to the point of no return - it would have been very convenient to turn the person over to the state.
Truly it is a tough situation. Some are probably too far gone ... and drugging them up is all that is left so perhaps laws need to be changed to accommodate this last ditch effort.
I understand it is tough ... As a Christian who is NO BETTER than anyone else ... I believe we have ab obligation ot Christ to look after our own and others in a humane way. We did and it wasn't easy. I am no better than anyone else so don't think I'm being “self righteous”. There are times when our “reward” isn't on this earth ... .
I can say that after I moved to Kansas and started seeing a Christian psychiatrist, symptoms and side effects diminished to nothing. Granted my stress level is a lot less. The community in general seems more supportive and accepting.
My meds would be a thousand/month without insurance. A few are available as generic as of this year, which helps. I'm fortunate to have good insurance -- unlimited in-patient, pharmacy coverage. I've met many who couldn't afford it -- and could never break out of the system.
Closing these hospitals was a bad ideas, along a long history of many bad ideas.
We need to start building them again, and going back to the old ways.
The “old ways” were when FAMILY took over the burden. That's what we have done. It's not easy - emotionally or financially. WE also KNOW that warehoused away they will be ABUSED. You'd be surprised at what kind of person “works” in these nut houses - typically sadistic people that are underpaid. Paying them more isn't the answer either ... .
Warehousing them is not the answer.
I realize that my "solution" is not so realistic with most people because parent's don't even take the time with their KIDS who and (hopefully) not insane! They warehouse their kids away in "before care" and "after care" to chase the dollar. If they won't STEP UP for their own kids ... I suppose it is silly of me to think they will STEP UP to care for a troubled relative. I suppose you should take my advice with a grain of salt.
Absolutely true.
And the disease is treatable with medication. Caught and treated early, it never needs to escalate into danger.
>>Many never even experience full-blown mania.<<
Or it manifests years later.
We had a patient who was treated for depression for 40 years. One day, no one knows why, she swung Manic.
She started at a local restauant and bought for everyone in the place. Then into the mall to treat children to gifts. It went on for a week before her daughter caught on, although she lived with her, the daughter worked and had daycare, but the workers were not there full time. Only four hours that the daughter was gone for ten. Lots of damage can be done in six hours.
By the time she got to us, she had gone through 30,000 in savings. My boss hospitalized her to get the depression meds out of her system and begin to treat her for the manic swing. That was six weeks that she was hospitalized.
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