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Our Insane Mental Health System
World Magazine ^ | 08.23.08 | Marvin Olansky

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


TOPICS: Crime/Corruption; Culture/Society; Government
KEYWORDS: apa; disorders; ill; mentalhealth; mentalillness; mentally; olasky; psychiatry; psychology
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To: nmh
My parents and family disowned me 15 years ago because I was mentally ill. I've had one phone conversation with my brother a few years ago and send occasional notes to my parents if I have an address or phone number change. All their phones are unlisted.

These are so-called conservative people which, really, I'm grateful to have out of my life.

41 posted on 08/21/2008 9:12:55 AM PDT by DaveMSmith (If you know these things, you are blessed if you act upon them. John 13:17)
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To: RepoGirl; nmh
Boy, I'll tell ya', even after 61 years, the depth of some peoples self-righteous ignorance never does cease to amaze.

Let me lay it out for you - in terms even a couple of fools like yourselves should be able to understand.

I know someone - a paranoid schizophrenic - who needs to be convinced that they needs treatment.

And I'll pay you $1000 an day to make the effort - provided you are willing to be locked in a room with them, along with a kitchen knife with a 8" blade, long enough so that you know you will be going to sleep.

Just sign this release and have at it!

Not willing?

Awww... what's the problem? After all, it's just an "inconvenience" if you get your throats slit - what are you, some kind of some kind of "narcissists"?

Meanwhile, if I understand you correctly, you are perfectly willing to sign up (for example) someone's aged parents for the job?

********

42 posted on 08/21/2008 9:13:19 AM PDT by M. Dodge Thomas
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Comment #43 Removed by Moderator

To: nmh

How do you take care of someone who won’t take their medicine?

Also the legal climate has changed.

If you so much as grab someone nowadays that you share a household with, even to keep them from hurting themselves, that is Domestic Violence and if the Police are called they take YOU away.

There have been cases (at least one that I know of, and more such incidents that I have read about online) that even such a thing as a husband trying to take the car keys away from his wife who has been drinking and calling 911 so that the cops would help him get her under control got him arrested for Domestic Violence.

What was he supposed to do? Answers he got afterwards was to ask her for the car keys before she started drinking, or call 911 but don’t touch her.

Don’t believe me? Ask a therapist, a cop, or an attorney.


44 posted on 08/21/2008 9:19:20 AM PDT by Screaming_Gerbil (How do you know that the light at the end of the tunnel isn't a muzzle flash?)
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To: nmh

>>The “old ways” were when FAMILY took over the burden.<<

Have you had to deal with someone with a mental illness? Not all of them are alike.

While some can be cared for by family, a violent or suicidal person simply cannot. Period.

We had a young girl, Lord she was darling and sweet, who was cared for by the family. They thought they could deal with her depression. They thought she would be okay. They watched her like a hawk, mom even slept in her room. One day, the brother was watching her while dad was at work and mom ran to the store for milk.

When mom opened the garage door upon her return, there was her daughter hanging from the rafters. The brother dozed off. That sweet girl was 19.

You have no clue unless you have been there.


45 posted on 08/21/2008 9:19:21 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: DaveMSmith

Wait, but on the other hand I have a sister with untreated Munchausen Syndrome that puts the responsibity of her life on everyone else.

I tried for years and years, paid tons of money, damn near raised her kids and she still was a victim and always needed more.

Sometimes one must cut the strings. At 15, your parents should have gotten you help and stuck by you.

When I am 35 and still taking care of my 43 year old sister, who refuses treatment, it’s time to cut ties.


46 posted on 08/21/2008 9:24:46 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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Comment #47 Removed by Moderator

To: netmilsmom
I didn't say it was easy ... they need constant care. You cannot leave them alone because some will do what you described ... .

My point was that people are too SELF ABSORBED to care about anyone else other than themselves ... .

I cannot compromise on my “solution” - family who is there at all times to “babysit” the person.

I know my solution is not acceptable to today's society but it is the right answer even if sacrifice is needed ... and that's where it doesn't fit in with today's society ... we don't sacrifice anything - heck we can't even live within our means ... mortgage “crisis” ... so caring for a troubled person is asking too much ... and then we wonder about “the times we live in” ... . I don't wonder about it ... we've lost our way - that is the “sane” people ... .

48 posted on 08/21/2008 9:26:31 AM PDT by nmh (Intelligent people recognize Intelligent Design (God).)
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To: All

My “solution” doesn’t fit today’s society of convenience.

I should not have responded on this thread.

What I think most people want to hear on this thread is more laws to involuntarily lock up the insane people so the burden is shifted to the state. The state could then load em up wiht more chemicals and family wouldn’t have to be bothered and go about life as usual. It’s the shifting of responsibility that troubles me ... . This “solution” is not something I would advocate and yet I know what I’d like to see will not happen - insane or troubled people are not something that a typical person wants to be burdened with ... it interrupts their life and is an inconvenience.


49 posted on 08/21/2008 9:29:55 AM PDT by nmh (Intelligent people recognize Intelligent Design (God).)
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To: RepoGirl

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.

Cancer treatments could be made to meet market pricing if insurance gets out of the way. How can a family cope with a severely psychotic individual who is unsafe and at times suicidal or murderous? Or one who cannot take care of themselves?

Give me a hint? The wealthy can afford the round the clock care, but the middlc class cannot.


50 posted on 08/21/2008 9:32:46 AM PDT by Chickensoup ('08 VOTING, NOT for the GOP, but INSTEAD, for the SUPREME COURT that will be BEST for my FAMILY!!)
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To: nmh
No, my FRiend. You just don't know enough people who have said that they could do what you are saying, and ended up with tragic results.

Everyone must sleep. If a person is psychotic and wants to either suicide or kill, they wait.

These are not stupid people, remember there is a fine line between genius and insanity. Some of the most intelligent people in the world are also very sick. When I worked Psych, I had poems written to me, songs recorded for me and was sketched more than once. They will plot to do what their minds are telling them to do.

No amount of “care” from the family can overcome that.

51 posted on 08/21/2008 9:33:00 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: nmh

>>You cannot leave them alone because some will do what you described ...<<

She wasn’t alone when she suicided.
Now imagine if she was homicidal instead.


52 posted on 08/21/2008 9:34:57 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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To: Jedidah

The meds dull his senses, slow him down. Reality isn’t nearly as much fun.

absolutely. What mental illness does to the people who have it and to families is tragic. I have lived it and I work it.


53 posted on 08/21/2008 9:35:24 AM PDT by Chickensoup ('08 VOTING, NOT for the GOP, but INSTEAD, for the SUPREME COURT that will be BEST for my FAMILY!!)
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To: nmh

“My point was that people are too SELF ABSORBED to care about anyone else other than themselves ... .”

You’re wrong. Or just way too cynical about people.

“I cannot compromise on my “solution” - family who is there at all times to “babysit” the person.”

BABYSIT? BABYSIT? You think you can “babysit” people who are sometimes homicidal and completely delusional?


54 posted on 08/21/2008 9:37:38 AM PDT by gracesdad
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To: nmh

In some cases the state requires visitation AND co-op from parents..that is untill they are not able to-elderly.

But believe me..NOBODY who does not understand the SMI can take care of them.

Now for the drug induced mentally ill? Thats another matter because druggies who by their addiction caused their insanity are...I dunno what to say about them. I really cant pitty them.


55 posted on 08/21/2008 9:40:02 AM PDT by crz
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To: nmh

I sincerely hope that you never have a family member with serious mental illness, because if you do, the words you’ve written on this forum will taste bitter indeed.

Ignorance is your only excuse.


56 posted on 08/21/2008 9:40:28 AM PDT by Jedidah
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To: nmh

I don’t but I fail to see where it should be a taxpayer problem. They are REMOVED from any emotion towards the victim.

If you are saying taht family should be involved in the care of the mentally ill, that could be true, if the mentally ill would let them. You misunderstand the basis of the problem. These people when psychotic are so adversive that mother will turn out child, and voluteers will run away. they are medicated to sleepiness because that is all that some of them can manage sucessfully. And they often dont take their medications without an instituional boatload of assistance from technicians.


57 posted on 08/21/2008 9:40:46 AM PDT by Chickensoup ('08 VOTING, NOT for the GOP, but INSTEAD, for the SUPREME COURT that will be BEST for my FAMILY!!)
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To: All
Okay!

Have it your way ... whatever that is ... .

This is so typical of today's society ...

enlarge the “nanny state” and dump the problem there and wonder why things don't change ... the problems only get worse ... . Lastly, personally vilify me for even suggesting the responsibility rests with the family.

58 posted on 08/21/2008 9:41:09 AM PDT by nmh (Intelligent people recognize Intelligent Design (God).)
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To: Chickensoup

Thank you for your gentle heart. More understanding is needed. But, is locking these people up the way to go? How do we go forward? Such a sad, sad situation.


59 posted on 08/21/2008 9:52:34 AM PDT by janismcgee
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To: nmh

I think you have it wrong.
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.

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.

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.


60 posted on 08/21/2008 9:55:01 AM PDT by netmilsmom (The Party of Darkness prefers to have the lights out. - Go Fierce 50!!!)
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