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
Ya know maybeI`m so out of touch that I`m hopeless, but you want to decide who needs to be locked up by A BOOK?? You say you have 20 years experience, but have you ever LIVED with anyone with mental issues?? I have. Book experience is one thing but, living experience is another. If you truely want to understand this issue, leave the books behind, reach out with your heart.
I’m sorry to see that family is not a consideration.
I also don’t agree with your extreme rejection of family.
until you have watched families who have been rejected by their psychotic memebers and who have no abilites or powers to change or protect their ill member, you have nothing to contribute here. Family is the first line of defense in the mental health care system. Families break down and are unable to contribute by the time it is societies issue.
Your one trick pony doesnt work here.
In the majority of situations that is TRUE a burden that interrupts their normal lives.
Let’s atleast be honest about that fact.
This, more that anything else shows your extreme ignorance of the subject. This is not like the difference between daycare and stay at home moms.
Rosemary Kennedy. She may have had some mental illnesses, but nothing unmanageable. But Joe Kennedy was a man with a dark heart, and he decided to have her lobotomized to prevent her from being a political liability. She died in a nursing home just a few years ago.
First of all, where did I EVER say I had twenty years experience?
Second of all, YES I have lived with a person with mental health issues. A depressed alcoholic mother and a sister with Munchausen Syndrome (untreated) and her mulitple suicide attempts.
How much medical experience do YOU have? Do you understand that the DSM diagnostic tables are THE tools for diagnosing Mental illness?
I don’t think that you are hopeless, but I do think that you are looking at this issue from an emotional and not rational point of view. There are many degrees of mental illness. Many. And even within a diagnosis there are degrees of severity. Living with one person cannot give one the big picture on the complexity of it. Not at all.
I was not attacking you at all. I`m sssooo sorry that you thought that. Please, please accept my aplologies. I have lived with my mother with mental problems all her life. My point was that she could not be put into a neat little box with a diagnosis. I am sssooo sorry if I hurt you. Did not mean to do anything like that. We are all just people trying to connect. That`s it thats all I was trying to do.
Don't say "we", Kemo Sabe. This egg was laid by the liberal chickens, and it's all theirs, despite the attempt in the article to drag conservatives into it. The conservatives might have voted in favor, but the "let'em all out" notion was thunk up by the liberals, and pushed into legislation by the liberals.
I do know people on these drugs. They still need occasional institutionalization and frequent psychiatric visits. Caring for them is not a few dollars. And even more disturbing, when let loose they breed. Whatever genetic mis-wiring they have then gets passed onto a new generation. Again, more expense. This is eugenics in reverse.
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.
you may not be able to pity them but they make our streets less safe and they do need custodial care.
personally vilify me for even suggesting the responsibility rests with the family.
What you dont seem to understand is that in many cases the families have done MAXIMUM. What you are saying is similar to saying that when a person commits a crime against society that their FAMILY should take care of the issue.
Although I do not equate MI with criminality although there is sometimes overlap, there are somethings too big for a family to deal with or that they have dealt with it beyond endurance (see this scenerio often)
But, is locking these people up the way to go? How do we go forward? Such a sad, sad situation.
For some people custodial care is necessary because ofthe breadth and depth of their illness. They would not just be locked in but the negitive forces in the world would be lockied out. they need protection from themeselves and from others. They are prey. Having a home in an institution is not a bad thing.
My biggest fear is that the radical individulism and leftist rehtoric will lead us as a culture to kill these people rather than instinutionalize them. We are rapidly approaching the place in our culture that we would be able to talk ourselves into killing them rather than taking away their freedom.
Why did we let the STATE close those mental hospitals in the 1960s??? That was where our sick relatives needed to be. We can’t care for them, unless we have a degree in psychiatry, even then you half to have a place to hold them safely.
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.
I dated a lefty hoptital closer at that time. He had no concept that people might not take their medications. No understanding that sleeping under a bridge would be acceptable to someone not thinking clearly. He put his middle class lawyer values on the floridly psychotic.
“How do you take care of someone who won’t take their medicine?”
They way they did it before deinstitutionalization. They got all the psych workers into the room and told them that if they did not cooperate they would have the injection any how. This process is still occuring in psych hosptials when patient’s are in imenint danger.
Honestly, I didn’t take it as an attack.
You must understand that when it comes to the diagnosis and treatment of mental illness, it’s not a box, its a catagory. With any diagnosis it is a series of symptoms that lead to that diagnosis. That’s how it’s done.
This is an example of the DSM-IV symptoms for Narcissistic personality disorder.
(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant, haughty behaviors or attitudes
Compare that to the Borderline Personality Disorder
1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. identity disturbance: markedly and persistently unstable self-image or sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms
I can tell you that just looking at a person, it is very hard to tell a big difference in these disorders. You wouldn’t believe it, but it’s true. Those people with either disorder can act exactly the same. Only though the diagnostic criteria (and asking many questions) is a doctor able to come up with a diagnosis and treat in the proper way. Every case is different and some cross over.
The sooner one has a positive diagnosis, the sooner the proper treatment can begin.
All the best to you and your mom. Mental illness is not horrendous. It’s a disorder like a heart condition or diabetes. Under proper medication people can live perfectly normal lives.
Not that I doubt this number, I would like to see the data to back it up.
We're told that a large percent of all homicides are committed by illegals.
Somehow the number together don't seem to jive or someone is pulling our legs.
It is not a rejection of family in any way. Family is always the first choice, and they are usually those who suffer the worst, after the victims of mental illness.
The true story of suffering is a very dark place, from beginning to end, and even seeing it a piece at a time can break your heart.
Often it is very gradual, as severe depression is the #1 mental illness in the US. The family member slowly withdraws, losing their vitality, their personality, feeling discomfort when approached because it takes so much energy to even respond. They stop working, or helping, or being a member of the family, lethargic and exhausted. Many killed themselves not out of mental anguish, just because they couldn’t stand the endless fatigue and exhaustion. They are not kicked out by their family—if anything their family leaves them behind.
The first effective drug for depression was brutal. It had every side effect in the book, and some extremely serious ones not discovered for years. But it didn’t matter. It broke up the depression and gave people the chance to live again. At its height, it was prescribed to 2M Americans. And it was widely abused, as well, though it would not make you high. (Desipramine Hydrochloride)
But it saved countless lives, and families. Research on better drugs was guaranteed.
Depression was bad, but it was nothing compared to Schizophrenia.
Schizophrenics can be terribly irritating to even be around. Their minds are intermittent, their awareness of others fleeting. One second they are your beloved child, the next they grab a blunt object and try to hurt you with it, unaware that you are even there. Much of the time is spent intently gazing at nothing, in a state of great tension and agitation.
And it destroys their physical brain. Nobody ever really gets better. All the drugs can do is help them see more reality and less illusion. It is especially cruel because it often strikes in the early 20’s. So parents get to see the child they loved, who they had raised, viciously taken away right when they were supposed to become an adult, with all its rewards for the hard work of childhood.
And other diseases. Manic depression, severe paranoia, Alzheimer’s disease.
Oh that last one is horrible. I have seen wards that are almost nothing but old widows, sitting in wheelchairs in corridor rows, staring at the blank wall in front of them if they are conscious, or asleep. The living dead.
In this case a family might help for a long time, and many families try. But eventually the continual need for professional medical care, now becoming so expensive in America it will be outsourced to Mexico—a reasonable alternative, overwhelms even the most noble of children.
The Mexican alternative is actually a good one, and might be expanded to other kinds of mental health care. The idea is to build American communities down there, where there are many, much less expensive, but quality English speaking health care workers. The drugs and procedures are good quality, but unburdened by rampant government.
They can give the infirm elderly and the mentally ill the labor intensive care they need. In Mexico, their elderly are kept at home and cared for by their families, so die much younger. But they would care for ours.
Yes, families can do much. But as bad as the system is, it is not based in ill will, but a true desire to find solutions for sick people in need. And families who can only do so much, when confronted by horrible sickness.
If freepers want to know how in the old days families took care of elderly parents or disabled family members, they can buy themselves a copy of “Wisconsin Death Trip”:
The Good Ol’ Days ain’t what they used to be...
. And even more disturbing, when let loose they breed. Whatever genetic mis-wiring they have then gets passed onto a new generation. Again, more expense. This is eugenics in reverse.
This is becoming a real issue. People who would have been sterilized or not be able to have children are now dropping very geneticly and chemically disabled children onto the state. This is a rapidly growning population.
Funny I am the only adult out of the 14 in my “set” to have children and I adopted mine. Fourteen healthy educated, creative and mostly advaced degreed adults did not reproduce for various reasons but there are a number of very disabled ones who do.
Thanks for the recommendation. Read the review and just now requested a copy at my local library.
I had a drunk female try to enter the house I was living in. I had to physically restrain her from coming in. She called the police and claimed I assulted her. The police knocked on the door around 11 at night and gave me the business. They were close to taking me downtown.
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