America's mental health care crisis
April 29, 2013 8:35 PM   Subscribe

Schizophrenic. Killer. My Cousin. "It's insanity to kill your father with a kitchen knife. It's also insanity to close hospitals, fire therapists, and leave families to face mental illness on their own." [Via]
posted by homunculus (25 comments total) 28 users marked this as a favorite

 
Trapped: The Story of the Mentally Ill in Prison
posted by homunculus at 9:04 PM on April 29, 2013 [2 favorites]


FWIW: the main article is a lot more far-ranging and thoughtful than the title makes it sound.
posted by Now there are two. There are two _______. at 9:40 PM on April 29, 2013 [8 favorites]


This is all too common here in Louisiana. The governor of Louisiana, Bobby Jindel, closed Southeast Louisiana Hospital.

Reaction from community leaders
State District Judge Peter Garcia, part of a six-person panel that set the tone for the night, said if mental health treatment facilities continue to be shut down, "the treatment is going to be jail."

To drive home the point that mental illness and crime are so intertwined, Garcia said of the more than 5,000 parole cases being supervised in St. Tammany and Washington parishes, more than 1,000 suffer from mental illness.

And Cecile Tebo, who spent seven years as commander of the New Orleans Police Department's crisis unit, said chronic mental illness figured into perhaps 70 percent of the 350-400 calls per month the unit rolled on.

"They're shutting down something that's 100-percent full, with a waiting list," she said of Southeast. "That's significant."


Something really needs to be done to help the mentally ill.
posted by JujuB at 9:56 PM on April 29, 2013 [1 favorite]


The governor of Louisiana, Bobby Jindel, closed Southeast Louisiana Hospital.

He's following Reagan's example.
posted by homunculus at 10:00 PM on April 29, 2013 [8 favorites]


if mental health treatment facilities continue to be shut down, "the treatment is going to be jail."

Well then I can give you one guess who would want more people in jail.
posted by Malice at 10:57 PM on April 29, 2013 [3 favorites]


One thing that anti-gun-regulation activists often do is to try to distract the conversation onto the poor state of mental health care in America. The implication, I suppose, is that there is no need to regulate guns, because only crazy people would shoot up classrooms - so if we had more mental health care, the problem would go away.

While I don't agree with any of those connections or implications - mentally ill people are not, in the main, more dangerous than anybody else - I at least agree with them that there should be much more health care provided for the mentally ill. Any society that does not take care of its mentally ill members and provide them with the support that they need is a failed society.

Basically, while I suspect it of being a rhetorical tactic - like the right's sudden concern for Muslim women - I wonder if the gun control debate might indirectly draw attention to the issue of mental health care?
posted by lucien_reeve at 2:22 AM on April 30, 2013 [1 favorite]


Welcome my friends to the ugly face of a society that worships individual Freedom at all costs. The freedom of Adam to have infinite money without sharing, the freedom of Jane to stab Adam to death despite it being obvious for 10 years that she was batshit insane.
posted by delackner at 2:29 AM on April 30, 2013 [4 favorites]


Any society that does not take care of its mentally ill members and provide them with the support that they need is a failed society.

Unless of course you see this sort of forced care as a violation of civil rights. Mentally ill people used to be put into institutions in the United States until a wave of Disability rights legislation in the late 1960s and 1970s made it illegal.

In 1967, the California Legislature passed "the Lanterman-Petris-Short Act, which makes involuntary hospitalization of mentally ill people vastly more difficult. One year after the law goes into effect, the number of mentally ill people in the criminal-justice system doubles."

People have a right to be crazy in the United States.
posted by three blind mice at 2:42 AM on April 30, 2013 [4 favorites]


FWIW: the main article is a lot more far-ranging and thoughtful than the title makes it sound.

I second that. This is a great piece.

Also, the photos from the "Trapped" work are great. Photo gallery.

Great post, homunculus.
posted by alasdair at 3:46 AM on April 30, 2013


I'm not sure what you're saying there, three blind mice. It was better that they were taken out of the health care system and put into the criminal justice system? That sounds like 1 step forward, 2 (or more) back.
posted by zombieflanders at 4:21 AM on April 30, 2013


One of my high school friends developed schizophrenia as a young adult. He had managed to get through high school in fine form, graduated from Villanova and eventually passed the bar, landing a good job with a District Attorney. His mental illness was not discovered until a bizarre incident which was picked up by a "funny news" website I happened to be reading.

I knew Chris as a gentle, kind and caring soul but had not seen him in years; the news account made no sense and sent me on a quest to find and speak with him. This proved fruitless as he changed addresses shortly after the news story broke. I continued to hunt sporadically for years. He had been a good friend and I worried about him, and it pained me to think of people laughing at something that clearly indicated a serious problem.

I finally found him online. I was one week too late--what I found was his obituary.

I got in touch with his family and learned that his last years were spent being cared for by his siblings, as no suitable environment could be found that they did not feel put him in danger. They did not elaborate. He died of diabetes which was poorly treated due to his mental illness.

The cruelest twist is that Chris is long gone, but that news story is still available for reading online if you search for his name, and that is his sole Internet presence. His mental health tragedy is now a joke for an electronic eternity.
posted by kinnakeet at 5:57 AM on April 30, 2013 [8 favorites]


" People have a right to be crazy in the United States."

This is true. But it's also true that setting the bar at "harms yourself or others" for involuntary confinement puts parents in a horrible bind. Until they hurt themselves, you can't make them get help. But after they hurt themselves (or others), well, now they're stupid/evil and don't deserve help. Putting the right to be crazy above all else makes it easier for those budgets to keep getting cut.

I have a friend whose brother is schizophrenic. They are smart, loving people with financial resources. But they can't force him to get help, and ten years ago, he ran off during one of his spells. They think he's somewhere out west, and are basically waiting for The Call. The one where they're told he's dead, or even worse, killed someone else. It's awful, the waiting.
posted by snickerdoodle at 6:33 AM on April 30, 2013 [9 favorites]


His mental health tragedy is now a joke for an electronic eternity.

This makes my heart break.
posted by MysticMCJ at 6:55 AM on April 30, 2013


I'm not sure what you're saying there, three blind mice. It was better that they were taken out of the health care system and put into the criminal justice system? That sounds like 1 step forward, 2 (or more) back.

posted by zombieflanders at 7:21 AM o



I think TBM's point is that the current state of mental health care in the US may be an unintended consequence of the wave of disability rights legislation and activism in the US.


I don't think it's any secret that the civil rights of the mentally ill were horribly abused in many institutions in the past. But as activists worked to shut such places down, they were also calling for more home-based care for the disabled. Their reasons were well-intentioned: to reduce abuse, and to allow people living with disability to direct their own lives. But their pitch to politicians was: think of the money that can be saved.


So, a lot of facilities were closed, legislation was passed, and many, many disabled people benefited tremendously. They could decide for themselves if they wanted treatment, and where they wanted to live. But for a lot of people with certain illnesses, mostly the severe mental illnesses, they're now stuck in a bind. The laws that chafed other disabled people benefited them, in the sense that they could be forced into treatment, and a facility would exist for them. Now, they and their families have no place to go, and no legal backing force someone ill into treatment even if an appropriate facility can be found.


Fern Kupfer wrote, in her essay Home Is Not For Everyone:

…the view that the “home” is the best place for every child has dangerous ramifications. Government funds are cut for human services under the guise of anti-institutionalization. Well-meaning reformers who tell us how terrible the institutions are should be wary lest they become unwilling accomplices to politicians who only want to walk a tight fiscal line. It takes a lot of money to run residential facilities.


That's why you get stories like kinnakeet's and snickerdoodle's.


I don't know how you resolve that. I don't know how you write legislation allowing families to force someone into treatment that doesn't compromise the rights of a lot of people who don't want or need treatment.
posted by magstheaxe at 6:58 AM on April 30, 2013 [8 favorites]


It was better that they were taken out of the health care system and put into the criminal justice system?

I think the point is that you cannot have both. You can't both have people forced to take care of themselves when they don't want to be and have freedom. Many, many people with mental illnesses do not want to be in institutions. They do not want to take medication. They want their own agency to make their own choices. Do you want to curtail their civil rights, or do you want them off the streets and out of the prison system?

(You see similar issues with Downs children, as well. The push to get Downs children out of institutions meant that parents who actually did want to institutionalize their child had nowhere to do it.)

These are real and important choices. But the one thing they definitely are not is simple. It is not as simple as "more money, more hospitals, on mental health."
posted by corb at 7:07 AM on April 30, 2013 [4 favorites]


I at least agree with [NRA gobshites] that there should be much more health care provided for the mentally ill.

Except that they don't really mean (or want) that; what they want is a distraction, and that callous exploitation of the mentally ill is yet another reason why they're bastards.

The largest mental health facilities in the US are within prisons. Prison is the welfare system that middle-class white America is prepared to pay for, and only just. Community mental health is, by comparison, even more threadbare and built around crisis response, which is on the cusp of becoming a matter for the criminal justice system and into the "stupid/evil" moral framework that snickerdoodle describes.
posted by holgate at 8:57 AM on April 30, 2013 [2 favorites]


Community mental health is, by comparison, even more threadbare and built around crisis response

This is my experience of it, as a former crisis hotline volunteer, the relative of someone who has worked in their local psych unit and in the local jail doing health care, and the friend and acquaintance of different people who have been patients. Quite often, once someone has come out of the crisis situation and are being treated (with medications or simply out of a crisis-inducing situation, i.e. college), they rebel against being labeled "sick", probably because of the stigma, and either go back into the situation that created the crisis or go off their meds, and cycle through again.
posted by Halloween Jack at 11:37 AM on April 30, 2013


from personal experience (both with and without health insurance) and as a hotline volunteer, it is hard to get into a therapist and to a psychatrist, hell even a regular old family doctor. i had a friend who's insurance would not let her see them both on the same day. seriously. if you try to get into anywhere, it's at least 4-6 weeks and that's if you can are able to take off work to make the first available appt. you need evening or weekend? you're looking at 3 months from now. how on earth are you supposed to find a doctor that meets your needs when you have to wait 3 months between "interviews" for your new provider?

how many questions are there on askme about "how can i cope while i wait for my appointment?". at least those people have together it enough to have navigated the system, set up an appointment, and then go further by asking for assistance in mitigating their anxiety/whatever in the meantime through healthy means.

how many people are just falling through the cracks like those in the article? the author's Aunt Terri was very lucky. Houston wasn't exactly falling through the cracks - he had a supportive family, but there was no support for them to be able to provide him. i guess that's falling through the crack.

for a country that seems to value efficiency, it seems like we'd all be a lot better off if everyone had adequate mental and physical health care - i know i'd be much more productive (and am much more productive) when my mental and physical needs are met.

i don't know if adequate mental health care would have prevented Houston from killing his father, but it seems like professionals in the article think so. instead of spending tax dollars on prevention and treatment, we're now spending them on incarceration and trials and such.

cause that makes sense.
posted by sio42 at 1:00 PM on April 30, 2013


Except that they don't really mean (or want) that; what they want is a distraction, and that callous exploitation of the mentally ill is yet another reason why they're bastards.

Or maybe they also want a reduction in violence and effective treatment for the mentally ill. Your chances of being mentally ill or knowing someone who is and having compassion for them, is in no way dependent on your ownership of a firearm or membership in the NRA. In fact, not having crazy people shooting up schools and theaters or the odd cop in the wrong place is a really good thing for anyone who cares about gun rights. Instead of just writing off a very large group of your fellow citizens who care enough about a specific issue to actually donate money (and maybe time) why not listen to what they have to offer and maybe use that passion to accomplish a larger goal?

But then if you do that you don't get to be RIGHT and those mean, nasty people with a hobby you don't like aren't WRONG and you can't spout sanctimonious bullshit about several million people's motives on the internet.
posted by bartonlong at 4:05 PM on April 30, 2013 [2 favorites]


The claim that a commitment to individual freedom prevents us from taking care of people who are mentally ill is mainly a cynical excuse for refusing to pay to treat them, but if E. Fuller Torrey is anywhere near right, the ultimate cost to society of this disingenuous and short-sighted selfishness has become truly enormous:
Ten percent of US homicides, he estimates based on an analysis of the relevant studies, are committed by the untreated severely mentally ill—like my schizophrenic cousin. And, he says: "I'm thinking that's a conservative estimate."
posted by jamjam at 4:34 PM on April 30, 2013 [2 favorites]


and those mean, nasty people with a hobby you don't like aren't WRONG and you can't spout sanctimonious bullshit

That is all my bum. The NRA's weaselry about "fixing mental health" means nothing more in practice than wanting money spent on a nice big register of the mentally ill. It's a smokescreen and an insult, not just to those with mental illness, but to the professionals who treat them and have to deal with their crises.

And they aren't my "fellow citizens", in so many ways.
posted by holgate at 7:05 PM on April 30, 2013 [1 favorite]


Why the NRA keeps talking about mental illness, rather than guns
posted by homunculus at 8:21 PM on April 30, 2013 [1 favorite]


I think the point is that you cannot have both. You can't both have people forced to take care of themselves when they don't want to be and have freedom. Many, many people with mental illnesses do not want to be in institutions. They do not want to take medication. They want their own agency to make their own choices. Do you want to curtail their civil rights, or do you want them off the streets and out of the prison system?

My mother has schizophrenia. I've been her caretaker for going on 40 years now. She doesn't like her current medication which requires a monthly shot but provides her with the ability to maintain a semblance of a normal life. She can go to church, run errands, visit friends. But she would rather take a different medication that is a daily pill. The problem is that when she has taken this route in the past, she forgets to take them for a day or two or three or four, has a psychotic break and ends up in the hospital for weeks at a time, usually following some upsetting events that embarrass her when she learns about them later. So who's to say where real freedom lies? In her choice? Or in mine and the doctor's?

My young adult daughter had a psychotic break due to manic depression last year. When she lied to the ER doctor and said she hadn't planned to hurt herself, did I stop him and make him go back in and ask her again in front of me? Would I have lied to get her the help she so desperately needed that night? Sure i would've. I really didn't give a rats ass about her civil rights or agency, I wanted her to get the medical attention that she needed. She wasn't in the position to make those decisions for herself. Two weeks later with the right treatment, she was better and is better now. There's not a doubt in my mind that if they would have let her walk out of that ER as they were about to do; she wouldn't have survived the night. How many lives have to be ruined because we are more worried about someone's agency than we are about getting them help? They don't stop being your child because they've reached some magical age.
posted by tamitang at 8:21 PM on April 30, 2013 [4 favorites]


How many lives have to be ruined because we are more worried about someone's agency than we are about getting them help?
posted by tamitang at 11:21 PM


I'm so sorry for the difficulty that you and your family have had to go through. I can't imagine how hard it is.


But how many lives have been demonstrably ruined because in the past we've forced people into accepting treatment, and ignored their agency? The annals of disability history are full of people who've been horribly mistreated because they had no say in their own lives, when they could have lived full and happy lives.


One of the slogans you hear in disability activism, especially when it comes to mental disabilities, is "assume competence". That is, in the absence of conclusive data, assume the person with a disability knows what they're doing and treat them accordingly. That's what our society is choosing to do now, because ultimately it's the least dangerous assumption for that person.


The ugly truth is that certain illnesses can unpredictably eliminate any competence, and then return it just as unpredictably. That unpredictable nature makes it hard to get conclusive data quickly, and thus makes it very difficult to assist people with those illnesses, especially if they are in crisis. We assume competence because we believe it helps, and I think in many cases it does.


But assuming competence can also prevent us from helping someone who isn't aware he needs help, or is reluctant to ask for help. So for someone like your mom or your daughter, the assumption of competence is an potential threat to her well-being. And I believe assuming competence is abused: many times we assume competence in the interest of short-term money savings, or of pushing a thorny problem off onto someone else.


I don't know how we resolve this as a society, I really don't. I don't know if we can realistically write legislation that protects the rights of some disabled people while restricting the freedoms of others. If we try, won't that just lead to additional problems for the people living with those particular illnessed? Stigma and prejudice and goodness knows what else?


Do you have a suggestion? 'Cause I'd love to hear it. I'd love for us to stop talking about the problem--because we all know it's a problem, a big one--and start talking about what it's actualy going to take to fix this, beyond vague statements of "we need genuine health care reform in the US." How do other countries handle it? Is there some society out there with a best practice we can adopt?



They don't stop being your child because they've reached some magical age.
posted by tamitang at 11:21 PM



Not every person living with a disability is fortunate enough to have family members who are genuinely concerned about their well-being. One of the benefits of prioritizing agency is that folks living with disabilty are afforded the opportunity to reduce or eliminate the role of non-beneficial family in their lives.

That's not a cure-all. It doesn't save everyone, but it's saved enough people that I for one am reluctant to see any of those rights of agency rolled back.
posted by magstheaxe at 8:23 AM on May 1, 2013 [2 favorites]


I don't know. If holding someone for a three day evaluation is the price we pay to prevent another Sandy Hook or Aurora then i say it's worth it. When a kid's parents are BEGGING for help, and it's all about his agency right up until he chops his dad's head off, for Pete's sake, something has to change in how we access help for seriously mentally ill people in this country.
posted by tamitang at 4:08 PM on May 1, 2013


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