America's Mental Health Crisis
August 27, 2014 3:33 AM   Subscribe

Brave and afraid and heading down the longest road [Part 1/3] The cars made a wet rushing sound as they swept past him, close enough that he could feel their motion in the air. He was certain if he tried, he could reach out and touch them. Mike Bourne stretched out both arms, fingertips extended. He was walking in the middle of the busy street. The yellow line on the pavement told him where to go. He thought of it as the yellow brick road. It would take him somewhere, he knew, somewhere beautiful.

Days of crisis, compassion, faith, and futility [Part 2/3]

Later that night, Mike called the police. “I don’t know if I should take my meds,” he told them. “Some of my friends have died.” He was sure the pills were dangerous. Take your pills, the dispatcher advised. The next morning, Mike was up early, and he was wearing his suit. It was never a good sign.

Desperately guarding a spark of hope [Part 3/3]

Later the same week, at the end of May, Peggy came home and found a waiting bouquet of carnations. She took it as a plea from Mike for forgiveness. She clung to the evidence of the good in him, but frustration and helplessness engulfed her. At night, she dreamed she was pulling all her hair out. She dreamed that doctors were removing part of Mike’s brain. She woke up breathless, in a panic.

My Son is Mentally Ill, So Listen Up

The only time mental illness dominates the national conversation is when something goes tragically wrong. But the dialogue doesn't last. It gets buried under arguments about gun control, video game violence and unheeded signs of trouble -- until there's yet another mass shooting.

If Only They Had Treated Him Before

Often, family members bear witness to their loved one's unraveling -- and are stymied by a system that is structured for the back end, to hospitalize and treat mentally ill people after they become a danger to themselves or others.
posted by ellieBOA (16 comments total) 30 users marked this as a favorite
The debate isn't about whether reform is needed; it's about how best to implement it -- a delicate balance between treatment, civil rights and public safety.

"Delicate balance" is an understatement. We used to have a system where anybody vulnerable enough could easily be involuntarily committed on somebody's say-so just for being a nuisance, and we ended up with institutions so crammed full of people who had no reason to be there that the system broke under the strain. I don't think it's any wonder if the pendulum has swung farther the other way than anyone intended.
posted by The Underpants Monster at 6:04 AM on August 27, 2014 [6 favorites]

God, a caseworker would be heaven. I've been clawing my way through the medical system in the few waking hours I've had lately trying to get on medication that actually works and get treatment for what's obviously a condition of some kind and being my own advocate when I'm so exhausted I can hardly even take care of myself is a living hell.
posted by NoraReed at 6:04 AM on August 27, 2014 [9 favorites]

I wonder if the painkiller thing is because of a contraindication with his medications, or some misguided (in my opinion) sobriety thing? I admit that I skimmed the article, but I didn't see anything about substance abuse problems.

Suppose he does have cancer. Do they expect him to avoid pain meds then?
posted by thelonius at 6:08 AM on August 27, 2014 [3 favorites]

These stories just rip the heart out of your chest. I had honestly hoped to find at least a few links at the end of either the Globe or the CNN series about where people like the ones described (especially the caregiver families) might start looking for help. But no, nothing. All the brick walls they described in the stories and hey, here's two more. Anyway thanks for the post, ellieBOA.
posted by jfuller at 6:18 AM on August 27, 2014

An assistant DA read from a police report, recounting the facts that had led to his arrest. The charge was for “obnoxious behavior” undertaken “to cause public inconvenience.” Mike pleaded guilty, and the judge issued the sentence: one $100 fine for disturbing the peace; another $100 for disorderly conduct.

Why is he being punished for having a disease?
posted by Obscure Reference at 6:39 AM on August 27, 2014 [2 favorites]

comparing this to the earlier post highlighting Lena Dunham's ready access to mental health resources is jarring, to say the least.
posted by leotrotsky at 7:56 AM on August 27, 2014 [5 favorites]

I've been meaning to make an FPP about my local paper's exemplary work on this topic, but I'll leave a link here instead: Chronic Crisis: A System That Doesn't Heal. (In Milwaukee County, only police officers -- never mental health professionals -- can sign an order to have a person involuntarily hospitalized. No specialized training is required. You just need to be a police officer.)

State and county mental hospitals are terrifying and often acutely dangerous places, but that's exactly where we shunt our most vulnerable citizens: People who need treatment but don't have the familial resources, money, or insurance coverage to be sent to the kind of private hospital that has the bandwidth to treat them. Officials who make noises intimating that more people should be involuntarily committed or held for longer periods tend to be unwilling to work to acquire the fiscal and human resources that will be required to accommodate said uptick. Instead, we just keep the revolving door turning. Instead of focusing on actual healing, we focus on getting indigent patients back out onto the street as quickly as possible (which tends to mean medicating them as heavily as possible, in hopes that they'll be sedated into compliance) so we can free up beds for another go-round.

I've had MDD since I was very small, for as long as I can remember. I work hard to keep it in check, I don't want it, I didn't ask for it, and I wish every single day that it would just go away, but people with mental illness -- no matter how severe it is -- are generally treated like we could get over it if we tried a little harder or wanted to be well a little more sincerely. I don't much like talking about it because I know exactly what acknowledging that you have a severe mental illness does to a healthy person's idea of you: Whether they'll cop to it or not, consciously or subconsciously, it makes them think you're crazy, and that you can't be trusted because your mind and judgment have been deemed to be unreliable and unpredictable. It gives them a card to pull on you if you ever fall out of their favor. So no matter how sick we might get, no matter how desperately we might need help, we're encouraged to try to hide it at all costs and never let it slip for an instant, because we know any admission to the contrary means our employment, physical health, familial stability, and friendships will be put at great risk.

And even as well-meaning politicians and celebrity doctors rush to TV news studios to yammer about how hard they're working to Eliminate The Stigma, even though one in four Americans suffers from some form of mental illness, even as bought-off psychiatrists write out Abilify prescriptions with their Seroquel-branded pens, we still talk about it in hushed, frightened tones. Even from supposedly sympathetic sources, if mental illness is discussed at all, it's discussed in the same breath as murderers and violent psychopaths.

The CNN link sums it up well: "The Navy Yard. Newtown. Aurora. Tucson. Virginia Tech... People don't ask how to help boys like Daniel. It takes a James Holmes to grab the nation's attention. A Jared Loughner. An Adam Lanza." The only time the public at large seems to be moved to think or speak about mental illness is when someone goes on a killing spree (or hurts themselves, but only if they're famous or there's a newspaper article written about them) -- who would do anything like that except for a CRAZY person? -- so we're all tarred with the same brush; there are no mitigating sentiments. Mentally ill = threatening, unpredictable, violent.

I think involuntary commitments destroy more lives than they save, and not only because society simply isn't willing to support suffering people before they're in a situation where 5150 might come up. I think the officials in charge know this, I think they aren't doing anything about it because they don't care, and I think they don't care because they don't have to care: No one listens to or cares about crazy people, especially when they're poor, unless they kill or grievously wound someone. Then we can all spend some time making sympathetic noises about how we need to take away the crazy people's guns and give them more medication and everything goes back to business as usual until it happens all over again. I'm tired of having an illness I did not ask for afford people the opportunity to talk about how having mental illness makes me and people like me inherently more dangerous than someone who hasn't been diagnosed. I don't have a solution. I don't know what should or can be done. I'm just tired. For Mike and Will and Daniel and all of us, I'm tired.
posted by divined by radio at 8:01 AM on August 27, 2014 [23 favorites]

I think people have a problem seeing two extreme's- one in which all mentally ill people are involuntarily committed, and the other in which no one is ALLOWED IN even if they desperately want help, unless a danger.

It's a bizarre and terrible state of affairs. I had one friend who used to park his car in the parking lot of the mental institution here and think about walking in and self injuring so that they would take him in, because they wouldn't just take him in because he felt bad. Of course part of why he felt bad was all the child abuse, and being a runaway and living in his car for years, and not having a stable home or ability to work a job that would pay for a healthy quality of life or a safety net if he needed to work less hours to deal with all the stress and trauma.

We're forgetting how intricately entwined housing, food access, financial safety net, and social support resources are mixed in with mental wellness and outcomes, and those resources need to exist both PREVENTATIVELY to prevent people be injured by those conditions of instability and also in tandem with mental health and trauma care for those already damaged. We won't be healing anyone throwing meds at homeless people, or people so ill their work ability has been impaired and they can't afford a healthy stable living situation even while working at the jobs or hours they can handle. And certainly not by taking them in for a few days and tossing them back out on the streets even with an hour of therapy a week available (which usually isn't).
posted by xarnop at 8:24 AM on August 27, 2014 [7 favorites]

Reading that series, I was just exhausted for Peggy. Mike's journey is his own, and it's horrifying thinking that he can't feel good because if he does, his mind can't be trusted, and if he's in an acceptable state for society, he feels terrible. But his mother has given her entire life to trying to care for him, and the articles really pointed out that no matter what she tried to do, she was so limited in help, and her love and attention alone weren't going to help her.

I wish them both peace.
posted by xingcat at 8:27 AM on August 27, 2014 [5 favorites]

And yeah, failing to provide comprehensive wellness resources (which requires FUNDS) so that people healing are in stable, healthy nurturing environments with healthy food, permanent housing (unrelated to mental health status) and a financial safety net and extensive wellness, stress management, and healthy living resources and simply invoking the idea that all these mentally ill people need to be on more meds or stuck in involuntary commitments more often is a rather horrifyingly common practice among those who have way to much power to influence policy and social education.

When we wait for people to become ill to provide support services we are facilitating a state in which people have to become ill to get services-- and STAY ILL to receive them.

We need to decouple support services (such as housing, financial aid, food, emotional support) from diagnostics, and help people in need, knowing that whether they are currently ill or not, helping them get stable living conditions and support to develop is the right thing to do.
posted by xarnop at 8:32 AM on August 27, 2014 [3 favorites]

We still involuntarily commit tons of mentally ill people, but now it's in prisons and jails, e.g. Rikers, where, conveniently, those who enter with no or minor mental health issues have a good chance of those issues turning major and debilitating. Go, us.
posted by rtha at 9:17 AM on August 27, 2014 [2 favorites]

Why is he being punished for having a disease?

Because a disgusting number of people view mental illness as a moral failing, and not a disease. "Just cheer up," they say, "it can't be that bad. I've been depressed before but I got over it."

FITB with any mental illness of your choice, pretty much, and that is how a really frightening percentage of the population views actual mental illness. The last couple of times someone has pulled that bullshit on me I've shown them my scars and outlined in detail exactly what it's like to be admitted to hospital after OD'ing on purpose.

permanent housing (unrelated to mental health status)

I know exactly what you mean here, don't worry, but your words bring up yet another problem: how many people who don't understand how very much a stable and healthy living situation contributes to improved mental health outcomes. Stable housing won't automatically make you better, but it helps, and unstable housing will always, always make things worse.
posted by feckless fecal fear mongering at 10:03 AM on August 27, 2014 [3 favorites]

I've been thinking about my own problems with mental illness in relation to what else has been going on in the world. And I realized that even though I am a white lady, educated and relatively priviledged, well medicated and currently stable, if I ever am compelled to do something in protest or sacrifice myself for another or an ideal, the only thing that anyone will ever notice or attribute my actions to is that I was crazy.
posted by monopas at 10:11 AM on August 27, 2014 [8 favorites]

Amen. It's not just stable housing; anything you can do to cut out major stressors and uncontrollable forces seems to (in my admittedly limited experience) greatly reduce the problems that stem from mental illnesses. For those situations I've experienced, at least. I mean, it's sort of a silly-obvious thing to say, but if you're stressed the fuck out about where you're going to sleep, if you're going to be able to eat today, if your boss is going to fire you because you couldn't make it in to work because of your illness, etc., then you're more likely to start a downward spiral.

Having a safety net that actually caught people and supported them would not only be the right thing to do, but would seem to go a good way towards reducing the symptoms and suffering that result.
posted by introp at 10:13 AM on August 27, 2014 [2 favorites]

Yeah, but as a culture, North America is not particularly interested in pennies of prevention being worth pounds (or kilos north of the border) of cure. It's just not something that exists on our radars.

I very firmly believe that not only do we need to train a lot more psychiatrists, but that everyone should visit a psychiatrist for a couple hours at least once a year, same as you'd go to your GP for a physical checkup. The savings from such a societal investment would, I suspect, far outstrip any upfront costs of doing these things.
posted by feckless fecal fear mongering at 10:24 AM on August 27, 2014 [1 favorite]

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