Lack of Assistance for the Mentally Ill

So many mentally ill people ended up on streets after state institutions closed.

Leaves Homeless and Violent People on Streets

Mother Jones reported in May/June 2018 “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.”

In the story, the author wrote about the start of state mental institutions.

“ON OCTOBER 12, 1773, the first patient was admitted to the Public Hospital for Persons of Insane and Disordered Minds in Williamsburg, Virginia, the first North American facility of its kind. The governor, an Enlightenment man, had prevailed upon the assembly to create a place where ‘a poor unhappy set of people who are deprived of their senses and wander about the countryside, terrifying the rest of their fellow creatures’ could, with the help of experts, reclaim their ‘lost reason.’

Over the next 100 years, the rest of the country followed suit, taking ‘lunaticks’ out of cages in jail basements after Boston schoolteacher Dorothea Dix happened into one such dungeon in 1841 and launched a fact-finding and activism rampage that led to the establishment of 110 public psych hospitals by 1880.”

Now almost 250 years later, in the supposedly enlightened United States, the mentally ill are back to wandering the streets.

When speaking at a recent Palisades Rotary Club meeting about the downtown Skid Row homeless population, the Midnight Mission’s David Prentice said, “About 90 percent have mental health issues.”

In an August 5 Wall Street Journal article (“Mental Illness and Mass Murder”), author Dr. E. Fuller Torrey writes “There are some one million people with serious mental illness living among the general population who 60 years ago, would have been treated in state mental health hospitals.”

He cited an FBI report released last month “Mass Attacks in Public Spaces– 2018”) in which investigators found that 67 percent of the suspects displayed symptoms of mental illness or emotional disturbances. “In 93 percent of the incidents, the authorities found that the suspects had a history of threats or other troubling communications.”

The Wall Street Journal editorial on August 5 (“The Killer in Our Midst”) recommends several steps in preventing mass shootings. One is dealing with mental health issues. “This is a matter of policy more than money. . . The problem is identifying those with mental illness who are a threat, and then allowing society to intervene to prevent violence. Overwhelming evidence suggests that the de-institutionalization of the seriously mentally ill has had tragic results.”

In Pacific Palisades, one only need look at Ruby, who is homeless and sleeps in the library entrance. Her legs are so swollen, she can barely walk. Or Timmy who has moved back near the 881 Alma Real Building in his wheelchair. Is there no place they can go – or be forced to go?

Removing the mentally ill from institutions started with good intentions.

President John F. Kennedy

President John F. Kennedy in February 1963 wrote: “I am proposing a new approach to mental illness and to mental retardation. This approach is designed, in large measure, to use Federal resources to stimulate State, local and private action. . . . emphasis on prevention, treatment and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.”

More than 500,000 people were housed in state institutions when The Community Mental Health Act of 1963 was passed. About 1,500 mental-health centers were to be constructed to provide community-based care. Kennedy’s vision was to treat patients while they worked and lived at home.

The act focused on five essential services: inpatient beds, partial hospitalization beds, 24-hour emergency evaluations, outpatient services and consultation/education.

However, after the passage of the Act, 90 percent of the beds were cut from state hospitals. And three months after signing the legislation, Kennedy was assassinated. Only about half the proposed centers were eventually built and none were fully funded.

According to a 2016 blog from UC Berkeley from a course Foundations of Legal Studies (“The Community Mental Health Act of 1963: A Response to Institutionalization and What Came After”) there was a shift in policy from a state responsibility to a federal one.

States were supposed to apply for federal funds for community centers.

On July 30, 1965, Medicare was signed into law, giving states an extra incentive to move patients out of state hospitals. Once out of hospitals, federal governments covered the cost, rather than states.

During the 1960s and 1970s more than half of the state hospitals closed.

From 1965 to 1969, federal outlay towards Community Mental Health Centers dropped to $260 million. Then between 1970 and 1973, Richard Nixon dropped funding to $50.3 million.

In the 1970s, the mental-health program competed with domestic programs, some of which were health-related, some not.

Rosalynn Carter

First Lady Rosalyn Carter chaired a Commission on Mental Health in 1977 and it was decided to reinvigorate the program with added funding. Congress passed the Mental Health Systems Act of 1980 to continue funding for the remaining Centers.

A year later the Reagan Administration passed the Omnibus Budget Reconciliation Act of 1981 which effectively ended federal categorical grant programs to local communities, changing them to block grants. This allowed states to spend money however they chose.

Hospitals continued to close, and since states chose funding for other projects, many mentally-ill people housed in hospitals went into nursing homes, jails and prisons, or were left homeless.

According to one report, nursing homes became the single largest type of placement from state hospitals because federal funding through Medicaid was available for nursing home care but not for non-institutional settings.

According to Paul Appelbaum, a Columbia University psychiatry professor, the three largest mental health providers in the nation today are now jails: Cook County in Illinois, Twin Towers in Los Angeles County and Rikers Island in New York.

During the 1970s, public opinion started to shift: thinking that mental illness is curable, which meant state mental institutions should be closed.

Laws were changed to limit involuntary hospitalization. That meant that people couldn’t be committed, no matter how mentally ill, without their consent, unless they were a danger to self or others.

John Campo wrote in STAT News “It’s Time to Recognize Mental Health as Essential to Physical Health” that:

“1. Most emergency departments are ill-equipped to meet the needs of patients in the midst of mental health crises.

“2. Most insurance plans view mental illness and addiction as exceptions to standard care, not part of it and,

“3. Despite an overall cultural shift towards compassion, our society still tends to view the mentally ill and those with addiction as morally broken rather than as ill.”

Peter Earley, award winning novelist and journalist, wrote about the struggles to help his son Mike’s severe mental illness in “Crazy.”

One of the questions he asks his son is “Why won’t you take your medication?”

Earley writes, ”Let’s skip the obvious reasons –that some anti-psychotic medications can dull a person, make them feel physically lousy, kill their sex drive, cause them to gain weight or send them to bed exhausted even though they are already sleeping for 16 hours a day. Let’s ignore the fact that no one really knows the long-term health impact that medication can cause on a person’s body.”

His son writes “Denial was a strong factor in my understanding and even when evidence of my own madness would be presented, my mind would find a way to weave out of the circumstance and an obtuse reasoning would somehow form that would keep my own pride intact. Always two steps ahead of the truth, my brain would tap dance its way into a room where I was not at fault, where it was everybody else versus me, where I was some sort of prophet or special medium who was undergoing visions, not hallucinations, and I was important, not a victim.”

Elyn Saks with her husband Will Vinet. She spoke to the Palisades Task Force on Homelessness.

When Elyn Saks, the author of The Center Cannot Hold: My Journey Through Madness,” spoke to the Pacific Palisades Task Force on Homelessness in May, she noted that about one in three homeless have severe mental illness and then spoke about her own struggles with schizophrenia and her battles of taking medication.

“I wanted to prove I wasn’t mentally ill,” she said, “by not taking the medication.”

Her advice about treating mental illness was to provide more and helpful treatment, which would include medication and therapy; use force less and study how to get people to treatment and redefine grave disability.

Saks said that as a result of mental illness, people can’t understand the choices and the law doesn’t allow us to care for loved ones. “We need services in place,” she said, and spoke about her difficulties in finally accepting and taking her medication.

“I’m totally committed to it,” said Saks, who is Associate Dean and Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the University of Southern California Gould Law School.  “Do I want to slobber at night or be psychotic? Do I want to gain weight or be psychotic? I’m dedicated to medication now, but I’m glad I got to make the choice.”

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One Response to Lack of Assistance for the Mentally Ill

  1. Rosalie says:

    This is such a thorough look at the status of mental health and the homeless connection. Thank you, Sue, for your work on this.

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