Mental health system's gaps pose threat to us all
By DR. MARC J. YACHT
Published April 25, 2007
Mental health treatment represents one of the largest holes in our health care system. Health coverage eludes 47-million U.S. residents, but millions more have inadequate mental health coverage. Surveys suggest that about 15 percent of the U.S. population seek mental health services each year. Half that number have significant mental health problems and one in three of that group receives services. That translates to 15-million people with serious mental disorders with little or no care.
The history of mental health services in the United States began with the asylums that evolved to mental hospitals and finally community mental health centers. The advent of the centers in 1955 marked the era of deinstitutionalization and what was touted as a more humane approach to mental illness.
The states and federal government bought into deinstitutionalization and the community mental health network hook, line and sinker. After all, look at the savings; and if the experts are sold on the idea that the state hospitals are inhumane and archaic, who are we to argue. If the experts believe that a community mental health network can offer treatment and a normal life to many who might spend their life institutionalized - it's a win-win; it's the right thing to do!
Unfortunately, the mass exodus from the state mental hospitals left many very ill people without care or their medications, and a very large population of these folks never stepped foot in a community mental health center.
Although the experts pointed to populations that were mainstreamed, little attention was given to the rising numbers of homeless, one-third of whom were mentally ill and often from the state hospital system.
Even today, psychologists and psychiatrists will argue that mainstreaming this population was the correct and humane thing to do; they will also admit that the community mental health system was never funded or able to capture the full population of mentally ill that were released.
Law enforcement has its own problems with the mentally ill who don't receive treatment. The extra burden on law enforcement officers has been overwhelming.
But more important, disturbed people are placed in the prison population without adequate evaluation and treatment. Often, particularly in the dangerously psychotic, that treatment requires isolation and lockdown. Rarely is a jail equipped adequately for that inmate.
However, treatment modalities are superb in treating an array of serious psychiatric disorders. Many, who prior to 1955 might be permanently housed in state hospitals, could, with the treatment regimens available today, live long and productive lives within their communities.
The problem is, as it is throughout our health care system, too many mentally ill cannot access the services and medications they need.
How many tales have we heard of mothers with seriously disturbed children who cannot get the treatment or medication needed for their loved one?
How many walk our streets with bipolar illness and other significant mental disorders without treatment?
How many violent crimes are traced to mentally ill individuals who cannot get or refuse the treatment they require?
Efforts to mainstream the mentally ill must be viewed as progressive and humane. However, that should not interfere with the need to properly isolate and treat the dangerously sick. The state reception centers had the ability to make such identification and house and treat those in a hospital environment. Careful professional determinations would be made for their ultimate release - if ever - into society.
Allowing the discharge of the seriously mentally ill from prison and allowing the untreated to walk the streets without access to medication or services leads to the all-too-frequent headline about preventable death and injury to innocent people. The emotional price on all of us cannot be overestimated.
The opening of the community mental health centers should not have emptied our state mental hospitals and allowed so many untreated mentally ill to roam the streets. That is what happened regardless of the intent of the growth of the community mental health care system. We continue to pay daily as a society for not addressing this problem.
The reception centers should be reopened and the seriously mentally ill isolated from the community with adequate treatment and housing.
Tragedies will continue to strike us within our own communities without the proper attention and resources provided for mental health services.
Dr. Marc J. Yacht is the retired director of the Pasco Health Department.
[Last modified April 25, 2007, 06:38:45]
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