Mental Health Conundrum
In the1960s, I was part of a Lexington, Massachusetts research project to train volunteers to help empty state mental health facilities. After nine months of training, our group of twelve was assigned patients. Our mission was to reintroduce them to the world. The forty-year-old woman in my charge had been in a locked ward for most of her life. Her mother resided in the same hospital.
State mental hospitals were horrible places where inmates had no rights. Their dormitories were overcrowded, attendants poorly trained, and the grounds were a fenced-in prison. I saw one woman nearly catatonic after having a lobotomy. The ward my patient was confined to held severely ill people. One wall was lined with women staring into space while tied to their chairs. Two others were talking to the wall as they turned in circles. While waiting to meet my patient, a woman wandered into the nurse’s station and started choking me. It took several nurses to ply her hands from my neck.
The situation I found myself in, started as a response to prison conditions in the mid-1800s where psychotic inmates were “chained, naked, beaten with rods, and lashed into obedience.” After witnessing these deplorable conditions, Dorothea Dix of Massachusetts lobbied for states to create asylums. By 1955, half a million people were in state-run psychiatric facilities. They were set up to be safe, therapeutic places where people could live productive lives. Many put patients to work in small-scale agricultural farms, others had laundries or bakeries. By the mid-1980s the number had dropped to 100,000 and incarcerations grew.
By the 1950s, Mental health professionals were lobbying to abandon the hospitals and treat patients at community mental health centers instead. They believed that erratic behavior could be controlled by medications making it possible for mentally ill people to lead normal lives. Unfortunately, that is not what happened.
More patients moved in and the facilities outgrew their capacity. Staffing became even more critical during WWII when doctors and nurses were drafted. It wasn’t long before these hospitals resembled the earlier prisons.
In 1954, FDA approval was given to the antipsychotic drug known as Thorazine. It introduced the idea that mental illness could be cured with medication and state mental institutions were no longer needed. President John F. Kennedy sighed a law in 1963 to replace custodial mental institutions with community health centers. Medicate, created in 1965 accelerated the shift by not paying for inpatient care.
What happened is that few mental-health centers were built and Thorazine, the miracle drug, had serious side effects. Research shows that a simple drug can’t cure conditions like bipolar disorder and schizophrenia. Those who benefited, often couldn’t manage their medications. Community-based care turned out to be a failure.
Mental health crises today are usually dealt with by law enforcement. These officers are poorly trained to deal with such emergencies, and the laws intended to protect civil liberties made it easy to arrest disturbed people but difficult to hospitalize them against their will. According to a Washington Post database, nearly half the people in jail and more than a third in prisons are diagnosed with a mental illness. One-quarter of fatal police shootings involve a person with mental illness. Suicide among this population is high, and care is inadequate for incarcerated prisoners. The mental hospitals of the past and the prisons of the present are shockingly similar.
The shift from hospital to prison created other differences. State hospital patients were primarily composed of men and women middle-aged or older. Today’s incarcerated patients are largely young, male, and not white. These numbers grew along with the 1972 to 2009 War on Drugs where the prison population grew 700 percent. Many mentally ill people self-medicate with illegal drugs, making them especially vulnerable to incarceration.
In Oregon, a judge recently called for the release of 100 patients from our overcrowded state hospital. At the same time, there are calls in the community for new treatment facilities to separate the mentally ill from the prison population. Throughout the nation, Crisis Intervention Teams are being formed to respond to psychiatric calls, yet there is no evidence that a few hours of instruction will overcome use-of-force practices.
Other alternatives to prison are being tried. Over 300 mental-health courts oversee people who agree to treatment, medicine, and regular check-ins with a judge. But without a real system of mental health care, it remains likely that more people will enter the criminal justice system. Forty percent of the homeless suffer from mental health issues.
Overall, twenty percent of the population suffers from mental health issues. How to help is a conundrum. Do we let them wander through life without hope or do we step to the plate and change the way their treatment is handled? Mental conditions are complex and require a personalized approach, but imagine how much better our communities would be if this problem was tackled straight on. Right now, we lack an effective system of mental care.
There continues to be a demand for good residential treatment facilities. My hope is that the mental help system will be rebuilt with compassion and that services will be within reach of the general public, not confined to the wealthy. There are wonderful private facilities that serve as an example of the kind of programs that should be available to all.
References:
Torrey, F.( 2013) Ronald Reagan’s shameful legacy: Violence, the homeless, mental illness. retrieved from https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/
Lyons, R. (1984) How Release of Mental Patients Began. New York Times. retrieved from https://www.nytimes.com/1984/10/30/science/how-release-of-mental-patients-began.html
Roth,A. (2021) THE truth About Deinstitutionalization. The Atlantic. retrieved from https://www.theatlantic.com/health/archive/2021/05/truth-about-deinstitutionalization/618986/
Sheppard Pratt website. Care and Service that change lives. retrieved from https://www.sheppardpratt.org/care-services/
Do you have a friend or family member suffering from a mental disease? Do comment below.
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