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We need to move mentally ill out of prisons, into hospitals

 

The son of a friend of mine, I’ll call him Kevin, is schizophrenic. He graduated from Mac High drug-free and mentally healthy, but later succumbed to a family history of mental illness.

Guest Writer

Scott Gibson M.D., a frequent contributor to the News-Register’s Viewpoints section, returned to his childhood home 30 years ago to practice medicine. He served on the McMinnville School Board from 2011 to 2017, when he and his wife Melody, moved to Amity to open a bed and breakfast inn. He has an abiding interest in science, which has expanded from the medical core disciplines of biology and chemistry to encompass physics, astronomy, geology and others. He is also a study of public policy. .

In his 20s, he gradually spiraled into paranoid delusions and auditory hallucinations. He separated himself from his family and became homeless.

His girlfriend, also mentally ill, became pregnant. But he could not support the child financially or parentally. 

His family tracked him down and took him to the county mental health clinic. But he refused to take prescribed medications and skipped scheduled appointments, as his paranoia made him distrust the very people trying to help him.

He veered to the street, where he was arrested for shoplifting headphones he hoped would drown out the voices echoing in his head. Only then was he administered medications that freed him from his racing, delusional thoughts.

Kevin’s case exemplifies the situation of hundreds of thousands of mentally ill Americans who are relegated to live — and all too often die — untreated on the fringes of society.  

There was a time, ranging into the mid-1960s, when people like Kevin were hospitalized, often against their will, in state-run institutions for the mentally ill.  There, they were obliged to take medication while remaining for indefinite periods.

Abuses in some of these institutions, and a belief that the mentally ill could be treated more effectively and humanely in community clinics, led to their wholesale “deinstitutionalization.”

In 1955, there were 337 psychiatric beds per 100,000 people in the U.S. Today, there are 12 per 100,000.

Over the same period, the incarceration rate in U.S. jails and prisons has risen from about 150 per 100,000 to about 850. 

Some have termed this process “transinstitutionalization,” as the mentally ill are effectively just being transferred from hospitals to prisons. 

According to the U.S. Department of Justice, about 15% of state prison inmates and 24% of county jail inmates meet the criteria for psychotic disorders such as schizophrenia. The corresponding figures for mania are 43% and 55%, respectively.

It seems we no longer treat psychotics, we simply jail them.

Psychiatric beds are at such a premium that patients present in the emergency room with a mental health crisis often languish in the ER for days, sometimes even weeks, awaiting placement. The scarcity of psychiatric beds also means patients are discharged earlier, in less stable condition. 

Joel Braslow, a professor of psychiatry at UCLA, writes, “Hospitalizations became shorter and less frequent, as homelessness became an increasingly permanent and normalized fate.” And far too often, the homeless mentally ill refuse treatment.

Like Kevin, they cannot sense their own illness and harbor great suspicion for others. The voices in their heads become their only guides.  

Even if they start treatment, they often quit prematurely. Of those who start anti-psychotic medications, 74% call a halt within 18 months.

Yet our system grants them the same right to refuse treatment as a person choosing whether or not to take their cholesterol medicine, a right granted in the name of respecting “autonomy.”

This is dangerous nonsense. Allowing a person to sleep under a bridge in freezing weather, because inner voices tell him to shun help, is not a sign of respect.

At what point did we decide death from hypothermia was a victory for human dignity? Are we now to celebrate screaming at space aliens on a street corner as a triumph of individual freedom?

It is time that we, as a society, admit our experiment with deinstitutionalization of the seriously mentally ill has proven a woeful failure.

Those whose mental disorders are uncontrolled and hazardous to themselves or others should be admitted to mental hospitals.  If they will not accept help and they are living in an unsafe environment, they should be institutionalized.  

We need mental health hospitals that are adequately sized and humanely operated to secure patients until their disease can be brought under control. We also need something akin to the criminal parole system to follow patients after they are discharged.

This is not to control their lives, but to ensure that they continue to get the ongoing care necessary for a chronic, debilitating and often dangerous illness. 

Families should be involved when patients are institutionalized.

Too often in our current system, family members that are critical to patients’ success are excluded from treatment plans. Yet families are typically the first to know when patients quit their medications and begin having hallucinations again.

Caring for the seriously mentally ill must be approached communally and holistically, while still recognizing their dignity as individuals. 

Building and staffing the mental health hospitals we need will be expensive, but prisons are expensive, too. We can build on the systems we already have—improve them, expand them.

Providing adequate mental health care will be a decades-long project, but one we must start now. Our homelessness crisis is but one very visible indicator of how wrong our current system is.

Kevin is better now. With years of herculean efforts by his family, he is taking medication regularly and it hasturned his disease around. He is back at home and looking for work. 

He could have been helped much earlier, and avoided homelessness, a criminal record and a child born too soon to an unprepared father. 

Treatment works. It can and does change lives.

Homelessness and criminality are not the inevitable fate of the mentally ill. We just need the will to change the flawed system we have created.

Comments

Tuvey

Thank you for this. You're right in that we need to start treating mental disorders instead of letting them try to "treat" themselves. I believe a first step would be to start treatment in prison and maybe even have a special prison ward, as opposed to building a new mental hospital. What kind of funding would you suggest? How would we go about "arresting" those who would need to be institutionalized? How would we make sure we don't put someone in who shouldn't be? You've started the ball rolling, now follow up and put some action into your words.

Megmaa

yes yes yes yes yes yes. Right when we began to "de-stigmatize" mental illness is right when we pulled the carpet out of treating it effectively. The lack of oversight of handing out medications in such large quantities without more oversight is also a tragedy that has come from removing "institutions". This leaves a person alone to try to decode the world of pharmaceuticals and the path of their illness.

Megmaa

yes yes yes yes yes yes. Right when we began to "de-stigmatize" mental illness is right when we pulled the carpet out of treating it effectively. The lack of oversight of handing out medications in such large quantities without more oversight is also a tragedy that has come from removing "institutions". This leaves a person alone to try to decode the world of pharmaceuticals and the path of their illness.

gregtompkins

Our county does things more innovatively than others in Oregon. But why do we as a state rank at the bottom of the barrel and have for many years? Similarly California’s mental health system is very poor. But we bend over backward for the illegals yet totally spite our own struggling citizens (you sure don’t see many illegals living as homeless and mentally ill.) I’ve also heard that it’s because west coast uses “front desk access model” but on the east coast they are more integrative? At any rate our Democrat state sure doesn’t seem to be doing anything right in social services including mental health care?

Scott Gibson

Thanks for the comments. I like the idea of a mental health section in prisons (though I am not enough of an expert to suggest how this could be carried out). We house the mentally ill there, we should devote more resources to giving them optimal care. My general idea on how to fund such an ambitious project is to build on what we have already. More attention from the legislature into how to make outpatient mental health care more effective and accessible for starters. I would hope we could start to shift money from prisons to mental health facilities. Many of the people in prisons could then be treated in locked care facilities that are more designed for treating the mentally ill. And overlying all of this is the deficit of good mental health professionals, from mental health nurses and social workers to psychiatrists. IF the state showed a dedication to long-term, sustained action in mental health, more young people would see it as a viable profession that was respected and would provide a lasting career. We need young people involved in this change, as it will be a slow, decades long process. But it starts with changing legislative and societal attitudes toward how we view and assist the mentally ill.

Mike

The current Psychiatric Security Review Board has jurisdiction over those who are found not-guilty by virtue of insanity. There are two Panels, Adult and Juvenile. Those released into the community are supervised by Parole/Probation Officers. The Criminal Parole Board might consider an Psychiatric Security Parole panel and the officers who supervise in the community have additional mental health training.

gregtompkins

@ Scott Gibson So why is it that in the most leftist Democrat areas the mental health and homeless situation is so poor? New England is light years ahead of us with their system but in Oregon and California all you ever hear about is the plight of the illegals. Well piss all over the disabled and mentally ill Americans!

Scott Gibson

In response gregtompkins, the move to deinstitutionalize the mentally ill was a bipartisan effort, and I don't think the Democrats have done well in states where they are the majority in terms of rectifying the problem. It will take bipartisan support if we are ever going to make progress in this area. Fortunately, I suspect there is such support if it is structured well and done incrementally. If we tried to fix this problem all at once, the cost would, I suspect, erode public support so much that nothing would get done. Piece by piece we need to rebuild our care system for the mentally ill.

gregtompkins

Scott Gibson it isn’t humane to just let folks who are struggling just live on the street and live in their own feces. But that’s what you get with progressive governance have you ever been to Portland or the Springwater Trail? San Francisco of Seattle? These areas like to toot their horn they’re so “progressive” when they really just don’t even care about anything besides virtue signaling. Just like the hifalutin neighborhoods filled with liberals putting their propaganda diversity and in our America signs but they wouldn’t literally welcome diversity if it showed up in their neighborhoods. They have the same attitude about the homeless and the mentally ill. As long as it’s not in their back yard they don’t give a $$!!