Once again we face the dismal reality that as a society, we have made little to no progress in understanding and treating mental illness. Over the centuries, people with mental illnesses have been considered touched by the gods, possessed by the devil and full of the wrong humors. Once we understood mental illness was just that, an illness, you’d think we’d have come up with a rational way to deal with it. But this, of all illnesses, seems to be the one we can’t wrap our heads around. No matter what society says out loud, privately most people just want the mentally ill to somehow go away. Drug them into submission. Commit them to hospitals. Put them in jail. Just keep them from those society has deemed sane.
In the not too distant past, many mental health institutions were nothing more than horrifying warehouses where people with mental illness were barely treated as human. And even those facilities that were acceptable did little beyond drugs, shock therapy and restraints. They understood that their real job was to keep the rest of us safe by keeping those who were different away.
These facilities were eventually emptied out with the understanding that in re-integrating people with mental health challenges back into society, community mental health centers would be funded across the nation. But few community mental health clinics opened anywhere. Those that did were overwhelmed with the suddenly freed population of people with serious problems who were basically shown the door with little to any support in place.
I had the fortune, or misfortune, to do my psych nursing rotation at a huge mental health facility in New York harbor called Manhattan State Hospital on Ward’s Island. The buildings were multi-storied, grey and ugly. Each contained specific “types” of patients. The higher you went, the more significant the illness of the patients kept there.
As a very young and naïve nursing student, I had never seen anything like it. We were handed keys we kept clipped to the belts of our uniforms because that was the only way to get on an elevator. Patients would eye us with what I hoped was only envy every time we called the elevator up and were able to unlock the door and get on.
I don’t believe the people who worked at these facilities were evil or hated their patients and so treated them badly. On the other hand, given the patient/staff ratio, I can understand why the term “warehousing” was used. No one really got better there. I’m not sure that was ever a realistic goal no matter how many times it was written into a patient care plan.
So here we are over forty years later and what progress have we made in treating this ever so vulnerable population? Our psychiatric facility is understaffed and way too small to offer patients the time, energy and treatment they need. Our community mental health centers have never become a reality at anywhere near the level needed to deal with the population they serve. Jails have become our de facto mental health hospitals. And if these patients didn’t stand a chance in a psych hospital that was supposedly dedicated to their care and healing, imagine what improvements we can expect when we release them from jail.
I think we were wrong to willy-nilly empty psych hospitals before the community clinics were a reality. I think we continue to be wrong in assuming that there aren’t people with mental illness so significant that they need hospitalization for more prolonged periods than a 72 hour hold provides. I think expecting jails to deal with this problem so we can hide it while not dealing with its reality is a crime in and of itself.
We need an approach to this problem that is realistic and beneficial to both the patient and the community in which he or she will eventually reside. We need to get mental illness off the streets and into facilities that can make a difference because they have enough time and staff to actually provide treatment.
Sadly, I think all this is a pipe dream now. Because if Alaska refused to put any more money into this system when we were flush with oil cash, I highly doubt anyone will put it there now. And once again, some of the most vulnerable of our population will suffer because… well, because they can’t afford the lobbyists needed to get a politician’s attention.
As the Orangeman would say, sad.