Wednesday, April 14, 2010

The New Asylums: Complete System Failure

I have been meaning to write about this issue for a very long while, but have left it on the burner for so long I forgot about it. Then today in psych class I had it thrust into the forefront rather brutally. Before I go on, I want to share this episode of Frontline from 2005, one that I hadn't actually seen before. I should expect that it won't take long to get the gist of a truly magnificent breakdown of how we manage mental illness in the U.S.

It didn't take very long to provide you with a pretty good idea as to just how truly screwed up this is. Keep in mind Frontline filmed that episode in a prison that is still considered a model for psychiatric care in the prison setting. This is no way to treat people with mental illness, even people who really do need to be locked away from society.

What really makes me angry about our new model for dealing with serious mental illness, is that all the excuses made for closing state institutions are exacerbated by this method of dealing with the seriously mentally disturbed. It is far more expensive to deal with the mentally ill either in prison, or on the streets coasting in and out of jail. The biggest reasoning was expense - but the expense has dramatically increased. It is a huge expense for local communities and ultimately still costs the state more.

On top of this, it is extremely hard for the seriously mentally ill to actually get the help they need and even qualify for. There are "homeless" mentally ill persons who aren't actually homeless. They have a place in a group home and access to care. But then they wander off from home and end up living on the streets - off their meds, hungry and exposed. And there are truly homeless mentally ill persons who aren't getting any help - not because they don't qualify, but because they are not together enough to go out seeking it. And even if they try, the system is not set up to be managed by a paranoid schizophrenic who believes there are people trying to kill her, or someone with bipolar who walked nearly a hundred miles from people who knew him while in a manic phase. That is not the "freedom" that wellmeaning, but ultimately ignorant lobbyists/policy makers were trying to provide with the idea of mainstreaming.

And the local communities - the communities in which people who know and love a particular mentally ill individual lives, are not set up to deal with them. We have had forty plus years to get it together and help these folks and still we are flailing about, failing too many. Even here in MI, where the quality of care provided by county Community Mental Health (CMH) services is generally quite exceptional, we are allowing too many to slip through the cracks. In many places, there is virtually no organization to provide services to the mentally ill. In others, southern California in particular, the services provided are truly abysmal.

And again, the states are still fitting a huge portion of the bill - in many cases a much larger bill than the state hospital system cost.

Michigan is particularly hard hit right now, as we have closed some of our mental health facil...Excuse me, prisons at the same time we have also eviscerated the budgets of the county CMHs. We are dumping these folks onto their local communities and pulling the funding that might have provided services for them. The clinics that manage paroles and people on probation are getting overwhelmed - in many cases with clients who should not be outside of a lockdown facility. Meanwhile, people with less serious mental problems, but who do not have insurance and do not qualify for medicaid are screwed.

Myself for example. I finished with my last therapist about a year ago. I was told that I would see another intern therapist last summer - then that was bumped to the fall...I haven't bothered trying to call again - I know what is happening and know that I am not going to get help. At least I am on meds and not left completely screwed. For more people are worse off than I am. No therapy, no psychiatric services - they won't get help until their mental illness becomes acute and they either commit a crime and end up in prison, or at least get picked up by the cops and pushed through the medicaid requirements.

Please don't think that things are much better elsewhere. For the past several years MI has managed to provide mental health services on a shoestring, that far outstrip the quality of care offered in many other states that have substantially larger budgets per public mental health consumer. It is not like those services have improved as budgets get hit across the U.S. Indeed the quality of care here has not actually suffered that much, we just can't provide that care to the people who desperately need it.

I have some hope that the new healthcare plan is going to help with some of this. The APA has managed to push for some provisions that should improve access to mental health services and they went through. But it is only going to help with people in temporary crisis. People who are dealing with situational mental problems or who exhibit mild symptoms. It is not going to do a damned thing to change our prison and "homeless we can ignore" based system of care for the seriously mentally ill.

Just so we are perfectly clear about this, those scenes where they showed these yellow cages in a half circle - their "group therapy" session - that is not a reasonable way to provide group therapy. Not an effective means for any sort of functional therapy. Punishing inmates for breaking rules they don't understand is not effective therapy. Pretending that there is anything valid about an admission of guilt for rules violation, coming from a guy who is incapable of understanding what he is pleading guilty to is a fucking atrocity.

And remember, the system we got a glimpse of in that video - that is a model system for prison based mental health care. That is worlds apart from what one gets in county lockup or most prisons in the U.S. It gets far, far worse than what we see in that episode of Frontline.

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