. . .of mental health services for the most disturbed and indigent leaks like a sieve. This is the case in Florida in 2014, and I have no reason to believe that it’s substantially better in any other state even tho Florida usually ranks near the bottom in funding for mental health. I read recently that nearly 40% of inmates in jails in New York are mentally ill. This figure is nearly double what it was a mere eight years ago. A recent U.S.A. Today article noted that 10% of the inmates in the Federal Bureau of Prisons were taking psychotropic medications. It’s disturbing to realize that in most of this country the network of services was better funded and implemented two, three and four decades ago. Jails, prisons and public parks are where most mentally ill reside today. “Care” for the least of us in 2014, is little more than a joke.
I’ve worked in the field for over 40-years. My career started in the late-1960s. I worked for the Illinois Dept of Mental Health at H. Douglas Singer Zone Center. The Zone Center was a new 240-bed facility that offered truly comprehensive inpatient and outpatient services to all categories of disability: acutely mentally ill, chronically mentally ill, addictions, developmental disabilities, and children and families. It provided services for a 10-county region in an area northwest of Chicago. I believe there were seven zone centers located around the state and they were backed up by a network of older state hospitals. The plan was to gradually close down the state hospitals and have treatment done at the zone centers and in the community.
Today, the Zone Center sits vacant. It finally closed a year ago after its programs were gradually shut down. However, what it devolved into in the 21st century was a pale shadow of what it was in say, 1970. I suspect that’s the case in many other states. It certainly is in Florida. I moved to Florida in late-1972, and spent about 14-years working in community mental health centers. My estimate is that the network of care for the mentally ill peaked in Florida somewhere in the era circa 1979-1988.
When I worked at Seminole Community Mental Health Center in the mid-1970s, NE Florida State Hospital at McClenny, near Jacksonville, had about 3,000 residents. When Last I heard it was down to 300. Their website says they have 633 beds and that they serve 30 of Florida’s 67 counties. A couple of Fla’s state hospitals have closed altogether, in an era when Fla’s population has exploded. Obviously, for the almost half of Fla they serve, there should be more than 633 long-term beds available.
Where did those 3,000 people go? They didn’t suddenly get well and no longer require help. And to make matters worse, because Florida doubled in population in the past three decades, there should be many more in long-term hospitals rather than fewer. Florida’s solution: the mentally ill and indigent can now be found sleeping on park benches, living in the woods or residing in local jails or the state prisons.
Cleaning out the state hospitals (Deinstitutionalization) started in the late-1960s. I worked in a deinstitutionalization program for several months during my Illinois internship. Its initial impetus was humanitarian. State hospitals had become dumping grounds for the chronically and seriously mentally ill. Generally, they were “snake pits” that were poorly supervised and under-funded. There was no treatment, just custodial care. People were left there and forgotten. However, new psychotropic medications, such as Thorazine, reduced mania and hallucinations and thus made folks more manageable in community settings. Whereas the initial impetus was humanitarian, legislators quickly picked up on the fact that it was cheaper to maintain the mentally ill in group homes using local hospitals and jails as the backup.
And so state hospitals were gradually shut down and federal money, SSI and Medicaid, was used to subsidise community care. Community care works as long as there is considerable close supervision by case managers and plenty of back-up beds available in local hospitals.
I have several good friends with adult children who are mentally ill. Their bios are all remarkably similar. They came from Christian homes, but homes with “issues.” They had learning disabilities and ADD in school. They struggled but eventually graduated. As adolescents they started experimenting with street drugs and quickly became, if not full-blown addicts, at least problem drug abusers. The drug abuse eventually set off a bipolar or schizophrenic process in them. And today they are in and out of jails and hospitals. Because they are often uncooperative, disturbed adult-children gradually wear out their families as care-givers.
They become hospitalized when, off their meds, they make threats to harm themselves or others, or when their behavior is so obviously disorganized that they come to the attention of law enforcement officers. They are then taken to hospital ERs and end up in the psych ward. In 24 to 72 hrs they are medicated and obviously somewhat more stable and are discharged. They know the system well enough to convince the shrinks that they’re not an immediate threat to anyone. Those are the lucky ones. The less fortunate end up in jail where their problems go largely unrecognized and untreated by the criminal justice system.
Generally speaking, the most likely diagnostic categories to end up in the revolving doors of hospitalization and jail are those with Bipolar Disorder or Paranoid Schizophrenia. The bipolars usually enjoy the manic phase of their illness too much to want to take meds that will bring down their “highs”–and they’re not inclined to listen to the advice of a therapist or a case manage telling them to slow down and make sensible decisions. The paranoids often just incorporate helping professionals into their delusions of persecution.
Part of the problem is that the chronically and seriously mentally ill are in denial about their illness. This is particularly true with young males. But no one, male or female, likes to be thought of as being vulnerable, of being impaired, as having a disability that’s “mental.”
Another part of the problem is that they’ve all been over-medicated at one time or another and so, tired of the unpleasant side effects, stop taking their medication altogether. After they stop taking their meds, for at least a while, they feel better. This confirms in their mind that they’ve made the right decision. The problem is that in a matter of a few weeks their thinking and self-care starts to deteriorate, and within days they are back in the revolving door of jail, hospital and homelessness.
But the major part of the problem is simply too few resources for too many patients;
(1) There needs to be more and better trained and better paid case managers. The chronically mentally ill require close monitoring. They need experienced, well-trained case managers who can link them to community resources.
(2) There needs to be more subsidized transitional apartments and group homes. These beds are far more cost effective than jail, and far more humane than sleeping in the woods.
(3) Community hospitals should be reimbursed enough so that they’re willing to keep a decompensated chronic in a program for more than a few days. They actually need to have a structured treatment program that goes beyond a couple of days worth of group therapy.
For several years (2006-2010) I was part of an initiative that provided food, clothing and other resources for the homeless in downtown Orlando. We were part of a ministry from Northland Church. About a dozen of us would minister to 50 or 60 folks in a public park two nights per month. I no longer participate in this ministry on a biweekly basis but in my occasional participation I’ve noted a huge increase in the homeless served and in the numbers haunting the public parks in downtown Orlando. My estimate is that well over half of the homeless we served were either substance abusers or seriously mentally ill.
Unfortunately, the solution to the mentally ill and homeless problem is more funding, and in this era of “conservatism” legislators and the public are loath to provide more tax dollars to a group which doesn’t vote and which in many cases is not even appreciative of the help which they are offered. Even the so-called “faith” community is reluctant to minister to folks whose behavior and diagnoses defy understanding. But we will be judged as a society by how we minister to the least among us. Several millenia ago the prophet Isaiah said: “Is not this the kind of fasting I have chosen: to loose the chains of injustice. . .to set the oppressed free. . .Is it not to share your food with the hungry and to provide the poor wanderer with shelter–when you see him naked to clothe him, and not to turn away from your own flesh and blood? Then your light will break forth like the dawn, and your healing will quickly appear; then your righteousness will go before you. . .then you will call and the Lord will answer; you will cry for help, and He will say: here am I”. . .” (Is. 58:6-9) In effect he’s saying that we, our country, will be blessed and healed when we care for the homeless, the hurting and hungry—the least among us for whom Jesus advocated.