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What Happens When the Mentally Ill Have Nowhere to Go?

You can find an article such as this, along with the research to back it up in so many places. This happens to be from an excellent 2017 NPR article by Samantha Raphelson titled: How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis.

A severe shortage of inpatient care for people with mental illness is amounting to a public health crisis, as the number of individuals struggling with a range of psychiatric problems continues to rise. A study published in the journal Psychiatric Services estimates 3.4 percent of Americans — more than 8 million people — suffer from serious psychological problems. The disappearance of long-term-care facilities and psychiatric beds has escalated over the past decade, sparked by a trend toward deinstitutionalization of psychiatric patients in the 1950s and '60s, says Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania. "State hospitals began to realize that individuals who were there probably could do well in the community," he tells Here & Now's Jeremy Hobson. "It was well-intended, but what I believe happened over the past 50 years is that there's been such an evaporation of psychiatric therapeutic spaces that now we lack a sufficient number of psychiatric beds." A concerted effort to grow community-based care options that were less restrictive grew out of the civil rights movement and a series of scandals due to the lack of oversight in psychiatric care, Sisti says. While those efforts have been successful for many, a significant group of people who require structured inpatient care can't get it, often because of funding issues. A 2012 report by the Treatment Advocacy Center, a nonprofit organization that works to remove treatment barriers for people with mental illness, found the number of psychiatric beds decreased by 14 percent from 2005 to 2010. That year, there were 50,509 state psychiatric beds, meaning there were only 14 beds available per 100,000 people. "Many times individuals who really do require intensive psychiatric care find themselves homeless or more and more in prison," Sisti says. "Much of our mental health care now for individuals with serious mental illness has been shifted to correctional facilities." The percentage of people with serious mental illness in prisons rose from 0.7 percent in 1880 to 21 percent in 2005, according to the Center for Prisoner Health and Human Rights. Many of the private mental health hospitals still in operation do not accept insurance and can cost upwards of $30,000 per month, Sisti says. For many low-income patients, Medicaid is the only path to mental health care, but a provision in the law prevents the federal government from paying for long-term care in an institution. As a result, many people who experience a serious mental health crisis end up in the emergency room. According to data from the National Hospital Ambulatory Medical Care Survey, between 2001 and 2011, 6 percent of all emergency department patients had a psychiatric condition. Nearly 11 percent of those patients require transfer to another facility, but there are often no beds available. Most hospitals are unable to take care of people for more than 72 hours, Sisti explains, so patients are sent back out into the world without adequate access to treatment. In order to bridge the gap between hospital stays and expensive community-based care options, Sisti argues for "a continuum of care that ranges from outpatient care and transitional-type housing situations to inpatient care."


My Take

What this article doesn't address is the substitution for institutional care with, what were back in the 60s and 70s, miracle drugs for treating mental illness. While this was the answer for some, for others, it was like sending someone in the throws of COVID back to work with a bottle of Tylenol.

It does feel as though something is happening now. Prisons, medical facilities, and community organizations that help the homeless are at a breaking point. Congress seems poised to act. The irony is that what finally spurred serious government discourse was the public horror over a spate of mass shootings ostensibly committed by persons that were mentally ill. The truth is the vast majority of mass shooters do not suffer from psychotic mental illness (read The Violence Project for some surprising stats on gun violence: https://www.theviolenceproject.org/). The full NPR article is available here: https://www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis.



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