November 4 2013
When we see a psychotic gunman kill 12 people in the Navy Yard, we wonder: how was this man’s mental illness not treated?
Even the left, which wastes no time in using such tragedies to call for more gun control, recollects itself long enough to stop and utter a few remarks about improving the treatment of the mentally-ill.
Dr. Sally Satel has a must-read book review today in the Wall Street Journal of Dr. E. Fuller Torrey’s new book, American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System (subscription required but the review is also on the AEI website). It will explain a lot about how we got where we are with regard to treatment of the mentally ill.
Much of what happened to bring us to the sorry pass was the result of good intentions. President John F. Kennedy, for example, possibly feeling guilty that his family had done such a tragic job of taking care of his mentally ill sister, certainly was well-intended when in 1963 he signed the Community Mental Health Centers Act.
This act forced state mental hospitals to “give way to a user-friendly archipelago of federally funded community clinics.” Warmth was supposed to replace the “cold mercy” of hospitals. The need for reform, Satel tells us, was real. It just didn’t work the way it was supposed to:
Some patients did well upon discharge, but the sickest were caught in a revolving door. Without closely supervised treatment, they failed in the community and went back to whatever institutions were left in place. Others ended up in a kind of limbo, neither institutionalized nor embedded in a community. Indeed, the number of psychotic patients in the federally funded community centers would never rise above 5%. And they were the lucky ones. Many others ended up living in flophouses, on the streets or in jails.
When Medicare and Medicaid came on the scene in the mid-1960s, states had further incentive to depopulate the asylums: They simply shifted the financial burden to the feds, who would pay for housing patients in poorly equipped nursing homes. Finally, legal decisions issued in the 1960s and 1970s made it hard for judges to order needed treatment for debilitated patients who were refusing care. "This malformed marriage of fiscally conservative state officials and politically liberal civil-rights lawyers produced a strong advocacy coalition," Dr. Torrey writes. It guaranteed "that the existing deinstitutionalization policies would be continued."
As Dr. Torrey makes clear, mental-health policy was a bipartisan failure. ...
The nation could use the funds earmarked for the mentally ill better. Torrey promotes court-ordered treatment (you can’t do that now because of “humane” laws) and other possible reforms. The reforms must be aimed at making life better for the mentally ill and preventing them from destructive acts of violence aimed at innocent people.
This is the discussion we need around mental health issues.