Our War on the Mentally Ill
According to a police report in the June 9th Towanda Daily Review, a 34 year-old woman was arrested at the Robert Packer Hospital Behavioral Science Unit for aggravated assault and was sent to the Bradford County Prison in lieu of $20,000 bail. The Review wrote that the woman was "smashing windows with a dinner tray" and "began stripping tissues out of every tissue box in reach and began to explain that she had magical powers and that she was going to burn the building down, and then she would flood the building to put the fire out." The police were probably called after the hospital security and staff realized that they were unable to properly control the situation, and the woman was subdued by the police after she punched and slapped one of the officers.[1]
The situation seems to have been handled with a minimum of property damage and no serious injuries, and to my knowledge, everyone acted correctly. Yet, a woman with a probable serious mental illness was arrested and incarcerated in an institution not equipped to diagnose or help the mentally ill.
The U.S. has had a sordid past treating the mentally ill as have most other countries. In 1773, the first U.S. hospital for the mentally ill was opened at Williamsburg, VA -- the “Public Hospital for Persons of Insane and Disordered Minds."[2] In 1841, Dorothea Dix, a Boston school teacher, was appalled at the living conditions of the mentally ill in the East Cambridge Jail. Her advocacy and lobbying efforts resulted in the establishment of 123 hospitals for the mentally ill by 1880.[3] Construction of state mental hospitals continued throughout the U.S., and by 1955, these hospitals housed 558,239 mentally ill patients, 71,619 patients in 1994 [4], and fewer than 55,000 in 2015.[5] From 1955 to 2015, the U.S. population increased by 92%, yet patients being treated in mental institutions dropped by 90%. The proportion of people with mental disorders has not changed, yet the proportion of people being treated has dropped by 95%.[6]
The problems began over 50 years ago when the John F. Kennedy's Community Mental Health Act of 1963 was enacted in response to the too often horrific conditions and treatments of the mentally ill in state run institutions. Deinstitutionalization was supposed to move mentally ill patients from state run institutions to community health centers with more humane treatments and the possibility of patients to be located in their own community closer to their own families. However, the community treatment phase was never fully implemented and far too many seriously mentally ill people were and still are left undertreated or untreated.[7]
Mental disorders include bipolar disorder, depression, personality disorder, post-traumatic stress disorder, and schizophrenia.[8] Consequences of undertreating or not treating the seriously mentally ill have been disastrous. In the U.S.: of 7.9 million people with severe mental illness, 3.9 million go untreated; there are 216,000 homeless adults with severe mental illness; there are 400,000 adults in jails or prisons with untreated mental illnesses; 13,000 suicides are committed each year under the influence of schizophrenic, manic or depressive symptoms; 50% of mass killings are by people with severe mental illnesses; about one-third to one-half of the mentally ill also suffer from drug abuse.[9][10] Deinstitutionalization has overburdened medical emergency departments, it has overcrowded jails and prisons, and it has left untreated mentally ill people on their own in the streets.[11]
Proper treatment of the mentally ill should include state mental institutions for those cases that are inappropriate for other facilities, and they would house the criminally insane, sexually dangerous persons, and those too dangerous to discharge.[12] It is vital that these hospitals do not become overcrowded and that staffing be sufficient. Community mental health facilities, as promised by the Community Mental Health Act of 1963 but never fully funded or implemented, would prevent overcrowding of the state hospitals. However, the intentions of the 1963 act needs to be fully implemented. It will be expensive to do, but vastly more expensive to continue as we have been. Otherwise, emergency departments will remain overwhelmed, jails and prisons will house those who should not be there, suicides and mass killings will continue, the mentally ill will still abuse drugs, and a 34 year-old woman who should have been treated for a serious mental illness ended up in even more miserable circumstances.
John L. Ferri
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