Finally, psychiatrists are so fed up with the regressive way our society treats those with serious mental illness that they are speaking up and making demands on behalf of some of the most vulnerable in our society. The Canadian Psychiatric Association just released a position paper called "The Criminalization of People With Mental Illness."
The paper was approved by their Board of Directors on December 5, 201, and is published in the February, 2012 issue of the Canadian Journal of Psychiatry. The paper itself, written by Hamilton, Ontario forensic psychiatrist Gary Chaimowitz, puts forth 10 recommendations for improvement. The three that I find most important are:
In the lead to this post, I used the word regressive to refer to how we treat the mentally ill. Dr. Chaimowitz and the directors of the Canadian Psychiatric Association provided a great deal of evidence as to why regressive is the correct word. They point out that in 1841, Dorothea Dix in the U.S. was so moved by the plight of mentally ill prisoners being held in inhumane conditions in prisons that she lobbied for psychiatric hospitals. In 1836, a Royal Commission in New Brunswick also began to plan for asylums in that jurisdiction.
Consequently, society in that period began to build psychiatric hospitals across all of North America on large tracts of land and in pastoral settings. According to the book Out of the Shadows: Confronting America's Mental Illness Crisis, within 40 years, the population of mentally ill prisoners in U.S. jails dropped to only 0.7 per cent of prison populations. Over time, unfortunately, many of these institutions became overcrowded and places to warehouse people although many caring and public-minded people did provide care and compassion.
In the 1950s and 1960s, for many reasons that coincided with more effective medications where none existed before, society began to depopulate these institutions. It began with the belief that these ill people would be able to live happily in the community supported by an array of services.
But, shortly after this de-hospitalization, the number of mentally ill in the criminal system began to expand in Canada, the U.S., and in much of the industrialized world. As an example, when the Santa Clara California Agnews State Hospital closed in the early 1970s, the county jail's population of mentally ill prisoners increased by 300 per cent, according to the paper "From hospitals to jails: the fate of California's deinstitutionalized mentally ill." Between 1955 and 1994, the rate of state hospital beds in the U.S. per 100,000 went from 339 to 29. In 1959, in Canada, the number of inpatient beds in psychiatric hospitals went from four per 1000 population in 1964 to less than one per 1000 population in 1979 .
The money from the hospital sector needed to provide community support for those discharged either did not get there or was insufficient. Those patients discharged to the community or new patients needing service could not get service. They were often out on the street and running afoul of the criminal system.
At the same time, it became more difficult for doctors to hospitalize patients who needed it or to keep them there long enough to bring about meaningful improvements. Laws designed to safeguard the rights of patients resulted in patients not being able to enjoy the right to be well.
Toss in the fact that hospitals are attempting to save money not in what they pay to their CEOs but in the service they provide, there is pressure on doctors and other staff to reduce lengths of stay.
The consequence of all this is that more and more of those with mental illness are not receiving care or are winding up in correctional facilities where they may or may not receive care. The average cost of maintaining one male federal prisoner is $100,000 a year ($180,000 for a female prisoner). Hospital stay and community support would be a great deal cheaper.
It is no wonder that Canada's psychiatrists are "as mad as hell and are not going to take this anymore" as Howard Beal, played by Peter Finch in the 1976 film Network, shouted out the window.
We should all be as mad as hell and demand changes. It is incomprehensible how a supposedly civilized society can treat ill people this way. Kudos to Canadian psychiatrists for speaking out.
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I think the point you made on separating the pots of money making it clear what money is for those with severe and persistent mental illness is a highly useful policy change. In California we do have separate pots set aside for different levels of service and it works relatively well in making sure that people that need certain levels of services get them (not that when recession hits politicians don't try to take that money and use it for other things). There is a large amount of money set aside for community treatment but it does not affect peoples ability to access hospitals when needed. When done right you can look at programs numbers and you can see that it works well in getting people off the streets (reducing homelessness), and reducing incarcerations and hospitalization. While at the same time you see people engaging in positive areas of growth.
So it is hard to say exactly at what rate mental illness is increasing but looking at the numbers it is clear that at least severe and persistent mental illness is doing so. So it is not as easy as saying that society has transitioned the care of the mentally ill to from hospitals to jails. (I am not denying that society has failed to provide quality care and that unacceptably a large percentage of people that would have been receiving care in a hospital setting are now incarcerated.) I would agree that there needs to be more money put into providing services needed for the mentally ill and that much of society has fallen behind a lot of the time letting it fall to jail and prison systems.
There is a contingency of people that feel that the creation and large use of psychiatric medications has led to the increase in in severe and persistent mental illness. (I do think medications are useful when used right but do not work for everyone. I also feel they are largely over proscribed.) A large number of people complete dismiss everything that group of people says because they are so radical but they do make some points that are worth examination. My opinion that is a large part of of increase in the mental illness is due to people using psychiatric medications versus using other coping skills. It is like the first thing many people want now is a pill quick fix versus concentrating on the bigger picture. People abuse benzo's at alarming rates to escape having to experience their feelings and dealing with current problems.
Looking at the current prevelance of mental illness aprox. 1 in 5 individuals in a giving year experiences symptoms of a mental illness, and more varying stats as far as what would be consider severe and presistant mental illness but you see numbers ranging from 1 in 17 to 1 in 25. Now looking back it is hard to say what those numbers would be in the 50's and 60's. However looking at the US Social Security you can track an astronomical increase on those recieving benefits for a mental illness. This means that people are increasingly experiencing mental illnesses that prevent them from participating in substantialy gainful employment. In 1987 1 in 184 people qualified for SSDI benefits due to mental illness in 2007 1 in 76 qualified that is a 284% increase. The WHO recently came out with a statement saying that they feel that by 2020 mental illness will be the second leading cause of death and disability.
Part of the reason many people with serious mental illness end up in prison and on the streets is because of the widespread distaste for involuntary treatment and the lack of understanding about why involuntary treatment can be life saving in some cases. A very high percentage of people with psychosis and serious mental illness have lack of insight, which leads them to believe they are not ill despite all evidence to the contrary. They subsequently stop taking their meds and often get in serious trouble with the law or end up on the streets.
My daughter has had 5 involuntary hospitalizations but they have all been from 3 days to a maximum of three weeks. If my daughter and others like her had the opportunity to be an inpatient for 4-6 months in a mental institution to get her medications adjusted and get some proper cognitive therapy she might have a chance.
Marvin Ross' article has provided us with information from the recent position paper of the Canadian Psychiatric Association. These psychiatrists generally have the most knowledge and experience in their work, caring for the seriously mentally ill. They have battle-front insights into the lack of timely and appropriate care and treatment for the most ill.
We must listen to them, along with the families who already mourn over their loved ones' untreated mental illnesses, which can only lead them to the dangerous streets in big cities, where violence stalks them. And they weep that the only place society deems they should live in. is bug infested run-down rooming houses where their only escape from their suffering, too often, is suicide.