03/02/2012 04:19 EST | Updated 05/02/2012 05:12 EDT

Has Our Mental Health System Gone Mad?

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:

  • The Canadian government should strike a commission to review the effects of deinstitutionalization, specifically holding provincial governments accountable for appropriate psychiatric resources in the hospitals and the community;
  • Governments should reconsider separate funding streams for people with serious mental illness to ensure there are sufficient psychiatric beds and resources available for people with mental illness for as long as they need them;
  • Resources and services should be put in place to provide appropriate and sufficient non-forensic, non-correctional mental health treatment to prevent the criminalization of people with serious mental illness.

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.