Should More Mentally Ill People Be Institutionalized?
Once upon a time there were places known as insane asylums. These were not pleasant places, by and large, but they were places where the “insane” (or mentally ill, as we now say) could live and receive some level of support. Insane asylums made a lot of sense because we didn’t have a lot of treatment to offer those who were too “insane” to live in the general population.
Fast-forward to the 1960s. By this time we understood mental illness a lot better and had developed antipsychotics and lithium that effectively treated many of the types of “insanity” that would have previously forced institutionalization. A movement of de-institutionalization spread wherein mental health services were moved into the community for people to access while living with the general population.
And while this sounds like a good and humane idea; I’m pretty sure we’ve gone too far with it.
De-Institutionalization of the Mentally Ill
The thing about de-institutionalization – which was a good idea – is that it left fewer places for people with serious mental illnesses to go. And this wouldn’t have been such a huge problem except for the fact that many of the community mental health services that were meant to replace institutions got closed due to lack of funding. So then a person with a serious mental illness, trying to living in the community, couldn’t get mental health services and wouldn’t have a place to go if they found they needed full-time support.
“Managed Care” of Mental Illness
And now things have gotten even worse for the general population as most people’s insurance frowns upon people getting admitted to a hospital on the grounds of a mental illness and when they do, they are covered for a few days only. Not nearly enough time to stabilize, let alone put skills in place to manage, a mental illness. And those who do have psychiatrist visits have generally seen those visits dwindle to 15 minute “med-checks” every few months – not nearly enough to manage a severe mental illness.
Case in point is suicide attempts. Frequently people who attempt suicide are not admitted to the hospital and those that are admitted may only be there a day or two. I find this outrageous and pretty much criminal on the part of the doctors (although I can understand their hands are tied financially in many cases).
Where Do People with Severe Mental Illness End Up?
And so we have a massive homeless population with mental illnesses and massive prison populations with mental illnesses. We’re talking one-third of the homeless population – 250,000 people – and half the prison population has a diagnosable mental illness and they are the fastest growing segment of the prison population.
So, people with a mental illness today get to live on the street or in a prison instead of in an asylum. How humane of us.
Re-Institutionalization of People with a Mental Illness
My question is, isn’t there a better way to handle severe mental illness than putting people behind bars or on the street where eventually they also end up behind bars? I think there is. And the answer is re-institutionalization. No, I’m not suggesting we round up people with a mental illness and put them somewhere but I am suggesting that we need safe spaces for people to go who need full-time support. Not everyone is equipped to live in the community – particularly not without a concerted effort on treatment first. And once a person has stabilized in a facility they can be moved to places that still offer support but also independence. We do this for people with addictions – sober living facilities – so where are the facilities for people with schizophrenia or bipolar disorder?
And before you reach for your pocketbook and complain about the money, consider this – Florida has determined it will need to build 10 more prisons in the next 10 years to house the increasing number of inmates. All I’m asking is that we spend even some of that money building facilities actually designed to help people rather than punish them.