Imminent Danger and Preventable Tragedies

It’s been a while since I last wrote about the problem of the untreated mentally ill in the United States but major media outlets have done so even as other preventable tragedies have occurred. On September 16, for example, thirteen people were killed and eight injured at the U.S. Navy Yard in Washington D.C. by a young man who heard voices and claimed that strangers were bombarding his brain with microwaves.

60 Minutes, Imminent Danger, Steve CroftOn September 29, CBS’ @60Minutes news program aired a segment called “Imminent Danger,” in which Steve Croft states that 10 percent of homicides and half of mass killings are perpetrated by schizophrenic young men who are either untreated or who have stopped taking their medication. The segment notes that most schizophrenics are not violent and that it is a disease of the brain, not of the mind. The point is illustrated with brain scans that show the physiological difference between a normal cerebral structure and of a schizophrenic. It’s a powerful demonstration.

Gary Fields has been covering the issue of the untreated mentally ill for The Wall Street Journal with multiple articles published this year. His most recent @WSJ pieces include “The New Asylums, Jails Swell With Mentally Ill,” on September 26 and “Lives of Mentally Ill, Police Collide” on October 22.

Deadly Assumptions

Even a cursory examination of the current situation as depicted in this articles, a simple Google search, or those listed in my previous posts makes four things clear:

  1. There are currently very few places in the U.S. where the mentally ill can be treated in a medical/psychiatric facility that removes them from society and protects them from becoming a danger to themselves and others.
  2. Most of the mentally ill in the United States reside either on the streets or in jails. Anyone who lives in, works in or frequently visits a large city has experienced demented people talking to invisible companions, shouting and waving at passersby, or making threatening gestures at trashcans and fire hydrants. The lucky ones have families who are willing, able, and allowed by the courts to care for their loved ones. Unfortunately, some of those family members are killed by their sons, grandsons, cousins or nephews even as they try to help. Other family members distance themselves after being threatened.
  3. Incarcerating the mentally ill, mentally ill in jailJails and prisons have become the new insane asylums, with police and guards responsible for the care of the mentally ill.  There is no treatment.  In fact, mentally ill inmates often get worse in prison–or get dead, mostly from suicide.
  4. Judges are the new psychiatrists who “diagnose” whether a young man is a danger to himself or to others and order treatment—which may or may not be received. In the 2007 case of Seung-Hui Cho, for example, a Virginian special justice ordered treatment but none was given before he walked onto the campus of Virginia Tech and shot 49 people, killing 32 of them.

We as a society seem to believe that housing or medicating the mentally ill to prevent the “crimes of survival” that send them to jail—petty theft to get food or trespassing to find a place to sleep—makes less sense than criminalizing their behavior and treating them as if they are in control of their actions. We also appear to believe that:

  • It is more logical to mourn the victims of mass murders than to prevent them from happening in the first place.
  • Having mentally ill people sleeping on heating grates or in alleys is acceptable in a wealthy country that is the leader of the free world.
  • Periodic mass killings and 10 percent of all homicides are simply collateral damage—only to be expected and then forgotten.
  • This all makes sense because we only care about costs and warehousing the mentally ill in prisons is cheaper that funding facilities for their real care and treatment.

Guess what? That’s wrong.

The Real Costs of Incarceration vs Treatment

The Lamp Community, a non-profit that works on behalf of the mentally ill in Los Angeles, reports that the cost of emergency-room visits and multiple incarcerations can exceed $100,000 a year for each homeless person. Permanent supportive housing would cost only $16,000. This is typical of estimates seen in other parts of the country, where the cost of housing and treating the mentally ill can be one third or less than the cost of incarceration. Simply put, it is cheaper to help these people than it is to warehouse or punish them–not to mention more humane.

Funding for the mentally ill is an easy target for those in state and federal government who want to cut expenses, however. No powerful corporations lobby on behalf of the mentally ill or provide huge donations to senators and representatives at either the state or federal level. Alana Horowitz reports in The Huffington Post that $4.35 billion in funding for mental health services has been cut from state budgets in the past three years alone. The few treatment centers that still exist are continually forced to reduce their services and turn patients away.

What will it take to change this destructive cycle? We may have made a start, at least. A little-publicized part of the Affordable Care Act mandates that insurance companies cover “mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy).” That means people who could never before afford therapy, medication, hospitalization, or outpatient treatment will now be able to receive it.

It does not mean, however, that hospital beds or outpatient services will be available.  And they likely won’t be unless we begin taking this problem seriously.

 

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