Annie’s post the other day got me to thinking about mental illness as it is treated in this country. It can be summed up in two words. It sucks. And it has sucked for many years.
One of the problems that I can see is that we are still in the dark ages when it comes to mental illness. It is treated as some booga-booga witchcraft thing, to be shunned at every opportunity. It’s not. Most mental illness is brain illness, and most of it is chronic. Your mother had nothing to do with it, except for what genes she managed to pass on to you. Medications can help with a lot of it, so long as you can get the mentally ill to take their medications.
Insurance policies that differentiate between mental and physical illness are discriminatory. Would you limit diabetics to twenty shots of insulin a year? Why, then, limit mental illness to twenty visits a year? Many of the more severely mentally ill require almost constant follow-up. Without a lot of support services, they are the homeless you see on the streets of many urban areas. Most of them are not a danger to the public, most of them are a danger to themselves.
Back in the olden days, before 1975 in this country, most of the mentally ill were confined to mental hospitals permanently. By this time, drugs had been developed that controlled some mental illnesses, and a case came before the Supreme Court that opened the doors to the mental hospitals. In 1975, the Supreme Court ruled in O’Connor vs. Donaldson, that the state could not confine a mentally ill person who was not dangerous to themselves or others. In spite of the passage in 1963 or the Community Mental Health Act, many people at the time were still being confined, even when family was willing to take them in.
Unfortunately, with the advent of Reagonomics, many states took O’Connor vs. Donaldson as a budget-cutting gift from heaven. Many people were released from mental hospitals into other milieus. A lot of them ended up in nursing homes, and that is where I encountered them. In more recent years, the trend has been to move them into smaller group homes, or just let them wander the streets.
Nowadays people cannot be confined to institutions unless the present a danger to themselves or others. However, since the budget cuts, mental health beds are in short supply, and you have some ridiculous situations developing. I could tell you stories. Ok, I will tell you stories.
I used to dispatch for the police department in a very small town. We only had one line on our police phone. I started getting calls from a woman who contended that “they” were playing music through her refrigerator. Most of these calls came in the middle of the night, at 2 or 3 AM. And she would talk on and on, if you hung up on her she would call back. Unfortunately, she lived about ten feet out of town, which put her in the province of the sheriff’s department. They would come over to the house, I would complain about the woman, and they would tell me they couldn’t do anything because she wasn’t a danger to herself or others. And give me wonderful suggestions such as to tell her to put aluminum foil on her windows. I finally got them to do something when I pointed out that as long as she was tying up the police line, no one else could get through (this was long before the days of call waiting) and that if she called me again at 2 AM, I was going to kill her, making her a danger to herself. I’m not sure which argument worked, but she was soon picked up and taken to the mental hospital. Of course, the next time I saw her was at my day job as a nurse in a nursing home.
A woman who had relatives in town was brought to the police station by her relatives. She was speaking gibberish, had a long history of mental illness, and a history of suicide attempts via pills. She also had a purse full of pills, and prescriptions for more. The social worker who saw her, however, didn’t think she was a danger to herself. By some accident, she got transported to the mental hospital, where the workers there had a different view of the situation, and she was admitted. I guess my ex-husband just didn’t hear very well when told to take her to a half-way house. I will try not to go on and on about the stupidity of having social workers as the gateway into mental health treatment.
We admitted another resident to our nursing home who had jumped off a bridge in a suicide attempt, breaking both legs and one arm. As soon as she was mobile again, she proceeded to go to the town sewage plant, and walk into a sewage pond. She was observed by one of the townspeople, and was rescued and transported to the hospital. Later in the evening, the nursing home was informed she had been released and was on her way back. For some reason, they refused to take her. Like maybe we didn’t have the staff for a suicide watch?
Another resident, a diabetic, suddenly began to not eat or take his meds, and refuse to leave his room. The community mental health worker was summoned, and the resident convinced him that if he could go home for a visit, he would begin eating again. The next day he slit his antecubital arteries with a razor blade he had secreted in his wallet on his visit home. The only reason he didn’t die is that he took that moment, after barricading himself in his room for weeks, to walk outside, blood streaming from his arms.
We also had in the community a man who was bi-polar, and in his manic phases was violent. For some reason, he always sought out my ex-husband to beat up. Finally, my ex had enough, and told him the next time he was violent, he wouldn’t fight him, he’d just shoot him. A reasonable course since he was six inches taller and about 100 lbs heavier than my ex.
So you can see, the definitions of “danger to themselves or others” are very loose, and that due to the lack of beds, many who need a bed are shunted into inappropriate placements. What’s the answer? I don’t know. But it is not the current system.

Possibly related posts: (automatically generated)