Reform Is Needed With The Mental Health Care System In America

It seems that every time a tragedy occurs, their is a rush to politicize it. The victims are forgotten in the desire to score political points or further an agenda. The real issues are pushed to the wayside in favor of more politically advantageous rhetoric. Thus when a murderous rampage occurs like the tragedy that unfolded yesterday , the issue of mental illness in this country is given lip-service and then promptly forgotten.

We need to face the fact that the current mental health system in America is flawed. To understand why and how this occurred, one must look at the history and evolution of mental health treatment in America.

Up until the 1950’s, large psychiatric hospitals abounded. These facilities were the primary place in which people with mental illness were treated. However, around this time the push for de-institutionalization began. The movement grew due to economics, abuses within the hospitals, and the introduction of psychological medications.

Economically it was perceived more cost-effective to create outpatient facilities with fewer staff members compared to a large psychiatric inpatient hospital. Adding fuel to the fire, several mental institutions were found to have poor living conditions, problems with overcrowding, and even instances of patient abuse. People with intellectual disabilities and sometimes physical disabilities were often incorrectly placed in these institutions with the mentally ill.

During all of this, pharmacological medications came into these mental institutions and offered a different approach to treatment. While these medications gave hope to many, it was the beginning of the current trend of emphasizing medication and ignoring more traditional psychological approaches. The push began to be to treat mental illness in the least restrictive setting, culminating with President Carter’s Commission on Mental Health.

While the goals of de-institutionalization were noble, it had some very negative consequences. The proponents of the ideology did not have a contingency plan for when the inmates of Arkham were released into American society. Their focus appeared to be all on those with only mild-to-moderate mental illness. The result was that those with severe mental illness either ended up homeless (30% to 50% are mentally ill), in jail, or committing atrocious crimes such as the massacre at Sandy Hook Elementary and the murder rampage in D.C. yesterday.

Contributing further to the problem has been the radical normalization of mental illness put forth by some well-meaning advocates. There certainly should not be any guilt or shame pushed on people with mental illness, lest it prevent them from seeking treatment. However, when it is normalized to the point in which it is seen as “no big deal” you get a form of apathy that proves detrimental to those suffering from mental illness and society at large.

It is time to revisit the notion of institutionalizing those with severe mental illness. Simply crossing our fingers that the young man down the street takes his medication so that he is not a threat to himself or others is not a sensible strategy. Treating severe mental illness cannot be reduced to a pill a day (placing all of the responsibility on someone who is severely mentally ill) and drive-through psychiatric help. An institution, while restrictive, is less so than jail or homelessness. It would provide a place for those with severe mental illness to obtain the intensive care they need while protecting the public from yet another failed social experiment.