JEFF JARVIS ON THE HOMELESS:
And the real issue isn’t homelessness. It’s insanity. The laws in this country make it impossible to commit and help even the obviously and often the dangerously insane.
I say that One Flew Over the Cuckoo’s Nest is as much at fault as any politician, for it made the institution frightening and the people who run it bad guys.
Yes. Lakeshore Park, the lovely place where I sometimes walk or jog, is actually on the grounds of the former Eastern State Mental Hospital, which housed thousands of people. There are still a few left in a couple of buildings, but what used to be a place to care for mentally ill folks is now a complex of baseball fields, putting greens, and jogging trails. The people who once would have been cared for there are now, for the most part, on their own.
My wife thinks that the de-institutionalization movement was a dreadful mistake, and that a lot of people have suffered as a result. And they’re not just the people who were deinstitutionalized, either, though they suffer the most. Her documentary on the Lillelid murders notes that the ringleader of the killers was discharged from a mental hospital after 11 days — actually a fairly long stay by today’s standards — despite a clear recognition that she was dangerous to herself and others; if she’d had proper treatment, the family that she and her confederates murdered would still be alive. (My wife felt strongly enough about the importance of this point that it’s in the trailer). Ironically, the killer is finally getting mental health treatment in an institutional setting, and she’s doing better than she was before. As my wife notes, prisons have become the mental hospitals for many people now — it’s just too bad that the price of an admission ticket is sometimes murder.
I think that Jeff’s right about the One Flew Over the Cuckoo’s Nest effect. And mental hospitals often aren’t — and weren’t — nice places to be (though they weren’t all hellholes, either: I recently talked with a woman who had spent six weeks in a Virginia state hospital back in the 1960s who said it was one of the most pleasant times in her life, as “they had a swimming pool, the food was good, and nobody bothered you”).
On the streets, lots of people bother you. Though we tend to talk about the homeless in terms of their bothering others — and, God knows, they do — the experience is usually pretty bad for them, too.
UPDATE: Reader Rosemary Bright emails:
Glenn, as someone who was in the graduate school of social work at the University of Texas in the ’80′s I saw the beginnings of the deinstitutional movement. Under the laws that were passed there was a time frame the state had to meet on getting the mentally retarded and mentally ill out of the state institutions. The day-to-day workers were against it, there weren’t enough group homes for folks to go to (neighborhoods went up in arms when a home was being converted in their area). It was clear to me, someone new to the area, that there were a lot of people who needed to stay where they were.
I’ve heard numbers that some 60% of the “homeless” on the street are mentally ill. Anyone who’s dealt with the mentally ill know they will get off their medications. Family members of these people are usually worn out from caring for them, worrying about them and are not equipped at all. It was the wrong kind of reform to take.
I got out of the whole profession … realized I was a capitalist at heart! But that whole concept of how to deal with mental illness desperately needs to be revisited.
De-institutionalization let states save money while looking compassionate. It was irresistible. But the more difficult (and expensive) follow-through was highly resistible. Reader Ben Bauman emails:
Many of the mentally ill need constant care and do not get it. My brother was one of these people. His mental instability constantly got him in trouble and the only way he could have a normal life was when he was in mental institutional care. He would only receive this when he would get in trouble and went to jail. We could not get him institutionalized through the courts. So, he roamed the country (primarily CA and NV) until he would get in trouble or some one would harm him (therefore requiring medical care). Normally he would be released after 6 months in a mental institution because he was “healthy” enough to make it on his own (survive). Well, this went on for years until he finally passed away last year at the age of 40. The system really did kill him. I thank god for the Salvation Army for all the time they spent trying to help him, but the evil people out there took advantage of him constantly. Again, I think your wife is right on this issue from my own personal experience.
I’m sorry to hear that. Not all the homeless are mentally ill, of course, but a lot are — and they’re usually the ones who have, and cause, the most serious problems.
ANOTHER UPDATE: More here.
MORE: George Roper emails:
Dear Mr. Reynolds, first, a great posting on de-institutionalization of the mentally ill. I started working in a mental hospital in 1969 as a recreation therapist. At the time I started working, we had well over 2000 patients in a hospital that could comfortably hold only 1800 or so. By the time I finished my graduate degree in 1973, the population was down to about 800 or so. The majority of the some 1500 clients were placed in nursing homes, with family or in sheltered homes. But, they didn’t stay. The mental health field adopted the idea of short term treatment for even the severely disturbed as the ultimate goal and psychiatry/psychology became a game of numbers. Legally, in Texas at least, you cannot be committed for treatment unless A. you are mentally ill and B. as a result of that illness you are a clear danger to yourself or others. So, no matter how disturbed you are, if you aren’t a danger under current law, you cannot be forced into treatment. Unfortunately, by the time a patient is patently dangerous, it may be too late.
The massive release of mentally ill patients between the late 1960′s and mid 1970′s unfortunately did not include the concept of required treatment. Because many of the anti-psychotic medications produce a significant decrease in libido, many patients quit taking their medications in favor of an active sex life. Many patients, left to their own devices quit taking their medications because they just didn’t remember. Many families quit “forcing” their family to take their medication because it was just too hard, too much work. The results are evident across the country.
We have collectively done a great disservice to those who, through no fault of their own, have severe mental illness and are not getting active treatment.
One example of the ignoring of mental illness and its resulting tragedies is the issue of suicide which I address in my blog here: Link
Judith Lown writes:
I worked for a year in a post-doc internship at a facility for the homeless mentally ill in San Diego. Not only are the vast majority of the homeless
mentally ill, most of them have long drug and alcohol histories. It’s really impossible to sort out self-medication from fried brain due to drugs. But after a
while, it’s possible to guess pretty accurately what drug is implicated in the variety of fried brain you’re seeing.
San Diego was the early capital of meth manufacture and use and we saw a lot of meth induced psychosis–some in people who were previously productive middle class citizens. I don’t have an answer. I left clinical psychology.
But the homeless mentally ill were my favorite clients. Beat the middle class navel gazers by a mile.
STILL MORE: Background and history on what went wrong, here.