Tuesday, April 30, 2013

Where Do They Go? Finding Places for the Severely -- and Dangerously -- Ill Patient

A doorway into a bedroomIn the upcoming Mother Jones article "Schizophrenic.  Killer.  My Cousin,"  Mac McClelland talks about his third cousin who suffers from schizophrenia and ultimately kills his own father. 

McClelland talks about the difficulty in getting an ill person help, changes in how resources have been allocated which make this difficult, and fears about calling the police to bring a mentally ill patient to the hospital.  McClelland writes:

"You can call the police," the deputy director of Sonoma County's National Alliance on Mental Illness (NAMI), David France, said when I asked him what options are available to a parent whose adult child appears to be having a mental breakdown. "The police can activate resources," like an emergency psych bed in a regular hospital, or transport and admission to a psychiatric hospital in a county that, unlike Sonoma, has one. But only if the police decide your child is a danger to himself or others can they arrest him with the right to hold him for three days—what in California is called a 5150, after the relevant section of state law. Otherwise you can be turned away for lack of space even if your loved one is willing to be admitted, or be left no good options if they're not. Ninety-two percent of the patients in California's state psych hospitals got there via the criminal-justice system.

But Mark didn't want to call the police. For one, he didn't think Houston was dangerous, just upset, despairing. 

McClelland goes on to write about her aunt's devastating struggle with schizophrenia and the economics of decreasing mental health care dollars and beds.  

 Ah, California. No. 1 in the amount of mental-health funding cut from 2009 to 2011, No. 7 in cuts as a percentage. Home to one of the largest jail/psych facilities in the nation, the LA County Jail. Where visitors can't believe how many bat-shit-crazy homeless we've got. Where deinstitutionalization was pioneered under Gov. Ronald Reagan with the 1967 Lanterman-Petris-Short Act, which made it vastly more difficult to commit people, and where the rate of mentally ill in the criminal-justice system doubled just one year after it took effect. Where, often, the severely mentally ill live in jail for three to six months because they're waiting for a bed to open up in a psychiatric facility. California: where, says Torrey, the psychiatrist who warns about "predictable" violence like my cousin's, "they led the way in [deinstitutionalization], and they've led the way downhill. They're certainly leading the way in consequences

One psychiatrist we know called the article 'sensationalism not journalism,' and I'll leave that judgement to you.