Last month, “60 Minutes” aired a wrenching segment about a mentally ill man, Gus Deeds, whose father, Virginia State Sen. Creigh Deeds, had tried to get him appropriate treatment, but was unsuccessful. His bipolar condition worsened, and after a surprising, violent attack on his father, Gus Deeds ended his own life.
The tragic story highlights a fact of life in the U.S.: There is a deplorable shortage of treatment for mentally ill people. In “For the Mentally Ill, It’s Worse,” recently published in the New York Times, writer Joe Nocera outlines how we have failed to improve mental health care despite understanding its prevalence and potential danger.
He recalls a magazine series from 1981 that became a book by Susan Sheehan in 1982 called “Is There No Place on Earth for Me?” It won the Pulitzer Prize.
It’s about a woman who suffers from severe schizophrenia and whose nearly lifelong effort to be treated was thwarted at every turn. “The story Sheehan tells is a terribly sad one,” Nocera writes, “and not just because of the flashes [the patient] shows of what she might have become if she had not suffered from mental illness. It is also appalling to see what she goes through as a mental patient: the hospitals that overmedicate; the misdiagnoses by doctors after the briefest of examinations; the lack of any kind of safety net when she is not hospitalized. But here’s the worst part: Even though the story Sheehan tells is more than 30 years old, there is only one real difference between then and now for the mentally ill. It’s worse today.”
We know we need to address mental illness. The regular incidence of gun violence by disturbed individuals is just one graphic example of this serious social problem. And we’re also well aware of the short shrift underwriters give to illness that isn’t physical. (See our blog, “Insurance Coverage for Mental Health Treatment Is Wanting.”)
There have been attempts to codify decent treatment of the mentally ill. In the 1960s, Nocera reminds readers, the federal government passed laws to liberate patients from “the acknowledged horrors of mental hospitals, where they were often confined for decades.” New antipsychotic drugs, it was understood, could help people with schizophrenia to live in the real world, and when they were hospitalized, to limit their stay. The federal government subsidized local mental health centers, and housing for the mentally ill.
By the time Sheehan met the subject of her story in 1978, the average stay at the New York psychiatric hospital where much of the story occurs was 38 days. Almost 7 in 10 people admitted there had been there before.
The new, powerful drug regimen and the “deinstitutionalization movement” helped many mentally ill people to better lives. But not for every patient. And some people stopped taking the drugs as soon as they left the hospital. But the effort to “mainstream” the mentally ill meant that no longer were there enough hospital beds for those who needed, so hospitals had to drug them up and get them out. And in the 1980s, federal subsidies declined.
Nocera refers to E. Fuller Torrey, a critic of our mental health system, who said that before deinstitutionalization there were 312 public psychiatric beds for every 100,000 people, which was “too many.” And today? Fourteen beds for every 100,000. Torrey estimates that we need at least 50 beds per 100,000.
What happened to patients after they left the hospital during deinstitutionalization could be barbaric. State mental hospitals released patients without knowing – or, apparently, caring – where they would go. Many wound up on the streets, or in prison, which Nocera says are become today’s “de facto mental hospitals.”
In some cities today, hospitals have been busted by local authorities for “patient dumping.” They briefly treated mentally disturbed patients, generally the homeless, then sent them off in a taxi or bus back to the streets.
Even people like Sheehan’s subject and the family portrayed in the “60 Minutes” segment who have support and resources get the shaft. These patients were loved, their families had connections and it didn’t matter. The powerless who are unlucky enough to be mentally ill don’t have a chance.
Some people are just too ill to fend for themselves. Sheehan’s patient “needed to be in a hospital – a humane hospital where she could get the care she needed,” Nocera writes. “It never happened. ”
And it didn’t happen a generation later for Gus Deeds.
“I remember thinking when Sheehan’s articles first came out … that someday we would look back in horror at the way our society treated the mentally ill,” Nocera said. “Thirty three years later, that day still hasn’t come. But it will.”