30 years ago, California, later followed by other states, decided to virtually close down the State Mental Hospitals. There had been multiple exposures of abuse throughout the Nation's systems such as over-medicated individuals kept on back wards for years without clinical justification. However, the primary force leading to the widespread closures was economic. Providing free room, board, medication and psychiatric care to the chronic and seriously impaired mental health population was expensive and failed to result in any positive financial or political benefits. Theoretically, these marginally functional individuals would now be cared for by a network of community service agencies that would spring up on a local basis. Unfortunately, such a network never existed and failed to develop for the same economic challenges the State Institutions had faced. Counties continued to provide outpatient services, with occasional brief local hospitalizations for those who became unstable, and nonprofit organizations were founded, and often financially foundered, to provide services. With few resources and the cognitive and emotional inability to connect with the few programs available, the mentally ill started to drift into the streets where they often self-medicated with illegal drugs. Within 10 years, police and social service agencies estimated that possibly one third of the growing homeless population had mental disabilities. An increase in street crime, the resentment of business owners who lost customers who would not cross the crowds of homeless on the sidewalks, and the disgust of working citizens who resented the litter and potential dangers of large numbers of people living on the streets, led to a political decision to crackdown on the homeless. Sweeps of targeted areas moved the homeless away - to other areas where the resentment was just as great. Petty street crimes to enable the penniless to live, and drug use, provided the excuse for more draconian measures. The homeless started moving again, this time into the prisons. It is now estimated that the penal system is the largest provider of mental health services in the nation. Apart from those Institutions designed for those who have been legally determined to be "criminally insane," the system houses mentally ill individuals who may make up a third or more of the total prison population. Building more prisons and hiring more guards is politically positive: voters want to keep their communities clean and safe and willingly pay for the fight against crime. While the murderers and rapists are held up as examples of those who need to be contained at all costs, the fact remains that a majority of the enormous and growing prison population are serving their time for drug-related activities or victimless crimes. The mentally ill have finally been fully recycled. They are still invisible but instead of vegetating in State Mental Wards, they are caught within a system which robs them of their dignity, provides less than optimal treatment, and costs far more to the taxpayers than would well-organized and efficiently run hospitals and clinics. This is progress? |
