Recent tragedies across the country have prompted media outlets to place considerable emphasis on inadequate mental health treatment. But how did we come to such a broken system?
In order for adequate psychiatric treatment to emerge in our society, it is important to understand the evolution of our defective behavior health system so the same mistakes are not repeatedly made.
In the 1950s, the World Health Organization recognized that long-term institutionalized psychiatric patients were stripped of freedom, isolated from society, and were victims of physical and social abuse. Efforts were focused on psychiatric reform and the integration of institutionalized psychiatric patients into the community for more humane treatment.
The idea of de-institutionalizing chronic behavioral health patients led to over 120 psychiatric facilities to close down. Massive amounts of long-term psychiatric patients were discharged into the community where many unforeseen problems arouse.
Psychopharmacology used most of the mental health budget, leaving little financial aid for developing supportive community resources. Lack of stabling housing and community supports have directly influenced the increase of homelessness, unemployment, substance abuse, mortality and morbidity. The homeless population that once prominently consisted of alcoholic men, has now expanded to include those with chronic and severe mental illness. An alarming 50 percent of homeless individuals now suffer from severe mental illness.
A new phenomenon called trans-institutionization has emerged. Rather than being properly managed in the community with strong support systems, the chronically mentally ill have been discharged from long-term psychiatric hospitals into nursing homes, residential homes, group homes and homeless shelters, many of which are poorly staffed with substandard therapeutic conditions. Not only does mental health treatment rely more on poor and underfunded community programs, but it also falls heavily on the families of the undertreated patient.
In a time of increased divorce rates, family mobility and women in the workforce, it is more difficult for families to provide care to their loved ones with severe mental illness. Lack of funding and support cause an increase in psychiatric patients presenting in other institutions to be managed acutely and often fall heavily on emergency departments that do not have the best means to care for this population. Harsh bright lights, loud noises, long wait times and a busy and crowded atmosphere can exacerbate psychiatric conditions and increase the risk of violence among patients and staff. With a greater influx of mentally ill people incarcerated, prisons are now forced to poorly manage them long term.
Now the question is, how do we transform this failing system into a supportive environment for the psychiatric population integrated into our communities? First, it is imperative that federal aid assist in the creation of more community-based organizations and stable, supportive housing. Community care housing that consists of home-like environments and are staffed with multidisciplinary teams have shown to improve the quality of life and decrease psychiatric readmissions. Supportive community-based housing has also assisted in the development of skills to live independently and provide the opportunity to gain employment.
More outreach programs, such as Assertive Community Treatment, need to be established and funded. Intensive community programs increase independent living and significant reductions in readmissions in the hospital. These programs provide in home treatment and encourage more community involvement and collaboration. There is a strong focus of staff reaching out to patients, rather than waiting for the patient to call or schedule appointments.
Deinstitutionalization, in theory, was an effort to stop the abuse of long-term psychiatric patients and give them a chance to have a better quality of life in the community. However, the government failed to provide the proper community resources to support their efforts in providing more humane treatment to our chronic behavioral health patients. Rather than living successfully in society, the mentally ill are stuck in a revolving door of decompensation due to lack of supports provided by the government.
Now I ask, which is the lesser of the two evils: living long term in a psychiatric hospital away from society, or being homeless in the community with lack of support and frequent trips to emergency departments and jails? It is no secret that mental illness still maintains a stigma within our society, but I question what will it take for changes to finally be made in order for this vulnerable population to have a better quality of life in which we all deserve.
Katie Delaney is an emergency psychiatric nurse at Hartford Hospital and is currently enrolled in a psychiatric nurse practitioner graduate program.