More Than a Statistic: The Human Cost of Defunding Inpatient Mental-Health Care

 

 

By: Darick Taylor

A precipitous fall in funding for inpatient mental health care is driving men and women who need treatment into the streets and jails of cities all over America. The Treatment Advocacy Center, a nonprofit “dedicated to eliminating barriers to the timely and effective treatment of severe mental illness,” published a report in 2014 revealing that there are more than ten times the number of severely mentally ill people in American prisons and jails than there are in state psychiatric hospitals. This situation denotes more than a public health crisis: the lack of sufficient inpatient care for citizens with mental illnesses is creating and perpetuating an epidemic of human rights violations.

The early-to-mid 20th century saw a spate of mistreatment of patients undergoing psychiatric treatment. Virtually everyone is familiar with the trope of the sadistic psychiatric nurse, as illustrated by Nurse Ratched in One Flew Over the Cuckoo’s Nest. Since those days, under the auspices of the government, the budget for inpatient care has steadily decreased as spending on prescription drugs and community outpatient care has increased—the pretense being that focusing on outpatient treatment would mitigate abuse and provide greater choice.

 

However, the fact is that inpatient treatment evolved from the vision of Bedlam that perhaps it once matched. There are no doubt unscrupulous people still working in the mental-health field, but the members of that industry have largely learned to see patients as valid humans in need of help. Without funding, inpatient facilities cannot adequately treat the severely mentally ill who might be suicidal or too affected by psychosis for the everyday therapist or psychiatrist with a private practice to treat.

Many of those suffering from acute mental illness could become relatively high-functioning members of their respective communities if they were able to spend enough time in a hospital to be properly diagnosed and given meds that work for them. The growing practice of doling out meds as a first reaction without examining the root cause of the individuals’ distress—whether it be pathological, experiential, or any mix of things—does not work well for folks in crisis: they often need to be observed for greater periods of time. Yet, under the Baker Act, patients may only be held up to 72 hours; many are kicked out long before that. And voluntary inpatient treatment is effectively not an option for those who are not wealthy, as there is no room for them in public facilities, and private hospitals charge exorbitant prices.

Though the problem spans the entire country, it is particularly bad here in Florida: the state ranks 49th in quality of mental-health care. Florida’s overall budget for mental-health services is far smaller than the nation’s average. So, the fact that in Jacksonville the county jail is known as the region’s largest mental-health care provider should come as no surprise to anyone. Florida stands out as a real blight on the land of mental-health care, which is saying something in a nation as filled with bad practices as the U.S.

Despite the sensationalist narrative we are often fed through the media, people with mental illnesses are far more likely to be the victims of violence than the perpetrators. This carries over into jails and prisons, as well. Mentally ill prisoners are three times as likely to be assaulted than their counterparts who do not have mental disorders; that all too often includes rape. Placing them in solitary confinement is not an effective remedy, either—as the isolation often tremendously exacerbates their symptoms.

To put a person in need of extensive treatment in jail or kick them out of woefully underfunded public facilities is, in itself, an act of violence. This violence is carried out in the name of profit. Underlying these new practices regarding what aspects of mental-health care to fund is the neo-conservative philosophy that everything, including the wellbeing of America’s citizens, should be subjected to free-market capitalism. Giving medication without involved, long-term treatment further empowers the machinations of the obscenely profitable pharmaceutical industry. Medication should be one option that is part of a comprehensive treatment plan, not the only option for desperate people who are not at fault for being sick. Unlike the doctors, nurses, and researchers who have the opportunity to interact and empathize with patients, these mega-corporations see people as dollar signs. And their ostensibly altruistic patient assistance programs bely the huge tax write-offs that remove even more funding from the public-health system that decides how much money should go to treating mental-health concerns. Patents on drugs only last twenty years—a paltry amount of time in the business world—thus the companies who manufacture these compounds are motivated to gather as much return on their investments as possible no matter the human cost.

Our government is also driven by the need to post enormous short-term profits. The failure or success of a politician is often gauged by how much industry they bring into a region (more prisoners also makes for cheaper labor) and how well they balance their respective budgets. That is why public services like education and health care are the first to be cut.

What then is the solution? I would posit that the best answer is in an active democratic resistance by citizens who are unwilling to watch their fellow humans be subjected to punishment for illnesses that are out of their control—if not out of virtue, then to prevent this epidemic from reaching their own backdoors. Let us end the practice of disenfranchising those most in need of help. We can begin by acknowledging that it is the mentally ill who are currently most underserved in our society.

 

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