Tuesday, January 11, 2011

The United States Mental Health Care System Is Insane

A popular saying these days goes as follows: The definition of insanity is doing the same thing over and over again, and expecting a different result.  In the wake of the Gabby Giffords assassination attempt, one can only conclude that our society as a whole is engaging in a form of insanity, by ignoring the need to provide institutionalized treatment for the mentally ill.

Jared Loughner is just the latest in a long line of mentally ill individuals whose names have been splashed across the headlines after their dangerous propensities came to fruition.

In 1980, Mark Chapman killed musician John Lennon; after changing his plea from not guilty by reason of insanity to guilty, he was sentenced to 20 years to life in prison.  In 1981, John Hinckley, Jr., left President Ronald Reagan and three other individuals injured in a failed assassination attempt carried out to impress actress Jodie Foster; he was found not guilty by reason of insanity and institutionalized in a psychiatric facility.  In 1996, John E. duPont, a paranoid schizophrenic and heir to the duPont fortune, shot and killed Olympic wrestler David Schultz; he was found guilty but mentally ill, and sentenced to 20 to 40 years in prison.

More recently, in 2007, Seung-Hui Cho, a student at Virginia Tech,  massacred five faculty members and 27 students, and injured numerous others, before committing suicide.  Cho had been declared mentally ill by a Virginia special justice and ordered to seek outpatient treatment.

These examples are just the more famous, or infamous, examples of mentally ill people who needed help, failed to get it, and went on to wreak havoc.  Anyone with a mentally ill family member, however, knows that lives are turned upside down every day in our society, because individuals who should be hospitalized and treated cannot receive that type of specialized help.

They cannot receive that type of help because a very good idea--deinstitutionalization--was corrupted by Reagan-era cuts in federal funding for community-based mental health programs, and states hell bent on cutting budgets. 

By the 1970's, the courts had concluded that treatment for the mentally ill and disabled should be provided in the least restrictive environment appropriate for the given individual.  These decisions were a reaction to the "snake pit" conditions that existed in many state mental hospitals at that time, and the lack of targeted treatment plans.  No longer could an individual with epilepsy or Downs Syndrome be locked away with the delusional or dangerously psychotic.  Nor could individuals be stripped of all rights merely because their illnesses involved mental functioning.  If treatment could be provided in a non-institutional setting, for example in a group home or on a medical out-patient basis, then that was the type of treatment required.

The courts' decisions went a long way in dragging society's treatment of the mentally ill and disabled out of the Dark Ages and into the Enlightenment. Had the states fulfilled the mandates set forth by the court decisions, each state would have a multi-tiered mental health system that would include well-maintained and adequately staffed in-patient mental hospitals, out-patient services, group homes, community based services, and in-home treatment.  Instead, many states read the courts' criticism of the atrocious conditions in state mental hospitals as permission to shutter those facilities and turn their occupants onto the streets.

As long as we as a society are willing to tolerate the occasional Gabby Giffords assassination attempt and related deaths, as long as we are content to have our jails and prisons serve as the hospitals for the mentally ill in our midst, as long as we accept death-by-cop as the treatment of choice for our deluded or dangerously psychotic citizens, we will continue to experience the insanity that is the current mental health system in the United States.

Nothing will change, and we will be no safer, until we demand that our taxes be used to build and maintain quality mental health institutions  and related services.


  1. Maris: This is my favorite post so far. I think it might be nice if you had a few links at the end to give readers an idea of steps we can take to "change the system." Maybe you could even do a follow-up post to introduce us to legislators, family groups, etc., who are already taking action.
    Dana T.

  2. xacerb8: you might be interested in the following: