America’s Approach to Mental Health: Sweep it Under the Rug

“Most people dealing with this sort of thing end up in jail or on the street. There really aren’t any other options.”

This is the response I received from an officer with the San Diego Sheriff’s Department when I called to request a visit from PERT, the Psychological Evaluation Response Team. After being told there were no PERT officers available on a Sunday, I was then informed that unless the mentally ill person is considered to be in immediate danger or a danger to someone else, they must agree to enter a treatment facility. I repeat – a mentally ill person must agree to enter a treatment facility – on their own volition. In other words, I was SOL.

PERT is a San Diego operation designed to provide an emergency assessment of an individual showing signs of severe mental illness. Uniformed law enforcement officers partner with licensed clinicians to assess a person’s mental health and needs in the moment. If PERT deems it appropriate, a person may then be taken to a treatment facility or hospital for further evaluation and possibly put on a 72 hour hold if they are seen to be dangerous. But what happens after that? They are released – usually with medication and an out patient treatment plan they are expected to stick to on their own accord.

So What?

Although this may not seem like a problem many people face, a study published in the Psychiatric Services early this month states 3.4% of adult Americans, over 8.3 million, suffer from serious psychological distress and 1.1% suffer from schizophrenia. With this amount of the population struggling with mental illness, it’s hard to believe the only real options are jail or homelessness, but after some research, it appears that is correct. According to data from the 2010 Annual Homeless Assessment Report to Congress, 26.2% of the homeless population is severely mentally ill as well as 20% of persons in jail and 15% of inmates in state prisons.

My Experience With Mental Health Care

I’ve seen the toll that mental illness can have on a personal level. Someone I love dearly, we’ll call him Paul, started showing signs of psychosis about a year ago, at least that’s when our family started to become aware of the situation. According to a recent study, victims of TBI have a 439% higher risk of developing a mental illness and are 65% more likely to develop schizophrenia. There is a possibility Paul’s psychosis is due to a TBI he suffered earlier in life or it could also be a substance-induced psychotic disorder. We aren’t sure, and trying to get a delusional individual to give any sort of straight answer is damn near impossible.

Paul was an extremely loving and loyal person, highly emotional and easily stressed, but the type of person who would literally give you the shirt off his back. He was the hardest worker you’d ever come across, a passionate person with drive, ambition, and an undying need to help others. He had been sober for eight or so years, had a gorgeous home in an upscale neighborhood, a beautiful wife, loving teenage daughter, and a close relationship with his parents and two sisters, but that didn’t stop mental illness from taking hold.

A Rapid Fall From Grace

One year later Paul is divorced, living in a small apartment (only thanks to his ex-wife footing the deposit), isolated from family and friends, angry, volatile, convinced everyone is against him, and sometimes suicidal. The problem with Paul is he has a mental illness, and not a minor case. Paul is suffering from severe psychosis or a break from reality complete with delusions, paranoia, and hallucinations.  Along with some others who suffer from psychosis, he is 100% convinced the government has implanted microchips in his brain that speak to him, control his eye movements, cause severe ear ringing and headaches, monitor his every move, tell him to do things and then cause him pain if he doesn’t do what they want. Let’s just say, he is not a person who is going to voluntarily admit himself to a psychiatric treatment facility, because in Paul’s mind, there is nothing wrong with him – it’s all because of the microchips.

So, where does this leave us?

For his family and friends, me included, who miss the Paul we knew and want to help him sustain some semblance of normal life, knowing that his options are going to jail or ending up on the street is unacceptable. He is not a bad person, he is not a wasted life, yet there are no substantial resources for a person in his situation. The officer told me he actually has to hurt someone or do something drastic in order to be taken in and even then, he’ll probably just end up in jail. I don’t know what the right answer is in this situation, but the way our mental health care system is currently set up, until someone is seriously hurt or even killed, there is nothing we can do to get Paul the help he needs.

As any concerned person would do, my family and I immediately got online to search for possible solutions. After dozens of calls to facilities and resource groups, we all came back with the same realization – in California, a person must be determined to be a grave danger to themselves or others, or unable to care for themselves in order to be put into a long term care facility. When I asked a counselor with San Diego Behavioral Health Services what that meant, he clarified that Paul must go to the extreme of not eating or drinking because of his delusions. Not being able to care for oneself, acting in an erratic and violent manner, and resorting to living on the streets isn’t enough.

Another suggestion was to contact an organization called the local In-Home Outreach Team or IHOT, that will send a mobile team to assess Paul. If they see fit, they can issue a court mandate for him to take medication and if he doesn’t adhere, he will then be arrested and placed in jail or a mental care facility – temporarily. Other than that, there is no way to have a person who is mentally ill forced to get treatment. As the counselor said, there is nothing illegal about being psychotic.

The Downfall of Mental Health Care in America

In the early 19th century, the majority of the severely mentally ill wandered the streets and ended up in prisons. In an attempt to remedy this situation and take a proactive approach to mental health, reformers went on to open state-run psychiatric hospitals to provide a more humane option. Then in the 1950s and 60s, politicians began to feel the financial weight of these facilities and opted to take a new approach. The majority of state-run psychiatric hospitals were to be shut down and most patients were transitioned to treatment at community centers.

This seemed like a good idea in theory since the hospitals were known for a stark environment and questionable practices. Rather than reforming the system, spending the time and money to improve the psychiatric hospitals, and getting these people the help they needed, it was easier and more cost effective to treat them with pharmaceuticals and put them back into society. The psychiatrists involved in policy making at the time were pushing this new approach and presenting an all too optimistic outcome for this solution. Politicians jumped on the opportunity to save money and conveniently ignored the major downside to this decision.

I don’t have to say much to reiterate the vast failure this approach to mental health care has had on our society over the last 50 years.  Adam Lanza. Jared Loughner. James Holmes. They all had one thing in common besides carrying out some of the deadliest shootings in American history – severe mental illness.

Our Country is Failing Us

How are we as a first world country with a world class medical system, unable to come up with a better solution for our mentally ill? My family’s experience and frustration with Paul’s mental health care is not rare. Countless cases like this have been documented across the country by helpless family members with no way to care for their sick loved ones and yet nothing is being done to remedy the situation. Until another tragedy occurs, all of our stories are simply swept under the rug.