Neglect Of Those Suffering Serious Mental Illnesses Is Criminal

The recent 25th anniversary of Threshold came to mind this week as I chatted with an older neighbor down the street  as I was walking my dog.  She told of being startled several times by a person who is obviously mentally ill as he emerged from an adjacent City park to stare at her house before ambling down the street.  Her description of his behavior suggests to me that he suffers from a severe mental illness called schizophrenia, possibly paranoid.

It doesn’t happen that often in Durham but I believe I’ve seen this guy.  It doesn’t happen often in Durham but I became familiar with people suffering schizophrenia a couple of decades ago during a stay in San Francisco.  They can appear aggressive but the vast majority don’t pose a threat and the few that are get huge amounts of publicity.

I’m sure the man has been reported to and picked up by police many times and sent to a state facility for evaluation and then released on the premise or promise he will take his medications and all will be well.   This nation made a tragic and costly error in the early 1960’s when leaders bought into the faulty premise that people with severe mental illnesses could be treated as out-patients and trusted to be responsible for taking their medications.

The truth: without diligent support systems, when people with severe mental illnesses begin to feel better, they all too often stop taking their meds because they don’t think they are chronically ill.

Because those with severe mental illnesses are mostly out-of-sight, out-of-mind for most citizens, society assumes the system is working while huge amounts of money, much of it hidden costs, are being spent because the support system has never been adequate.

For example, a significant proportion of people in prison and local jails are mentally ill.  Other costs that could be mitigated if invested instead on the front end to help those with serious mental illnesses include ambulance rides, police and courts, emergency room treatment, revolving doors at drug treatment centers and homeless shelters, poverty and other safety nets, child neglect, expensive but far too late healthcare interventions, school drop outs, lost productivity and depressed land values as a result of loitering and panhandling to name only a few.

However, resentment by those whose only priority is “smaller government” or “paying less in taxes” hamstrings society from devising a system that shifts back-end costs to a better system of front-end treatment.  Just like those who resent healthcare insurance reform fail to grasp the fact that they are already paying huge costs with a system where access is denied to too many on the front end, only to cost billions in back-end treatment.

Threshold is one of those valiant non-profits left to fill the gap for those with mental illnesses.  Now the oldest program in Durham, Threshold is organized on the Clubhouse Rehabilitation Model established 40 years ago by the now 60 year old Fountain House in New York City.  Threshold strives to fulfill  4 basic rights for residents with mental illnesses:

• The right to a place to come
• The right to meaningful work
• The right to meaningful relationships
• The right to a place to return

It takes this approach to rebuild and meaningfully impact the lives of people with severe mental illnesses and to make sure they stay on track.  Of course, there are other mental health organizations but the system as a whole isn’t working and hasn’t now for more than 50 years and as a society we’re paying huge back end costs by refusing to put in place an adequate system on the front end.

During the early 1960s, with the advent of a series of new medicines to treat mental illness, a system of state-run mental hospitals, long thought to be inhumane fortunately gave way to a major overhaul of the mental health system.  Unfortunately, war intervened and it was never fully or adequately funded and while reform is often given lip service, mental health was largely gutted during the 1980’s by the drive for “smaller” government.

Currently, 1 in 17 American adults and 1 in 10 children suffers serious mental illness with a total cost to the economy of well more than $120 billion in front end costs alone.  By comparison, people with seriously mental illness far outnumber Tea Party supporters in this country, mama grizzlies and all (although there may be some overlap. ) Just imagine if the money squandered on all of those anonymous corporate attack ads were combined with the $65 million alone spent on 161,203 ads demonizing one person, Nancy Pelosi, had been put to use making the mental health system viable and beginning to make good on a 50 year old promise.

We’ve been in denial about the issue of severe mental illness for far too long.  It is criminal.  We may be refusing to pay for it but believe me, we’re paying through the nose big time in hidden social, economic and monetary costs.  The result is almost criminal in neglect and a shame on the American Dream.  Until we seriously deal with mental illness, we’re living a lie.

In the meantime, groups like Threshold are all we have and here are some ways we can help.