I must be crazy to be in a loony bin like this.
McMurphy.
http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec7.html
http://www.schizophrenia.com/szfacts.htm
Emergency rooms are the bottom string in American society’s safety net. In addition to taking care of the ill and injured, emergency rooms become the primary point of care for many of the mentally ill. The tragic reality confronting both the psychotic and those taking care of them is that there is often no other alternative. Dirty, disoriented, hungry, and sick, without friends or family, they wander the streets of America until crime, violence or disease brings them to the emergency room.
Thousands of pages have been written about the dysfunctional history of American mental healthcare. One of the referenced articles is a good history for the power readers among you. The politically correct way to characterize the changes in the last 40 years is the replacement of inpatient state sponsored mental hospitals by “community” centered care. Additionally, mental health advocates and patient rights groups have passed very strict laws restricting the scope of involuntary commitment.
In my training I spent several weeks at the Massachusetts state mental hospital. It was a terrible place, representing the archetype of the mental hospital in the movies, very similar to “One flew over the Cuckoos Nest”. Patients were kept in large, noisy and often neglected wards. Restraints and padded cells were common. The popular revulsion which led to the closure of these facilities is certainly easy to understand. Unfortunately, closing these facilities just shifted the problem to the streets of America.
Hundreds of thousands of those patients are now wandering our cities and highways, becoming the most hopeless of the homeless. Some estimates put the number of schizophrenic homeless as high as 300,000 or more. Patients don’t take their medications, and quickly fall out of the system. No mechanism exists for finding these people. Laws prevent doctors from forcing them to receive care.
Legal and human rights considerations aside, tossing these patients out onto the streets, exposing them to violence, poverty, and the manifold abuses of homelessness is not a kindness. The mental health advocates, no matter what their motivations, have done these people no favors. As I discussed in yesterday’s post, we cannot apply our own understanding and experience to the severely mentally ill. Nonsensical theories and fanciful good intentions have inflicted unconscionable harm upon these people. Like children, they need to be protected, from both the world and their own actions. I suggest anyone who disagrees go to a big city emergency room and see the hell these people live in daily.
