Abdicating Our Responsibility

Spectator

By Stephen Tuttle | March 19, 2022

Our mental health as a nation isn’t so good, and it doesn’t appear to be getting better.

The National Alliance on Mental Health compiles and curates data from the Substance Abuse and Mental Health Services Administration (which is a branch of the U.S. Health and Human Services Department), the Centers for Disease Control and Prevention (CDC), and the Department of Justice (DOJ). The numbers are depressing.

In 2020, fully 21 percent of Americans—almost 53 million of us—experienced some form of mental illness, including depression and anxiety disorder. Fully 6 percent of us reported having suicidal thoughts. Perhaps more troubling, nearly 54 percent reported they neither sought nor received treatment of any kind.

Mental Health America (mhanational.org), which uses publicly available data from all 50 states, reports equally distressing numbers, including that 15 percent of our children under 18 reported experiencing major depressive issues. Nearly 11 percent of those children can be categorized as severely depressed, yet 60 percent of that group receive no treatment.

As one might have guessed, the pandemic did not help at all. According to the Kaiser Family Foundation Health Tracking Poll, the last two years have seen significant increases in reported anxiety, depressive episodes, and diagnosed depression.

When Governor John Engler closed Michigan’s 16 mental health state hospitals in 1997, the idea was that most patients could be mainstreamed into society and have their needs met by the creation of many community mental health programs filled with qualified professionals. Warehousing patients in large institutions had lost favor as early as the 1970s as revelations of horrendous abuse at some began to surface. Even those more progressive facilities—including those using the Kirkbride Plan like the Traverse City State Hospital which emphasized humane treatment, rehabilitation, and patient self-sufficiency—were tarred with the same negative brush and forced to close.

Unfortunately, the widespread community services promised were never fully budgeted by Congress or legislatures that saw little political advantage in helping the mentally ill. The promised community outreach and treatment never came to full fruition.

The result is an alarming lack of available mental health services and a crushingly overburdened system trying to fill gaping holes in the safety net. Now, instead of warehousing people in mental hospitals, we warehouse them in jails, homeless shelters, and cemeteries.

According to the Prison Policy Institute, 37 percent of those in state or federal prisons have been diagnosed with mental illness and 66 percent of them receive no treatment. It even gets worse as 44 percent of those in local jails have been similarly diagnosed.

It’s popular these days to suggest at least a partial solution involves sending out social workers or mental health workers on 911 and other calls not involving violence instead of uniformed law enforcement personnel. There is some evidence such an approach can be effective in some circumstances and can deescalate some situations. For example, Denver’s efforts to send a clinician and mental health professional to some emergency calls have reduced their police responses by about three percent. (USA Today, February 6, 2021)

Traverse City would like to try something similar. It would be a gift to law enforcement officers who are not thrilled about responding to attempted suicides or other calls involving mental health episodes absent of criminal activity. The real question is what happens after that initial contact is made.

To be truly effective, the response would require a fairly long list of support services and personnel. Avoiding interaction with the police might be a good starting point if we retrain 911 operators to identify mental health calls, but it does little to resolve the long-term issues. Where does that troubled and possibly struggling person now go for help? They can be forced into a 24-hour psychiatric hold at the hospital during which they can be observed and evaluated but must then be released. They can be referred to counseling or other services but can’t be forced to go. They can be prescribed appropriate medications but can’t be forced to take them.

Even the worst of cases involving the most deeply troubled of our neighbors cannot be quickly or easily resolved. Michigan now has only five psychiatric hospitals with only 722 total beds, all of which are always filled. Waiting lists for these patients can be disastrous.

We’ve never had the will to fully address this problem so it continues to fester. We need a financial commitment that dramatically increases the number of mental health workers and available facilities, provides the resources to identify and evaluate those who need help, puts a system in place that provides assistance quickly and efficiently, and then tracks patients who need follow-up treatment and services.

Continuing to use jails, homeless shelters, and cemeteries as first options is an abdication of our responsibility as a society. We can do better. We must do better.