As a New Mexico licensed psychologist of 30 years, I am concerned that there has not been more serious consideration of how to best apply forthcoming Federal mental health funds.
Ever since the 1980s, under the de-institutionalization program of the Reagan administration, entire communities have suffered from the increasing presence of the mentally ill living on their streets, under bridges, in parks, in halfway houses, or in jails.
Still, it would be historically inaccurate to lay the entire blame for our country’s failure to provide necessary services to the mentally ill at the feet of the Reagan administration. Rather, it was based on liberal (or perhaps libertarian) ideas that were espoused prior to the 1980s. In my early training, I was required to read Thomas Szasz's The Myth of Mental Illness, and an article by David Rosenhan, “On Being Sane in Insane Places,” both written by academic psychiatrists, the former arguing that mental illness was best defined as difficulty with social adaptation, the latter offering dramatic proof that professionals working inpatient could not tell the difference between someone who is truly mentally ill and someone feigning symptoms, however poorly. These writings amounted to philosophical arguments that had an unexpected impact.
Under the Reagan administration, cutting back on Federal funding for mental institutions created a windfall that was used to cut taxes. This turned out to be a one-off that had serious side effects. In New Mexico, we have had a barely functioning mental health system for decades. Most of us probably do not remember that we had mental hospitals and treatment centers that were to provide individualized treatment to those who could not survive successfully on their own in the community without support. Those of us working in the system could see what was not otherwise recognized as a problem, that the jail had become the new standard of treatment for the mentally ill, which is close to no treatment at all. I worked at the Bernalillo County Detention Center, an experience that was the basis for an article I wrote for American Jails in the 1990s entitled “Jail as a Psychiatric Emergency Room.” There also arose a new reliance on courts to intervene in mental health and substance abuse to divert offenders with a threat of punishment for non-compliance with a program of treatment. Some did not get better even with compliance.
The difficult reality of having had a lack of treatment programs is that most who are presumed to be trained in the mental health field, including psychiatrists, nurses, psychologists, social workers and counselors, no longer have the direct clinical experience to assess symptoms and work as a team to develop treatment plans that might have the effect of successfully transitioning their patients to the community.
Instead, as a result of de-institutionalization we have what amounts to an almost subterranean community within our community where the homeless, whose sole offense may have been to be evicted, live alongside addicts, sociopaths and the mentally ill. However different, all may be identifiable as severely mentally ill due to the extreme stress of a life of constant uncertainty and threat. All of these people despite their differences could find themselves in the same place, in jail, even though many of them might be at least managed and at best treated to the point that they can do well in community settings, perhaps obtaining employment.
Following 40 years of institutional neglect, any mental health program will need to triage to evaluate the need with assessments being made in jails, community health centers, hospitals, shelters, soup kitchens, motels and simply by combing the streets. Without such an infrastructure in place, little will be accomplished to provide relief both to the community and to the mentally ill.
Julian Lev, Ph.D.
New Mexico Psychology License #508
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