Our Vanishing National Mental Health Safety Net

Readers Digest (February 2014) reports that in the 1950’s more than a half a million people lived in the U.S. mental institutions – one in 300 Americans. By the late ‘70’s, only 160,000 did, due to the efforts by psychiatrists, philanthropists, and politicians to deinstitutionalize the mentally ill.

Institute of Mental Health 6, Nov 06

Institute of Mental Health 6, Nov 06 (Photo credit: Wikipedia)

Today there’s one public psychiatric care bed per 7,100 Americans – the same ratios as in 1850. Emptying the asylums was going to save money. And who needed hospitals with all of the antipsychotic drugs on the market? Deinstitutionalization was going to restore citizens’ rights and protect them from deplorable conditions. Wouldn’t it be better if the mentally ill were treated at home, given support, therapy, and medication via community clinics? It sounded good, but the reality was quite different.

In 1961, a joint commission of the American Medical and American Psychiatric associations recommended integrating the mentally ill into society. This plan depended on the establishment of local facilities where mentally ill people could receive outpatient care. Congress passed a law providing funding for these “community mental health centers.” In 1963, the states, under pressure from the patients’ rights movement, downsized their psychiatric hospitals faster than anyone had anticipated and between the Vietnam War, an economic crisis, and a lack of political will, adequate funding for community services never came through.

In 1980 the Mental Health System Act was passed to fill the gap. But a year later, Ronald Reagan gutted the act, then decreased federal mental-health spending by 30 percent and shifted the burden to the state and local governments. The crucial community services that the mentally ill were supposed to receive failed to materialize and more and more people ended up on the streets. Collectively, states have cut $4.35 billion in public mental-health spending since 2009.

As of 2006, 1.3 million of America’s mentally ill were housed where they used to be in the late 1800s: in prisons. Between 1998 and 2006, the number of mentally ill people behind bars more than quadrupled. In some county jails, rates of inmates with mental illness have increased by nearly 50 percent in the past five years. It’s not uncommon for individual jails to report that 25 to 30 percent of their inmates are mentally ill or that their mentally ill population rises year after year.

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