We have made some big mental health policy mistakes in my lifetime. And my son Tim is among the millions of our sons and daughters who have paid for them.
This is because he happens to be among the 6% of sons and daughters with serious mental illness.
We fail to see mental illnesses as often preventable and always treatable diseases. And although half of us will be diagnosed with one during our lifetime and mental illnesses cost as much to treat as cancers, we more readily send people with mental illness to jails and prisons than we do to hospitals and health centers. Meanwhile, we underfund mental health care, special education, and social services systems.
I explain what this has meant for my son in an essay just published by Health Affairs, the nation’s leading health policy journal.
How I Helped Create a Flawed Mental Health System That’s Failed Millions – And My Soncovers over twenty years of Tim’s life in Connecticut, Texas, and California – a life now lived mostly in jail, in hospitals, or on the streets. This isn’t because of his mental illness. It is because of the way we treat his mental illness.
The article appears in the September 2012 issue of the print journal, but Health Affairs has also made it available free of charge online and via podcast. There is a link at the end of this column.
In the essay, you will see that we former policymakers – along with educators and service providers – made a lot of mistakes that resulted in the isolation of people like Tim.
And today’s policymakers aren’t just repeating the mistakes we made. They are piling new ones on top of them.
As a Connecticut state legislator in the 1980s, I thought we had the right idea. Close the archaic state psychiatric hospitals, and move people with chronic mental illnesses back to their homes, schools, and communities.
There was a problem. Closing the institutions was popular, but returning people with mental illness to communities wasn’t. So we directed only some of the dollars we saved into services. The rest we used to lower taxes.
We justified this because we made taxpayers happy and because we believed that whatever happened in the community would be better than the underfunded services in the institutions.
We were wrong. Sometimes no services are worse.
Today, Americans with serious mental illnesses have life expectancies that are diminished by as many as 25 years. They die from violence and suicide, and from ineffectively treated chronic illness.
Those who survive suffer from stigma and neglect. This is because they often act differently from the rest of us, sometimes because of disease, sometimes because of the medications they take to manage disease, and sometimes because of the drugs they use when the medications don’t work.
We are afraid of them.
To make them less frightening, we use the term “behavioral illnesses” to describe what they have. But this in turn feeds a fantasy to which unsophisticated people (some of whom serve as policymakers) cling – that mental illnesses are the same as bad behaviors, and people with mental illnesses could choose to will away their diseases if only they’d try. As if someone with cancer or heart disease could will those away.
They can’t.
I can’t defend what we did in the 1980s to shackle people with mental illness with neglect. But it seems to me that today’s policymakers are doing worse.
They can see with their own eyes the results of neglect – people sleeping in our parks, lying on our sidewalks, and standing on our street corners begging. So how can they possibly defend the $3.4 billion in cuts they’ve made to state mental health services in the last three years, or some of the other horrible policy decisions I write about in the essay?
Maybe they just choose to look the other way.
That’s what most people do who see my son Tim – and all our sons and daughters who are like him.
And when they do, they miss seeing a gentle soul with an easy smile, a good heart, and an imperfect history who has accepted humbly the hand he has been dealt and graciously consented to me writing about it.
But what they miss most isn’t who they choose not to see, but an essential part of what makes us human – empathy. We were made to do better than this.
To read the full Health Affairs Narrative Matters essay, click here.
For links to the sources of data cited in this column, please see the mental health section of my data links page.
If you have questions about this column or wish to receive an email notifying you when new Our Health Policy Matters columns are published, please email gionfriddopaul@gmail.com.
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