Repeating the Same Mistakes in a Broken Mental Healthcare System

Once upon a time, there were mental health asylums across the US. But, they weren’t great, and some of them were even mistreating patients. So, we closed them. The thought was that community-based services would be better, and now that we were closing the asylums, surely the resources necessary to pay for and staff these community-based options would appear.

Except the funding didn’t happen, and the resources, for the most part, didn’t appear. There were a number of reasons for that, an unwillingness to raise the funds, an unwillingness to have mental health resources in “my neighborhood”, etc. but in the end, people with severe mental health problems were left with nowhere to go. I was reminded of this reality in a recent article about the different treatment available in a town in Italy, especially this quote:

On a visit last fall, colleagues from Trieste toured Los Angeles’ ground zero for human suffering, Skid Row. The extent to which we’ve allowed people to deteriorate on our streets far exceeds anything you will see in Trieste, where there is virtually no homelessness.

One psychiatrist told me, “You may think you closed the asylum in America, but we just walked through an open air asylum.”

This was the result of closing the asylum, not better treatment, but literally moving the problem from a resource that wasn’t managed well to, well, to the streets.

Oddly enough, I also saw an article recently about the state of Oregon, and their own problem with mental health care for people caught up in the legal system. It seems that the number of judges sending inmates to the state hospital in Salem was creating a backlog for any patients to get care, so the legislature set out to fix that, by making it harder to send an inmate there.

Oregon lawmakers responded with Senate Bill 24, which made it harder for judges to send people to the state hospital. While that reduced the longest waits for mental health care and ended the lawsuit, it’s left other people without the mental health treatment they need.

As it turns out, the legislature passed the law knowing they’d be creating a problem:

The hope, lawmakers said, is that they can secure funding to treat people charged with low-level crimes through community-based mental health programs, reserving the state hospital for defendants with more severe crimes and mental illnesses.

So yes, they “solved” the immediate problem of overcrowding in the Salem facility by basically putting people with untreated mental health conditions out on the street, pushing the responsibility for them on to the local community, which doesn’t have proper community-based services to care for them.

Maybe, someday, Oregon will raise some funds and build up those resources, but in the meantime? Nothing. Not even a place to stay. So people with clear mental health problems are being released to live on the streets.

Something we seem to have gotten pretty good at over the years. That’s a broken system. A system that needs to be completely overhauled, but won’t be as long as we pretend that it’s someone else’s problem.