Tuesday, March 05, 2013

Schizophrenia and Mass Killings: Feds Botch Treatment

Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center, tells us that 50 years ago, the federal government created community mental-health centers, or CMHCs, to take the place of state mental hospitals. The fed action was historic because care of the mentally ill had been a state responsibility for over a century.

And the fed take-over was a big mistake.  Quoting Torrey:
  • Over the following 17 years, the feds funded 789 CMHCs with a total of $2.7 billion ($20.3 billion in today's dollars), as the number of patients in state mental hospitals fell by three quarters—to 132,164 from 504,604—and those beds were closed down. 
  • From the beginning, it was clear that CMHCs were not interested in taking care of the [discharged] patients. Instead, they focused on . . . "the worried well." [Though] individuals discharged from state hospitals initially made up [just] 4% and 7% of the CMHCs patient load,. . . the longer the CMHC was in existence the lower this percentage became.  [CMHC] failed because it did not provide care for the sickest patients released from the state hospitals. 
  • half [those discharged from state mental hospitals], many of whom lack family support and suffer from the most severe illnesses such as schizophrenia and bipolar disorder, have done poorly. . . these untreated mentally ill are responsible for 10% of all homicides (and a higher percentage of the mass killings), constitute 20% of jail and prison inmates and at least 30% of the homeless. Severely mentally ill individuals now inundate hospital emergency rooms and have colonized libraries, parks, train stations and other public spaces. 
  • Meantime. . . Medicaid and Medicare [--not] originally intended to become a major federal support for the mentally ill [--] now fill that role. In 2009, 4.7 million Americans received [social security support] because of mental illnesses, not including mental retardation, a tenfold increase since 1977. The total cost was $46 billion. 
  • The total Medicaid and Medicare costs for mentally ill individuals in 2005 was more than $60 billion. . . the annual total public funds for . . . treatment of mentally ill individuals is now more than $140 billion. The equivalent expenditure [when] the CMHC program [began] was $1 billion, or about $10 billion in today's dollars. 
  • President Obama['s] Substance Abuse and Mental Health Services Administration['s] contribution to the . . . Dec. 14 Newtown tragedy focused only on school children and insurance coverage. . . its current plan of action for 2011-14, a 41,000-word document, includes no mention of schizophrenia, bipolar disorder or outpatient commitment. 
Torrey states the federal experiment has failed, as seen most recently in the mass shootings by mentally ill individuals in Newtown, Conn., Aurora, Colo., and Tucson, Ariz. He concludes, “It is time for the federal government to get out of [mental health treatment] and return the responsibility, and funds, to the states.”

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