The Mental Health Equation, Part II

Asylum: a place of retreat and security: SHELTER

 the protection or security afforded by an asylum: REFUGE

Merriam-Webster

Whoever dwells in the shelter of the Most High will rest in the shadow of the Almighty.                                             Psalm 91:1


“Come to me, all you who are weary and burdened, and I will give you rest.                                                    Matthew 11:28

The movement to “deinstitutionalize” persons with mental illness was well meaning, and fueled by a few reasonable concepts. One, of course, was money. It was expensive to keep people in a residential setting. The “treatment” in the hospital consisted of medication, meeting the needs of everyday life, benevolent treatment by staff (for the most part), and safety from a world which some of those patients simply could not understand. Indeed, the early concept of mental hospitals, (now highly discredited) was “asylum”. Yet asylum was exactly what some of my long-term patients needed. They were too vulnerable to be sent out into a world that they badly misperceived.

Another reason for “deinstitutionalization” was humanitarian. With the advent of more effective medications to control the florid symptoms of psychosis, patients could, if medication compliant, navigate the needs of everyday life- housing, taking care of personal needs, socialization, even employment. In theory, the “dollars were to follow the patients” into the community to help them become stable and productive persons with dignity and purpose.

No, the dollars did not follow the patients into the community.

However, I followed the patients into the community, and I went to work in the new field of “Community Mental Health”.  I loved the idea of helping to set up support systems for people newly discharged from the hospital. My colleagues and I were starry-eyed optimists, trusting that we could change the world in mental health.  As I found out, we could change the world for some individual people, but we could not change the world.  

Indeed, there were some great success stories of people who formerly had lived for years in an institution, and then went on to succeed in making a good life outside of the hospital. However, there were many who simply could not make the transition. The sobering truth that many of us came to realize was that as the institutional mental health system was shrinking, the correctional system was growing. Many of those patients sent back to the community ended up homeless or imprisoned.

Medications improved, and housing programs that we developed specifically for those with a mental illness helped. Indeed, at one point, community mental health systems were being held financially responsible to keep people out of the hospital. Boy, did we work hard to keep people out of the hospital!

However, the human equation is always the hard one when it comes to money and politics. The homeless problem was largely created by an influx of people coming into the community who suffered from mental illness and who had no access to the “asylum” of a hospital.

Tomorrow I will discuss some societal responses to mental illness.

Stay tuned…

Prayer: Lord, give us the wisdom and strength to see people as you see them, Amen

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