The Deinstitutionalizing of the mentally ill--a failure?

[BusynMember]

I think about this a lot because so many of our kids turn 18 with nowhere to go. I know a huge percentage of homeless people are mentally ill. What do you think about this? I think it's a huge failure. Some people do need help and a place to go when they are unstable. It's so hard to get any facility to admit a mentally ill individual unless they are literally brought in holding a knife to their throats. And what about after they've calmed down? What if they're psychotic and unable to function without help? Parents can't always do everything--we're not mental health professionals--and, worse, we can't live forever. Then what for our kids?
I wish they had facilities for the mentally ill. We could pass laws to avoid abuse, but there are people who need sheltering due to mental health concerns, and in my opinion they shouldn't be sleeping on park benches...how do YOU feel?

 

[DammitJanet]

MWM, I totally agree with you. I dont think we need those horrific places like in A Clockwork Orange but I do think there needs to be some place that can house these people who are not actively a danger to self and others.

Granted I dont think they should just keep a database of everyone with mental illnesses and go lock them up or they could do that to everyone.

 

[flutterbee]

You can't lock up someone that doesn't want to be locked up and who isn't a threat. However, there is no middle ground. You can only be locked up if you are an imminent threat. If you're just spiraling or unable to cope you're SOL unless you have the insurance coverage and/or money for long-term inpatient care.

There needs to be a more accessible middle ground for those that want the help they so desperately need.

 

[Hound dog]

Oh, I definately agree.

I'm not saying that necessarily the way state run hospitals were run before was all that fantastic. (would depend on the hospital) The system / laws needed revamped, not the hospitals shut down.

The need for such hospitals again is huge. But most professionals / lawmakers seem to choose to ignore because they're afraid of getting blasted for speaking up.

Any system can be abused.

But it doesn't subtract from the need.

And my grandmother was a woman who found herself committed by her husband via the court because she'd threatened to leave him. Took her a year to be declared sane, and she kept that certificate of "sanity" til the day she died some 50 yrs later. (by the way, she left him right after she got out lol)

 

[BusynMember]

I was thinking more of the homeless/mentally ill (some who are psychotic) being allowed to be brought to Safe Houses with psychiatrists so that they can eat, sleep in a warm bed and get treatment. I think the days of "One Few Over the Cuckoos Nest" are gone, but we have to do SOMETHING. What if it were OUR child walking around, talking to himself, hearing voices, scared, unable to work, etc. with no place to go.

 

[skeeter]

We often see people in court, that we know are going to wind up in jail, that DO NOT need to be there. They just need someone to oversee that they take their medications.

Vito is a good example. I don't know if he's BiPolar (BP) or schizophrenic, low IQ, or a combination of things, but he's (usually) harmless. He has a certain "turf" of street that he "patrols" and sings or talks to himself. He's not homeless - his grandmother lives in the neighborhood - but he often goes weeks between visits to her house.
However, he self medicates. And when he's drinking, there are certain buttons that can be pushed and he will become violent. The last time was with a new officer, so he wound up getting arrested for accousting an officer. He also can be talked into doing things for others.
We've tried to get him psychological help, but it's just not THERE. He's been to River City (our court ordered rehab) and now his only option is jail. He doesn't NEED jail - most of the time he's only a threat to himself and not the community.

 

[donna723]

From my vantage point, as an employee of the prison system, I can tell you that a large percentage of the homeless mentally ill end up in jails and prisons. The county jails are hit or miss and some get no care at all. The ones who end up in a state prison system (at least ours) do get mental health care - not the greatest but better than none. While they're there, they are under the care of a psychiatrist, they receive medications and are closely monitored.

BUT - we cannot keep them even one day longer than their sentence calls for. Even if our mental health staff knows that this person cannot function on their own and manage their own care, they are released and are back on the streets. They have no choice. There is no "transition", nowhere for them to go. Many have no families or no one to care for them. They're back out on the street with a two-week supply of their medications. They're expected to take their medications at the proper time, to seek psychiatric care on their own, to get their own medications, provide their own transportation, and manage their own care. The majority of them are completely incapable of doing this - even if they weren't "homeless", and especially once they're off their medications. It's almost inevitable - sooner or later they will be arrested again, and they're right back in the county jail or back in the prison system, and the cycle starts all over again.

The "system" is doomed to failure as long as there are these huge gaps in mental health care. The prison sytem has been forced to take up the slack and many of these inmates are people who would have been cared for in the State mental hospitals in the past. Most of these people do not belong in jail or in prison - what they really needed was adequate mental health care, but there is nowhere else for them to go. And when they are released, they are given $75, a bus ticket and a two-week supply of their medications, and are then expected to manage their own lives and be self-sufficient! Is it any wonder that the "system" has failed so miserably!

 

[house of cards]

In my ideal world we would have 3 levels of care. first, the intensive hospital for fairly short term treatment, then something more like a Residential Treatment Center (RTC) enviorment, then something like a half way house with medication supervision and requirement, but allowed to leave for the community during the day.

 

[Nomad]

I think it is a huge failure and I don't know what to make of it. There is supportive housing and this provides some help.

 

[crazymama30]

I think Nomad is right. How do we fix what is so hugely broken? How do you expect people to make the right choices (take the medications if they have them) when they are just not capable?

 

[judi]

And...it would nice to have the option for those that are mentally ill to somehow get insurance. But...in our society if you can't get and keep a job, no insurance and no Medicaid for males who don't have dependent kids either.

Its rough.

 

[TerryJ2]

Lisa, wow, kudos to your grandmother!

In reg. to the main question, yes, there must be something as an alternative to the prison system. If I were a state governor, I would definitely fund such a thing. However, you cannot keep some people there; they can simply walk away. Don't know what to do about that.
Good question ... something that may never be fully answered.

 

[Big Bad Kitty]

It all comes down to the almighty dollar.

Is it needed? Probably more than any other one thing right now. Does it generate revenue, or is this something the government would have to fund?

Well, there is your answer. That is why you don't see any.

It's a crying shame.

 

[klmno]

MM- great topic! I wish there was a way to make people more aware who are in the general population instead of those of us who see the real impact. My difficult child is 13 yo. I have started hearing some attention given to the facts that parents/family can't really help those over 18 yo get help when they seriously need it. In our situation, I am on the verge of panic because I can't get difficult child help now, should he need a psychiatric hospital.

He had been in an acute psychiatric hospital before, 2 years ago- short term. I had to jump through hoops to get him in that- I did it because I thought his life was in danger and/or mine or someone else's- whoever might try to keep him alive. Anyway, I was told then that he wouldn't be accepted for that short-term stay if he was not an imminent threat and I was told that, here, that basicly means the kid is holding a knife over their own wrist or someone else's body. Now, since he started a brush fire last year, I have been told that no psychiatric hospital or Residential Treatment Center (RTC) in this state will accept him, ever, because it was arson, period. The only possible option, and I underline possible (not definite), is that if he needs a psychiatric hospital in the future to keep himself or someone else safe, I would need to sign over custody, at least temporarily (RIGHT!!), to the state and they could send him to a psychiatric hospital or Residential Treatment Center (RTC) out-of-state. Again, my difficult child is 13 yo. No violent crimes. Hospitalized before for suicidal ideation/my fear. Brush fire- no one hurt and no intent to hurt. He's listed as a "non-violent" offender.

If it is this way now, what possible help could he get 3 years, 5 years, or ten years down the road?

So, I guess my answer to your question is "I definitely think parents/family who have actually been a part of difficult child's life on more than a superficial basis should be able to step in and find appropriate help for their loved ones." I think the caretaker should be able (and required) to show some sort of proof that they have been the primary caretaker, that this is what the difficult child needs, but then, that help should be available. Real help- not just "lock them up and throw away the key". But jeez, they can't even get outpatient tdocs to give much help- sorry, I just don't think many of them know very much. So how can they get more serious help available?

Just my 2 cents. This is a sore subject for me because of our situation- I'm not trying to offend anyone and really can't see beyond my own fears on this subject right now.

 

[klmno]

Oh, medical insurance? LOL! Before I went back to my old employer (who pays family medication insurance), the insurance co. told me the cost for difficult child's alone would be more than $1,000 per mo.- if he was approved. SURE!

 

[Fran]

It's a horrid failure. IMH).
The old institutions were disgusting but they should have been repaired and improved instead of opening the doors and letting all the butterflies out without any structure or supports.

How we treat our children and our disabled speaks volumes of our true heart.

I agree with several layers of care. A campus type environment where the mentally ill could have some independence but be safe, clean,fed. Obviously if stable the resident should have the choice to stay or go. If unstable there should be a way to keep them safe and away from danger.

There is virtually no services that will give your adult child a safe,healthy environment that isn't private pay. Basic safety, health care and food should not be something some disabled get and not others.

What was done to the mentally ill was a grievous mistake by the institutions and those that pushed for freedom for the residents by the institutions. Now they are in prisons, under bridges and homes that are not safe.
I'll stop but this is definitely a soap box issue for me.

 

[susiestar]

I agree that this is a HUGE failure. I am also pretty sure what we had before was a big failure. I wish I had an answer, because the mentally ill need a place to get help other than prison. (There are many who commit crimes simply to be sent back to prison - because prison will feed them, provide a roof, and at least SOME care.

It saddens me, but I do not have the answer either.

Susie

 

[slsh]

Boy, MWM, you sure hit the nail on the head. A real hot topic in our home right now.

My brain is a bit too mushy right now to even begin to come up with a plan, but one of the things I've run into this past week was the insistence by TLP that even though thank you isn't learning a doggone thing in current placement, it's essential he be there because otherwise he doesn't have a chance of learning self-help skills. A thought reinforced by potential Residential Treatment Center (RTC) when they denied him placement in their program because he's too "advanced". Hunh?

Then you have to throw in the mother-need to protect when our kids won't protect themselves, which I think has really skewed my take on where thank you is and what he needs. I don't know, maybe I was giving up with the line of thought that his ability is meaningless when he doesn't *do* anything. Whether he can't/won't do something doesn't matter because he *doesn't*, so from my perspective he needs to be supervised and "cared" for, which of course isn't going to exist once he graduates/ages out which is TLP's very strong point of view. And I can't say they're wrong.

For Boo, I absolutely believe in integration in the community as much as possible and his right to self-determination. I feel hypocritical because I do *not* feel thank you in his current state has the right to self-determination. To me, it seems oxymoronic - we're going to give a mentally ill kid who has some significant thought disorders the right to self-determine? I don't know - sometimes I think I'm the crazy one because I seem to be the only person in our little sphere here who sees this as a problem.

Ideally, there needs to be a supervised setting for adults who cannot/will not care for themselves (basic ADLs, medications, etc) and there needs to be a mechanism to force placement of adults on a long-term basis. It just doesn't exist right now. It's all voluntary.

I am really fighting the thought of obtaining guardianship of thank you because we will not be able to force treatment or safe living situations. What is the point if he will still have the "right" to refuse treatment?

I don't know, probably not my clearest morning to ponder this, but it is a huge problem and one that is haunting husband and I very much right now.

 

[Star*]

This is a neat question -
I'm enjoying all the responses.
VERRRRRRRRRRY interesting.

 

[4sumrzn]

Wow. This post has been sitting here for over 2 hours on my screen, trying to read all the replies & trying to respond! (everyone is finally quiet at the moment...I can actually "try" to think).

I'm going to have to say that Fran brought tears to my eyes. Many more of your replies are scaring me....only because husband & myself talk about this quite often. What will happen to difficult child if we are gone? Is there someone we can count on to take care of her? That's the "if we both are wiped off the face of the earth at the same time".... questions (which, there are many more we talk about). I noticed that quite a few of you already have difficult child teenagers(+) & I'm in the same boat "worrying" with my 7 year old.

I just wish there was a way that I could know....for sure...that if difficult child did not have her parents or family (that "maybe" would step in if we were gone)...she would have the help she needs. At this point in her life, I don't believe that is possible. She is not capable of self help skills, the ones she does have are minimal (can't dress herself completely, has eating issues, can't go to the bathroom with-o help, can't communicate at a level that would "make sense"......). SO, I couldn't even imagine her living under that bridge or in jail.......I really don't think she would even survive. But, like I said before, she is 7......maybe my thoughts on that will improve over the years. Doesn't change the fact that I worry what would happen if I (we) were out of the picture unexpectedly.

How do I put this??

My easy child is a "normal", hormonal, smart, loving, talented young man. I won't give him all of the praise because he gets tired of life in our home sometimes. We continue to remind him that difficult child is part of our family, as hard as it can be at times, we all love her & will do what we can for happiness for all. But, I believe if he were to lose us, he would be able to do what he needed to.....get through....continue on..make choices & has the "right mind" to be "OK" (hope that made sense?).

My difficult child....I'm lost here. If a family member wouldn't step up....she's lost too... "somewhere out there" or doesn't make it "out there" at all! At this time in my life, I don't believe there is anything available to take care of what she would need. But, wait......"if" I HAD a ton of $$$$$...I "might" be able to arrange "something", that "might" (with no certainty), help her be part of the normal world.

Hmmm....finally sitting down for the last time (I hope) to finish this. Still makes me cry.