The recent mass killings in Isla Vista, CA by a man who suffered from mental illness has once again raised the issue of the insanity of deinstitutionalization of the severely mentally ill.
Deinstitutionalization (releasing severely mentally ill from psychiatric hospitals) began in 1955 with the widespread introduction of Thorazine, the first effective antipsychotic medication. The widespread use of Thorazine moved the severely mentally ill out of state institutions and closed those institutions without ensuring that those discharged would receive the medication and rehabilitation services necessary for them to live successfully outside of the hospital. Deinstitutionalization exacerbated the mental illness crisis because, once public psychiatric beds were closed, there was no available treatment for people who later suffered from a mental illness.
Consequently, today approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment. According to Pete Earley’s book, Crazy: A Father’s Search Through American’s Mental Health Madness, the liberal movement of the 1960’s emphasized individual freedom and distrust of government, resulting in the perception by social policy makers of the time that mental hospitals victimized the mentally ill, depriving them of their right to freedom of choice over their lives.
The principle used for deinstitutionalization was that severe mental illness should be treated in the least restrictive setting. This ideology rested on “the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services.” A laudable goal, perhaps, but as Earley pointed out, this resulted in the mentally ill exercising their rights by living on the streets, starving and freezing to death.
Self-determination often means merely that the person has a choice of soup kitchens. The least restrictive setting frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.
Communities were supposed to replace mental hospitals with a system of community mental health facilities but these were never funded or established in most communities, resulting in a shocking increase in the criminalization of the mentally ill. Over 330,000 of the 2.3 million incarcerated Americans are mentally ill.
Most severely mentally ill people end up in jail because they have been charged with a misdemeanor, like disorderly conduct or stealing a pair of socks. Alcohol- and drug-related charges are also common because alcohol and drug use frequently occurs as a secondary problem among the mentally ill. Some police officers actually arrest homeless mentally ill people as “mercy bookings” to give them shelter or food. Other mentally ill people are jailed because their families have found it is the most expedient method of getting them treatment. As the public psychiatric system has deteriorated, it is common practice to give priority for psychiatric treatment to someone with criminal charges pending against them.
The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history. It hasn’t worked. The gay community was able to raise awareness about the scourge of AIDs in the 1980s and 1990s and demand treatment for their loved ones. It is past time for us to raise awareness and funds for research and treatment for our brothers and sisters who suffer with a brain disorder. We have to find a way to prevent such carnage as occurred last weekend in Isla Vista.