Too High a Price to Pay for Savings

By Tom Gomez

When I first saw the old man with the long white beard on the yard talking loudly to people who were not there my first thought was that he didn’t belong here at prison. It was obvious the old man had major psychiatric issues, and had such issues for a long time before he was imprisoned. If you have ever met ‘really’ crazy people who hear voices and see things that aren’t there you know it’s not all that easy to fake major mental illness. Its sufferers include large numbers of homeless people in almost every major city, and most look crazy. Back in the 80s a decision by the US Supreme Court on the deinstitutionalizing of the mentally ill in a case called Olmstead provided the legal basis for dumping large numbers of men and women who lack the capacity to care for themselves into the streets. At the same time municipalities were getting rid of low cost SRO (Single Resident Occupancy) housing and the federal government was making it harder for people with psychiatric disabilities to get social security benefits, including Medicare. The result of all these policies became clear when a gunman opened fire at Deer Creek Middle School last month. His father, Qar Eagle Eastwood, told the Denver Post he was unable to afford psychiatric care for his son.

Shelters, county jails, and prisons have become the leading care providers for the nations mentally ill. Here in Colorado, 25 percent of all prisoners are on psychiatric medication for some form of mental illness. According to figures supplied by the DOC to the state legislature in February, 2009, 15 percent are identified with “a serious and persistent mental illness,” while the psychiatric needs of the other ten percent are labeled “significant.” If such figures hold true nationally, than as many as 575,000 of the nation’s 2.3 million prisoners in federal, state and county institutions may have psychiatric problems, as many as 300,000 problems so severe as to constitute a permanent disability. In the prison System the seriously mentally ill are often at high risk for assault by other prisoners, something equally true of the mentally ill homeless.

To my way of thinking no issue shows more clearly the utter moral bankruptcy of the political leadership of the past 30 years.

Deinstitutionalization, the idea that people have a right to live in the least restrictive environment despite their disabilities, was not a bad policy. The era depicted the “One Flew over the Cuckoos Nest” was not a golden age we should long to return to. However, successfully deinstitutionalizing the mentally ill required the commitment of public resources, a theme? in an age of attacks on ‘big government’ as ‘the problem not the solution.’ Mental illness was seen as a problem that would rectify itself without any specific investment. It has not. Instead the state prison has replaced the state hospital in the long term treatment of mental illness and police are often sent to intervene in psychiatric crises they have little training for. The absence of a mental health policy has not been cheap. It has degraded the quality of life in this country, and left tens of thousands of men and women who can not care for themselves to beg in the street and eat out of garbage in every major city in the US. It has filled the prisons with hundreds of thousands of such people at an enormous cost. While most of the mentally ill are not violent, obviously some are and even with supportive families to care for them have erupted in psychotic rage caused by untreated mental illness.

There’s no quick fix here, and medication is not a panacea. At the end of the 90s a program of intensive case management instituted by San Francisco General Hospital to reduce the number of emergency room visits by that city’s homeless mentally ill showed dramatic results. Called “Mosaic,” it fostered a therapeutic relationship between its social workers and their clients based on shared goals, like the establishment of stable housing and qualifying for SSI disability benefits. By contrast in Colorado, of the $1,346,880 allocated for medication and supervision of mentally ill offenders in community supervision in 2008, $1,175,880 was rescinded. Unlike ‘Mosaic,’ DOCs “Psychotropic Medication Program for Community Based Offenders with Mental Illness” provides little but a 30 day supply of pills for prisoners getting out and a voucher for some more when they run out. Just as significantly id does nothing to address the need for resources to access mental health care for families, like that of Bo Strong Eagle Eastwood, before some catastrophic loss of capacity lands their loved one in prison if not dead.

another problem with deinstitutionalization

Not all mentally ill people at large are living on the streets.  A lot of families, in an effort to protect their mentally ill relatives from this fate, try to take care of them at home.  This can mean that other family members, especially children, are subjected to an extremely troubled and sometimes dangerous home environment.

Children should not grow up in a home with mentally ill adults.  And adult relatives of the mentally ill should not have to choose between sending their relatives out to live in the street, and taking them into a home with children.  It is a bad and potentially catastrophic situation for everyone.