This Halloween it will be exactly 53 years since President John F. Kennedy signed the Community Mental Health Act. With every good intention to help individuals who have a serious mental illness (SMI) migrate out of institutions, and with the development of promising new medications, the deinstitutionalization movement ensued.
Change is a sluggish process that requires ongoing cultivation and attention. Instead of tending to this experiment with sustained vigor, the offloading of responsibility took root between the states and the Federal government in a ghastly game of "Hot Potato" with those who have more persistent SMI like Schizophrenia and Bipolar disorder with psychotic features. From that day until now, the nightmare has not ended for this vulnerable population and their families.
Life with dignity is practically impossible for someone who has a serious mental illness without an appropriate living situation. According to Arizona Department of Health Services, Maricopa County has approximately 20,000 residents who are SMI enrolled (although Treatment Advocacy Center puts the numbers overall in Arizona much higher). There are roughly 400 behavioral health group home beds in the entire county. Let those numbers sink in for a moment.
To be sure, there are people who can manage independent housing well. There are also individuals who are able to live with family. Later this year Arizona will release a report on housing needs and I don't have any trouble stating confidently, albeit prematurely, that it will reveal just how dire the situation is for the fragile mentally ill. Even with the few group homes available, while some are good, many leave much to be desired.
We would never agree to letting our aging parents with Dementia or Alzheimer's disease fend for themselves on the streets or place them in dirty, over crowded group homes in drug infested neighborhoods. We would never move our parents into converted, dilapidated hotels in high risk areas and yet, that is exactly what we have chosen to do for a majority of people with more acute brain illnesses. Still, we continue to turn a blind eye to the discrimination.
Families who care for seriously mentally ill loved ones are often unable to keep their loved ones at home because they can’t keep them in treatment. When untreated, the hallucinations, delusions, outbursts and anger create an untenable home situation. That puts a demand on Arizona to build more shelters or jail cells. Treatment Advocacy center reports that the likelihood of incarceration vs. hospitalization for those with serious mental illness is 9.3 to 1 in our state.
Many groups are focused on advocacy for Assisted Outpatient Treatment to be made available in their states for the small percentage of people with Anosognosia, commonly referred to as lack of insight. There is also a push to add more psychiatric beds. Both appropriate and desperately needed. Arizona has very good bones as far as Assisted Outpatient Treatment laws, but currently ranks 48th in the nation for amount of beds per capita. Yet, even with appropriate application of AOT and the possible addition of more psychiatric beds, where do people with serious mental illness live after they are released from the hospital? Are they receiving adequate support? Are they living a life with dignity in our communities? Is this even possible? We propose, and wholeheartedly believe, that it is!
Moving Toward a Home and Purpose
Over the next few months, we will be sharing on our blog about what we believe a home that promotes life with dignity would look like. Don't get us wrong, we know that there are some organizations already doing this. We simply want to improve upon it.
Often our culture assumes that individuals with serious mental illness can do nothing more than languish on street corners or attend programs that lack meaningful challenge or purpose. We know that people who struggle with schizophrenia, schizoaffective or bipolar disorder with psychotic features are often extremely intelligent and perceptive about the people who surround them. We come into this world with an innate desire for purpose. Mental illness does not change this desire and it’s time to lift the standard of care to meet the needs of some of the most vulnerable in our community. It's time to rise to the occasion and face these challenges head on.
More to come...