Need for Long Term Care of Mentally Ill Unmet for Decades

Having worked with people living with serious mental illness for several years, I have seen the sad cycle many of their lives rotate through. During times of severe impairment due to psychotic episodes, severe depression, and/or extreme substance abuse, people with chronic mental illness will often find assistance in local hospitals. The staff will help them get stabilized on medications and sober then send them to outpatient programs that often are short of duration. Within weeks or months, many will be suffering again with serious symptoms and unable to care for themselves or make good decisions.

I first worked with the children of people with serious mental health and substance abuse problems. Unfortunately, many people who are unable to care for themselves have children that they cannot take care of either. Many of these children end up in the truly unhappy and often utterly dysfunctional child welfare system. I have seen families where the children of mentally ill people grow up and suffer with mental illness and themselves have children who are put into the foster care system. It's a devastating cycle for those in it and can be deeply saddening for those professionals who work with the families.

It is a system of perfect madness.

During the 1980s, under the leadership of Ronald Reagan, state run institutions lost federal funding and the hospitals that provided long term care for mentally ill people went by the wayside. Community programs were supposed to take their place and provide less restrictive environments so that people with mental illness could interact with the community. Unfortunately, this variation on the "pull yourself up by your bootstraps" theme has failed to address the serious needs of millions of people. Many of the people who previously lived in state facilities are now basically homeless. This situation presents many dangers both for people with mental illness, and often to family and community members when some of these people become violent.

We need a system like whole cloth that sanely addresses the needs of people with mental illness. For those most afflicted, on-going, life-long care is simply needed. Finding funding for this kind of care is a tough task, especially right now. The U.S. systems for resource distribution aren't even managing to get basic health care to millions of children, let alone sophisticated mental health care to the chronically mentally ill. We have such a distance to go back towards our humanity when it comes to the care of our most vulnerable.

But I argue that the emergency only care many people with mental illness receive is extremely costly as well. One of my current patients is in a facility that costs thousands of dollars a day and is designed for acute, short-term care. Unable to find appropriate housing, he's been at our unit for weeks. As with anything else, failure to plan often ends up more costly in the end.

Our nation needs determined leadership in the field of psychiatric care.There are highly effective and economical systems being developed to address the needs of the nation's very large elderly population. Perhaps we in the mental health field could borrow some of these ideas.

Having facilities that can address a spectrum of functioning levels as they have in retirement communities could work. People in these communities have options for fully independent living through end of life care in one facility. A comparable facility for people with mental illness could function similarly except people may be able to live in different sections at different times during their illness. For example, people stable on their meds could live in less restrictive environments, but people whose symptoms become more severe or who abuse substances are moved to more restrictive environments.

Innovative answers are out there. This, like the other issues that need to be addressed in our country, requires great will to support follow through.