Our Government’s Immoral Abandonment of People with Mental Illness

When times get tough, and state governments are taking in less revenue, they have to either raise taxes or make cuts to programs and services. It’s a well-known fact that Republican lawmakers opt to resolve this dilemma by making sure that corporations and the wealthy, those who can most afford to contribute more to society, actually come away being asked to sacrifice less. Meanwhile, they slash programs that are designed to serve the most vulnerable people in the nation, leaving them hurting, with substantial needs going unmet. This is certainly the case for people with serious mental illnesses, who receive programs and services at the state level, even when the federal government contributes indirectly through programs like Medicaid. The red states have historically been more much draconian with their service provision to people with serious mental illness than the blue states, but budgetary pressures have even driven some Democratic lawmakers to acquiesce and approve of cuts to mental health services in states like Illinois. As the traditional champions of the downtrodden and misfortunate, liberals are much needed advocates for people who suffer from serious mental illnesses.

Approximately 11 million Americans have some form of serious mental illness such as schizophrenia, bipolar disorder, or major depression. A substantial number of these individuals receive mental health care funded by public sources, because their mental illness leaves them disabled and unable to work. This care can range from community-based outpatient treatment to case management, and when necessary, inpatient hospitalizations. When these services become increasingly scarce, people in need commonly end up in one of three places: homeless shelters, jails or emergency rooms. It costs an estimated $10,000 per year to offer community services to an individual while paying to keep them in jail for a year costs approximately $35,000.  It is more difficult to estimate how much more it costs to treat a person with mental illness who is in crisis in emergency rooms rather than appropriate mental health facilities, but each visit to the ER costs approximately $1000 compared to a state psychiatric hospital’s cost of $400 per day.

In March 2011, the National Alliance on Mental Illness released a report entitled, “State Mental Health Cuts: A National Crisis.” This year, they released a second report, “State Mental Health Cuts: The Continuing Crisis,” further detailing the trend toward defunding services. In each report, the organization pleads with lawmakers to reconsider the decision to repeatedly slash funding for critical and necessary services while documenting just how severe those cuts have been.

Between 2009 and 2011, the states cut their mental health services by 9.5% (approximately $1.6 billion dollars), and the projected cuts for 2012 are on track to be deep as well. There is variation across states with some, like North Dakota, even increasing spending for the mentally ill. But the norm was for states to try and balance their budgets by looking for savings in programs that serve this group. For example, in Florida, Tea Party Governor Rick Scott and his legislative lackeys are willing to take this politically unvalued group and cut their services by 41%. This is in a state already being investigated for abuse and neglect of this population in its assisted living facilities. Some of the other states that have decided to reduce funding to mental health services include South Carolina, which cut back their budget by more than 39 percent, Alabama by 36 percent and Alaska by more than 32 percent.

In Michigan, the state government has dramatically cut mental health services only to pay more to warehouse the same people in the criminal justice system. Detroit and its surrounding suburbs have lost 75% of their state psychiatric hospitals since 1987.  The situation has become so drastic that the Wayne County Sheriff in Detroit, Benny Napoleon, has called his jails the largest mental health institution in the county. Past research has shown that at least 30% of the population imprisoned in Wayne County has a serious mental illness. It’s enough for the director of Michigan’s Department of Corrections to state, “I’ve got institutions that are just packed with people who are very, very seriously mentally ill.” Since 2008, the state cut 50 million dollars more from the mental health budget, and more than half of that money was cut from Detroit-Wayne County. In the meantime, Michigan Governor Rick Snyder cut taxes for corporations by 86% rather than address the crisis in mental health services that their criminal justice system is desperately trying to get recognized.

Unfortunately, the same thing is happening in Chicago where the Cook County jail now houses more people with mental illness than nearby psychiatric hospitals. Just like in Michigan’s Wayne County, the Cook County Sheriff, Tom Dart, has declared, “the system is so screwed up that I’ve become the largest mental health provider in the state of Illinois.” As Sheriff Dart points out, it is more expensive to house people with serious mental illness in jail, but it is also less humane. They are people who need help rather than punishment, but often end up imprisoned for acting out due to untreated symptoms. This point cannot be stressed enough. These are people in need of a therapeutic environment with supportive professionals, but instead they are receiving next to nothing behind bars. What is stupefying is that the city of Chicago is on track to close down half of its 12 psychiatric hospitals by April 2012, which will only intensify the problem.

Common sense and a great deal of research show that when services for people with serious mental illness are cut, they turn up in more expensive service systems. Unfortunately, both Democratic and Republican lawmakers have chosen to make cuts in mental health services despite evidence that it is a counterproductive and harmful strategy. However, overall, the influx of Republican legislators in 2010 brought with them even more sweeping cuts to services for this population. People with serious mental illnesses need advocates to keep up the pressure against these reductions in funding, because they are short-sighted and even immoral.

7 Replies to “Our Government’s Immoral Abandonment of People with Mental Illness”

  1. This entire country suffers post trauma stress.
    Set that aside and look at how many suffer
    trauma stress in countries we ‘invade’.

    No one can continue pretending.
    All Humans have brains; all brains can be
    traumatized.

  2. While the attempts to unravel the country’s safety nets go all the way back to a reaction to Roosevelt’s New Deal, it should be mentioned that Reagan was the first to turn the chronically mentally ill out into the streets. Ever since, an ever more insidious campaign has been taking place to remove services from all the vulnerable–including, of course, women. It’s time to take back our country, and our health. The ‘We Are Women March’ on April 28th is the ideal opportunity to be seen and heard, for women and everyone else who is feeling the oppression. See “First We March, Then We Vote” at http://thepoliticali.blogspot.com/2012/03/first-we-march-then-we-vote.html.

  3. The mentally ill have to be put out on the street to save money and to make money. Once out on the street it is easy to warehouse them into the ‘for profit’ prison system where the 1% will benefit.

    Who knows where all this is going to end, but it cannot go on like this for too much longer until everything collapses.

  4. Back in my salad days, when I was working the wards and seriously considering a PsyD., we thought these programs would always be funded, simply because “nice people” were too scared of “them” to leave them on the streets. Think again. It’s not even stinginess, but punitiveness, that is motivating these cuts. Unless you are filthy rich, everything that happens to you is your own fault. If you can’t pull yourself together, maybe you’ll get a sense of reality out on the street. If you can’t make it on the street without crime, you deserve to go to jail. If you can’t survive in jail, that’s Darwin. Voe victis.

  5. Thank you for your comments. Yes, your original theory is a good one, except for the fact that as long as the people that support DEFUNDING mental health programs have a GUN to protect themselves from the mentally ill, they are fine with defunding any therapeutic mental health programs.
    You know, Happiness is a warm gun………

  6. I lived in California when Reagan cold heartedly released many unhealthy people to try and survive on their own. I was also a State Hospital Employee at the same time.
    It was a disaster that CA has not yet recovered from.
    As an aside, I have been harping for decades about this country’s shameful ignorance of mental health issues.
    So the title of this article is apt, but I would like to add the word “Continuing”.
    “Our Government’s ‘Continuing’ Immoral Abandonment of People with Mental Illness”.

  7. There is only one word for this move on the part of the conservatives: stupid.

    Consider people who are homeless and combine both mental illness and drug/alcohol dependency. They’re considered the very toughest “clients” to deal with and almost impossible to get off the streets.

    “Housing First” went against standard wisdom (in the homeless “industry”) which states that people who are homeless are broken and need fixing (or are lazy and need punishment if you’re conservative). The premise is that the real issue of homelessness is lack of housing, and NOT personal failings. Well, Housing First works. Even with people who combine mental illness AND drug/alcohol abuse, the long-term success rates of Housing First is over 90%.

    Compare that to the usual “Continuum of Care” project… success rates of MAYBE 5%. That’s it.

    There were two things that came out of Housing First that really apply to this issue. First, the researchers found that Housing First was incredibly cost-effective in keeping mentally ill people housed and in treatment. Second, they found that in some of the cases, having housing (and needs met) helped the people so much that they stopped using drugs or alcohol on their own… they weren’t forced into it (drugs or alcohol are usually a coping mechanism for people who are homeless, and I wouldn’t be surprised also for people who are severely mentally ill). This made treatment for the mental illness that much easier and more effective.

    Housing First is not popular with conservatives because (1) it requires a greater outlay up-front and the benefits aren’t as easily seen on a balance sheet somewhere, (2) It doesn’t fix or punish people when they’re having a hard time, (3) the idea is that homelessness is a structural problem and not personal failings thus denying their favorite stereotype, and (4) the whole program doesn’t require things like drug treatment or anything else before people get shelter (in Continuum of Care, Housing is seen as a reward for completing the “repair” program successfully).

    I guess it boils down to this… do the Republicans (and conservatives) care more for people or profits? Even then, with the demonstrated effectiveness of things like Housing First, dumping people on the streets shows a pure and heartless callousness and cruelty (and greed) that IMO, takes them out from under the heading “human being” and puts them under the heading of monsters.

    Indeed, what they’re saying to these people is “Die quickly since we can’t make profit off of you!”

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