Given plans to introduce at least two mental health reform bills in Congress this month, some have high hopes that our leaders will soon deliver meaningful mental health reform. I do not.
As one of the more than 40 million American adults living with a mental illness today — one who has endured psychiatric hospitalizations, seclusion, restraints, strip searches and many other indignities — I recognize the serious need for reform firsthand. But not just any reform will do.
Before proposing new solutions, we would be wise to learn from past mistakes and abandon practices that have proven ineffective at best and counterproductive at worst. In short, to get it right, we must first quit getting it wrong.
For one, leaders and lawmakers ought to stop acting in ways that further marginalize the mentally ill. Many legislators perpetuate the stigma surrounding psychiatric disorders by citing rare mass homicides as their primary motivation for supporting mental health reform. As a result, their proposals are often more about protecting the public from the sensationalized threat of a mad gunman than about helping the mentally ill, most of whom are not violent and, in a cruel twist, much more likely to be victims of violent crime.
One of the planned bills — a reintroduction of a version of Republican Pennsylvania Representative Tim Murphy’s Helping Families in Mental Health Crisis Act — evolved as a direct response to the Sandy Hook Elementary School shootings in Newtown, Conn. and has drawn controversy on account of its call for increased involuntary outpatient commitment and reduced patient privacy rights for the mentally ill.
Controversy aside, we need not hang all our hopes on legislators. Plenty of problems ailing our current mental health system can be resolved simply by ending the widespread use of certain inherently traumatizing “treatment” practices. Mental illness is traumatic enough. Treatment shouldn’t be. Yet, for so many, it is.
In total, I’ve spent roughly a month inside of locked psychiatric facilities, all more than five years ago, and while I have since learned to live — and even thrive — with bipolar disorder, I have yet to fully recover from the trauma I endured as an inpatient. The deepest of these wounds relate to the use of restraints and isolation, but plenty of others concern overworked and underpaid mental health professionals who lacked the time and resources to do their jobs. Still, relatively speaking, I’ve had it good. Had a single police officer chosen to escort me to jail instead of a crisis center at the height of my first psychotic break, my fate would have been strikingly different — and yet painfully common.
More than three times as many people with serious mental illness are housed in jails and prisons than in hospitals in this country, making incarceration by far the most traumatizing feature of our current system. According to a report published last month by the Vera Institute of Justice, serious mental illness affects those held in jails at rates four to six times higher than in the general population. And among guards and prisoners, mentally ill inmates — many of whom are incarcerated for non-violent, low-level crimes — can easily become targets inside of jails and prisons. They are also often subject to solitary confinement, which can exacerbate their psychiatric conditions and incite relapse.
Were we to stop effectively criminalizing mental illness through mass incarceration, we could divert funds from so-called corrections toward research, education and facilities that actually benefit the mentally ill. We could begin funding research so that it better reflects the true disease burden of neuropsychiatric disorders, which are among the most common causes of disability worldwide. We could expandCrisis Intervention Team programs that train law enforcement on how best to respond to mental health emergencies. We could provide more and better psychiatric hospitals, community-based facilities, and housing options. And even without redirecting a cent to mental health, minimizing state-sanctioned traumatization of the mentally ill through incarceration would by itself constitute a major policy advancement.
That said, it’s not enough to simply stop unjustly and disproportionately imprisoning the mentally ill. We need better care. Mental health providers must acknowledge and work to reduce the risk of traumatization during the treatment process. This means adopting a more trauma-informed approach that seeks to minimize — if not eliminate — the use of seclusion and restraints, both of which degrade and dehumanize patients and staff alike.
This also means that some psychiatrists will need to exercise more caution in their prescribing practices. While on locked units, I often met patients who weren’t being treated so much as sedated. Were it not for the advocacy of a family full of physicians, I suspect I too would have been similarly overmedicated.
Certainly, hospitals — not to mention insurance and pharmaceutical companies — could also do more to support responsible prescribing habits, but ultimately, psychiatrists write the prescriptions. As such, they must be vigilant and seriously consider dosage and possible side effects and interactions before prescribing potentially dangerous psychopharmaceuticals.
Ideally, our political representatives would consider at least as much before proposing potentially dangerous federal legislation, but given their track record — not to mention big pharma’s heavy campaign contributions — I’m not holding my breath.
In the meantime, many within the health care and legal communities can do a world of good without an act of Congress, simply by doing less harm. To be sure, solving our national mental health crisis will require more than merely reducing routine reliance on incarceration, isolation, restraint and overmedication. Still, it’s a good start.