Fifty years ago, President John F. Kennedy signed the Community Mental Health Act. The law signaled a shift in thinking about how we care for the mentally ill: instead of confining them into institutions, the act was supposed to create community mental health centers to provide support.
But studies on the prevalence of mental illness among inmates and the homeless (PDF) show many patients are ending up on the street or in jail, instead of served by the treatment centers envisioned in the law. The homes that do exist are often subject to loose laws and regulations, leaving already fragile patients vulnerable to further abuse and neglect.
How far have we come? Here are some important reads on the state of mental health care today.
• Milwaukee County Mental Health System Traps Patients in Cycle of Emergency Care, Milwaukee Journal Sentinel, June 2013
In Wisconsin, psychiatric patients are often put through a revolving door of treatment: Experience a breakdown. Get arrested and brought to the emergency ward. Be released just a few days later. Repeat. Overall, "one of every three persons treated at the [psychiatric] emergency room returns within 90 days."
• Schizophrenic. Killer. My Cousin., Mother Jones, May 2013
When a parent is faced with an ill, potentially violent child, where can they turn? Journalist Mac McClelland details how community outreach in the 1970s and 1980s allowed her aunt to stay "independent until the very end." Thirty-four years and billions of dollars in mental health cutbacks later, her cousin's battle with schizophrenia came to a much more tragic conclusion.
• Nevada Buses Hundreds of Mentally Ill Patients to Cities Around Country, Sacramento Bee, April 2013
Psychiatric patient James Flavy Coy Brown got off a bus in Sacramento with no money, no medication, and no idea why he was there. He'd been sent to the California capital from a hospital in Las Vegas, who had regularly been discharging patients and busing them across the country. Patients are only supposed to be sent to other states when there's a clear plan for their care. But stories like Brown's show how many patients fall through the cracks.
• ‘Boarding' Mentally Ill Becoming Epidemic in Washington State, Seattle Times, October 2013
The number of available psychiatric beds in Washington state is shrinking. When those few spots are full, the state is increasingly turning to its emergency rooms and hospitals to "warehouse" the mentally ill. Patients are forced to wait an average of three days, but sometimes up to several months, without any psychological treatment.
• Breakdown: In Rural Minnesota, Mental Health Safety Net Is in Limbo, Minneapolis Star Tribune, October 2013
Minnesota ranked last in 2010 for psychiatric beds per capita. "The safety net is pretty much gone," said one mental health worker. And a Star investigation found that the few community mental health centers that are available are often ill-equipped to cope with severe disorders.
• At Homes for the Mentally Ill, a Sweeping Breakdown in Care, Miami Herald, February 2013
Even if Miamians struggling with mental illness avoid arrest, the county's homes for the mentally ill can "still feel like a jail." The Herald's investigation revealed a wide range of abuse and neglect, from staff who were beating and raping residents to ignoring their severe medical needs. And like other assisted living facilities, a patchwork of lax oversight and regulation has allowed even repeat offenders to remain in operation.
• Dallas Psych ER Staff Accused of Violence Were Kept on Duty, Dallas Morning News, November 2011
Instead of emergency care, psych patients admitted to Parkland Memorial Hospital reported receiving beatings at the hands of staff. The Morning News found many staff members were hired despite a history of abuse, and allowed to keep their jobs even after the alleged beatings. "It's supposed to be a safe place," said one patient. "I felt like I was in prison."
• Walter Reed and Beyond: A Soldier's Officer, Washington Post, December 2007
Anne Hull and Dana Priest spotlighted systemic mistreatment and neglect at Walter Reed Army Medical Center, and several other veterans health facilities across the country. Vets seeking psychological care faced dizzying bureaucracy and an under-resourced system buckling under high demand. Though Walter Reed was home to the army's largest psychiatric department, there was no specific PTSD center, and patients rarely received individual attention.
• The New Asylums, Frontline, May 2005
Frontline documents the movement of America's mentally ill away from closing psychiatric hospitals, and into the nation's jails and prisons. The result is a massive strain on the minds of afflicted inmates, and on the strapped prison system tasked with treating them.
• Broken Homes, New York Times, April 2002
Adult homes for the severely mentally ill were meant to be an improvement over New York's long-shuttered psychiatric wards. But a year-long investigation by the Times found a for-profit system neglecting vulnerable residents. The Times investigation found nearly 1,000 deaths at 26 adult homes across the city from 1995 to 2001, including cases of suicide, death at the hands of other residents, death from treatable ailments, and patients left to die after "roasting in their rooms during heat waves."