Paradoxical Nation

I’ve just returned from San Francisco after attending the meetings of the American Academy of Psychoanalysis and Dynamic Psychiatry and the American Psychiatric Association. More than 13,000 psychiatrists and mental health workers gathered from over 50 countries, and occupied more than 31 hotels. The smorgasbord of presentations was overwhelming. The diversity of interests, approaches and opinions seems as vast as the Titanic.

Several seminars and symposia touched on the failure of our present-day U.S. system to take care of the vulnerable, seriously mentally ill people.

Perhaps the metaphor of the Titanic has greater relevance than we’d like to think. The ship, thought to be unsinkable, too closely resembles the sinking of our humanitarian principles.

Since the 1970’s, state institutions have closed down. The fact that more funds are spent on mental health now, does not equate to better quality treatment for the seriously mentally ill.  From one public psychiatric bed for every 300 Americans in 1955, the ratio fell to one for every 5000 in 2012.  

Three times as many mentally ill are incarcerated rather than hospitalized as a result of new spending priorities, according the founder of the Mental Illness Policy Org., to D.J. Jaffe.

Mentally ill offenders in prison suffer from serious  afflictions such as schizophrenia, bipolar disorder, trauma, sexual and physical abuse. In spite of the Right to Treatment Act, they do not receive treatment but, conversely, mistreatment, misunderstanding, and neglect.  People with psychiatric disabilities are more likely to be victims of homicide and suicide than the general population.

At least part of the solution lies in establishing residential facilities staffed by mental health professionals, according to Dr. Herbert Pardes, New York-Presbyterian Hospital’s executive vice chairman of the board, who delivered the presidential address at the American Academy of Psychoanalysis and Dynamic Psychiatry.

Beyond the amount of dollars and cents, the answer is how and where they are directed. Recommendations include:

1. Mental health consultations and formal training of police officers.

2. Careful screening of incoming jail detainees

3. Diversion to the mental health system of mentally ill persons who have committed minor offenses

4. Assertive case management and interventions to assure outpatient treatment.

5. The ability of the courts to order treatment when necessary.

6. The availability of 24-hour structured care.

7. Guidance to provide support for families.

8. Funds directed more appropriately to provide adequate mental health treatment for all.

Conclusion: The general consensus of opinion of many diverse professionals is that current policies in our country have led to a regression in treating the seriously mentally ill, reminiscent of  our failings in the 19^th century.

In spite of our status as one of the wealthiest countries in the world, our paradoxical nation falls short; in 2013, without proper direction of funds, the ship of humanitarianism seems to be sinking.

Dear Readers, I welcome your opinions.