America’s Mental-Health Care System, Large Contributor to Homelessness

Every time I walk the streets of Downtown Los Angeles I come across countless homeless people. Some young, but most old enough to have earned the title “local” through their many years of loyalty to the streets. I see familiar faces who have managed to carry their made-up biographies of exaggerated stories and whispered rumors like summaries on their backs.

As for the unfamiliar ones, their incessant shouting at nothing, their angry pacing with clenched fists or waving hands, accompanied with looks of emptiness and confusion across their faces is the most I’ll ever know about them.

Even then, that tells me nothing of substance. How did they get there? What events in their lives led them to call alleyways their foyers? Do they want to be there or do they have no choice in the matter?

In everyday conversation, serious mental illness and homelessness are not always correctly meshed. Loose talks about how a person might be homeless because of drug addiction or alcoholism are more prominent than discussing the real possibility of a sidling mental illness.

In America, 1 in 5 adults have a mental health condition. What’s worse is the almost non-existent mental-health care services available to them. Each year, about 56 percent of Americans fail to receive treatment because they do not have access to proper care.

Public policies, along with cultural and social dynamics have made it increasingly difficult for those facing mental illness. Sufferers of such disorders who cannot recognize they are ill often end up homeless, incarcerated, or dead.

America faces a critical shortage of inpatient psychiatric-treatment beds, leading to catastrophic societal consequences.

The Community Mental Health Act of 1963, under the Kennedy administration, made it their mission to enforce humane treatment of mental patients outside of state mental hospitals. Instead of having patients confined to poor and sometimes abusive “care,” the president and Congress aimed to help patients by creating more efficient and cost-effective community health centers that offered prevention services, early treatment, and ongoing care.

The two-step “release and catch” policy fell flat on its face. Step one was effectively administered, releasing patients from dismal conditions in state hospitals. However, negligence to develop sufficient resources caused the program’s expiry.

More than half of these dreamt up community health centers remained as just an idea and were never built. After closing down costly state mental hospitals, many states pocketed the savings and never built replacement health centers. Even the centers that were in operation failed to receive the funding they were promised.

To this day, a similar pathetic excuse for treatment of mental health persists.

In many ways, it has worsened. The National Review reports that 97 percent of hospital beds for psychiatric patients were eliminated between 1955 and 2016. The same research shows there are now fewer beds per person in the U.S. than in 1850.

Neglecting mental illness exacts a huge physical and economic toll for Americans. More than $100 billion a year is wasted on lost productivity. Local hospitals take on more issues associated with chronic physical diseases. Schools often need to open more special education classes. Courts and jails must also handle large quantities of cases stemming from untreated mental illness.

The lack of beds and mental health care services pose tragic ramifications across the nation. An incredible amount of clinical and legal concerns about handling dangerous patients in community programs has contributed to the soaring rate of imprisonment. There are three times as many mentally ill people in prisons and jails than in hospitals.

“Prisons and jails have become the largest providers of psychiatric services in the United States,” with “more than 300,000 American prisoners . . . currently in need of intensive psychiatric services.”

As a result of the increase of inadequate treatment available to patients, long waiting lists for hospital admission from jails and prisons, along with civil rights lawsuits against states, have emerged. The excess of mentally ill prisoners who await transfers to state hospital beds threatens state officials with contempt of court for their delays.

Without the opportunity for care in a state hospital, only the streets, jails, and prisons remain for those with serious mental illnesses.

In the U.S., the criminal justice system has, in a way, become the mental-health system. In 2014, ten times the number of people with a severe mental illness ended up in prison and jails than in state mental hospitals. By no coincidence, the largest mental-health facilities in the nation are the Cook County and Los Angeles County jails.

The truth is, drug addiction is not the only reason homeless people trust awnings to keep them dry. Alcohol abuse is not the only reason homeless individuals call busy sidewalks their bedrooms. Mental illness is in fact a major contributor to homelessness.

In 2015, an extensive survey on homelessness found that 564,708 people were homeless on a night in the U.S. As of 2014, research estimated 140,000 individuals were seriously mentally ill, and at least 250,000 had any mental illness. 

Although inpatient beds render just one aspect of a suitable mental-health system, they are pivotal. Homelessness among the mentally ill is greatly associated with the lessening of psychiatric hospital beds.

“These beds represent the psychiatric equivalent of ICU patient beds,” said John Snook, executive director of the Treatment Advocacy Center. “Their loss has been disastrous for our nation and those most in need.”

The inaccessibility of beds leave the ill waiting long periods for proper treatment, forcing mental-health professionals to overlook many cases that require equal, if not more, attention. Simultaneously, patients left without treatment continue their lives in deterioration.

Restoring the availability of treatment beds is not an easy task, but it is necessary.

A step in the right direction would call upon President Trump to openly support the repeal of Medicaid’s IMD exclusion. This discriminatory and outdated federal law bars an individual suffering mental illness from receiving treatment. The IMD exclusion prohibits payments to states “for non-geriatric adults receiving psychiatric care in a treatment facility with more than 16 beds.”

Without these reimbursements, the states are solely responsible for financially maintaining the costs of inpatient substance-abuse and psychiatric care.

Dismissing mental illness, or calling it substance abuse, only enables the neglect of proper mental-health care for Americans. Ignoring these disabilities sentences more Americans to live in misery, pain, and poverty. Denial is simply not a solution.

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