We are experiencing a crisis of mental health treatment in America: we simply do not have enough care for the number of people with mental illness. From a height of over 500,000 people in state mental hospital beds in 1955, we have seen a drop in occupancy of more than 90%. Some of this has been absorbed by nursing homes for individuals with dementia and related conditions, and some people now live in residential settings. However, the overall number of inpatient psychiatric beds has fallen from 337 beds per 100,000 population to fewer than 30 per 100,000 in 2014. Things have only continued to decline over the past 11 years.
Furthermore, we have moved away from long-term inpatient care toward short-term acute stabilization. So we have fewer beds and treat people for shorter periods. This drop in beds has left more people with severe and persistent mental illness living on the streets or being poorly supported by overwhelmed families.
I am sensitive to the loss of liberty that results when someone is held against their will. I am well aware of the potential for abuse. There are many horrible stories from the first half of the 20th century. However, I could also share painful stories of parents desperate to secure care for their adult children and unable to do so—individuals who were not deemed acute at the time of evaluation but later killed themselves or someone else, sometimes even family members who loved them and could not get them help. And let’s remember the jails full of people with mental illness, and those incarcerated for drug offenses—often people attempting to cope with their conditions.
Life does not present us with easy choices of good and bad, no matter how much we wish it were otherwise. We must make hard choices. While in the mid-20th century we locked too many people up, today we care for too few.
We are likely to see more violence; it has been normalized. Unstable young men will act—often with families worried about them and no one to help.
It is past time for the American people to have a real conversation about severe and persistent mental illness and to decide that we want something better than this. We need more beds, and we need a pathway for longer-term treatment that can be accessed by everyone who needs it. It is in the best interest of us all that treatment be available. It is in our interests, and it is in the interests of the afflicted.
Unto the least of these.
Sources used:
https://psychiatryonline.org/doi/full/10.1176/appi.ajp.22179004
https://www.tac.org/reports_publications/going-going-gone-trends-and-consequences-of-eliminating-state-psychiatric-beds/
