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Unintended consequences…deinstitutionalization – UPDATED

January 9, 2011

There are a lot of conspiracy theorists out there – when a tragedy strikes it’s always tempting to look for two things. First – ‘what if…’ we were in a different place. Second, who should really be blamed for this terrible tragedy?

Look here, here, here or here for recent examples of this.

What I don’t see coming up are any real questions about the impact of much older policy decisions – say, deinstitutionalization. That’s a long word for “in the 1960’s someone thought it would be more humane to close down state mental health institutions and rely on outpatient/psychotropic drugs in community centers”

The deinstitutionalization movement is the name given to the policy of moving severely mentally ill individuals out of large state institutions and then closing part or all of the institutions. The idea behind deinstitutionalization was that individuals who suffer with mental illness could lead more normal lives in the community then they could confined to an institution. This movement was rendered in hopes that the communities would support the discharged with medications, community outreach support centers, and mental health services. Many problems would develop from this policy.

Did the nut job who shot Reagan have a coherent political philosophy? Depends on whether you think Jodie Foster is a coherent political philosophy….yeah yeah – “if there were no guns for the mentally ill to get access TO…” Nice thought there. Problem is that the criminals have a perfectly easy time getting access to the weaponry. Care to guess what constituency makes up a good part of the criminal element?

Many of the mentally ill patients were left homeless in the streets with some displaying erratic and anomalous behaviors….a countless number of mentally ill patients ended up incarcerated or sent to emergency rooms. This displacement posed a huge burden and quandary on the jail systems.

From another blog – he chronicles the difficulty his family had in institutionalizing his brother – a paranoid schizophrenic – who would incur random violence on the rest of his family and on strangers…

…there was a well-intentioned effort to reform commitment laws, starting with the Lanterman-Petris-Short Act…….. At roughly the same time, the federal courts became increasingly insistent on certain standards of procedure and proof for committing people to mental hospitals for indefinite periods of time.

From what we were told, from what we saw with my brother, and from what I have gleaned from reading countless newspaper accounts where the mentally ill finally got some attention usually after committing murder — our system is refusing to lock up large numbers of people who are clearly unable to care for themselves because of mental illness….

There are certain disorders that don’t get better. Borderline personality disorder isn’t even manageable. Bipolar disorder is manageable if they take their meds (which are easy to forget because the meds make them feel normal …so they stop). There are consequences to over-liberalizing a policy so quickly – as Senator Kyl says

“It’s probably giving him too much credit to ascribe a coherent political philosophy to him,” he said. “We just have to acknowledge that there are mentally unstable people in this country. Who knows what motivates them to do what they do? Then they commit terrible crimes like this.”

1/11/11: Updated with a Link to discussion on Hot Air

UPDATE 2: Link to Pajamas Media with a discussion from an author who can’t quite get their book published on this topic “Personal tragedies: Mental illness, deinstitutionalization and homelessness

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10 Comments leave one →
  1. Lynn Comp permalink
    January 11, 2011 9:23 am

    Found an excellent paper with plenty of cited sources

    even though police may recognize some disruptive behavior as resulting from mental illness, they often have little choice but to use “mercy bookings” as a way to get persons into mental health treatment. …These studies show that those who suffer from severe mental disorders are at an increased risk of violence and arrest (Link et al., 1992, 1999; Swanson et al., 1990).2 In many cases, those experiencing certain psychotic symptoms may misperceive the actions of others (including police officers) as threatening and respond aggressively (Link et al., 1999). These studies show, significantly, that the association between mental disorder and violence or arrest holds after controlling for comparable risk factors, such as sex, age, race, and socioeconomic status

    It’s not a conclusive tie – potentially because it can be controversial to suggest a policy that reverses the deinstitutionalization (not sure I’m there yet). But until more can be done than removing potentially violent disturbing people from your vicinity (into someone elses) before the worst happens – this continues to happen

  2. alarryyk permalink
    January 10, 2011 6:15 pm

    okay so mentally ill people are dangerous? prone to homelessness? and constitute ‘ticking time bombs’ to either innocent family members or ‘random’ by-standers? this smacks of sanism. there are many problems with the status-quo biomedical understanding of mental illness and the APA’s insistence of merely cataloguing symptom constellations into neat ‘disorder categories’ which can then be treated by mind-altering drugs. there are a host of social factors that go into the phenomenon of mental illness that make it appear to correlate with other such things as homeless. statistically, according to the canadian mental health association, people with mental illnesses are actually more often the target of violence than the cause. this is largely due to the automatic assumption of ‘dangerousness’ and the fear response it provokes. also if you look at the proportion of ex-service persons who are currently both homeless and ‘mentally disordered’ you may find that foreign policy can be crazy-making at the micro-level as well 🙂

  3. January 9, 2011 8:59 pm

    I find it somewhat interesting that your premise was that institutions made us potentially safer. And the first comment questions whether institutions might make us safer, including a fact that we’re using jails as an institution (after the crime, unfortunately), as an argument against… I may not like to pick, but this seems to be a wonderful summary of what got us here in the first place.

    If external treatment was flawless, it would likely be funded. The point is that it’s not working, and we’re waiting for the jails to do the treatment. But at some point we need to realize that you can’t fix dangerous people with understanding and medication recommendations.

    It doesn’t work as foreign policy either, by the way…

    • January 9, 2011 9:47 pm

      If you look at the % of ‘permanent’ homeless pre- deinstitutionalization and post, you’d be stunned. Ok, maybe Fister wouldn’t be stunned – but it’s almost a 1:1 correlation statistically.

      I’m not sure I’m advocating to lock them all back up – but even when an individual is creepy (and potentially violent) nothing can be done. Look at VA Tech & what happened there. Mentally ill people who don’t want help and who also don’t want to die alone often seem to find a way to make their wishes come true, meanwhile until the worst happens, the rest of society is powerless to do much of anything to keep others safe….

  4. Lynn Comp permalink
    January 9, 2011 8:02 pm

    There are some disorders that simply don’t fix even WITH drugs, and – at best – are emotionally destructive to the family around the mentally ill person. Did you even bother to read what the guy went through with his brother? His brother – right now – cannot be required to take the drugs that will make him stable (ok, he can’t until or unless he commits a horrible crime generally involving another innocent human victim and is incarcerated. Maybe then he or she can be required to take meds. Gee – how helpful to the potential/future victim and THEIR family….)

    Yeah, I suppose I am advocating for a degree of re-institutionalization. I have seen enough human collateral damage from NOT having the institutes and frankly, deinstitutionalization was an over-reaction to a situation that could have been fixed without throwing most of the inmates out on the street and hoping for the best while their unintended victims have to somehow get on with their lives.

    Perhaps it’s my own personal experience – but I’d rather not have the ticking time bombs out on the street waiting to go off around some random, usually innocent stander-by. The general response will be “oh, but that’s not what the policy intended!” yeah, well – that doesn’t change the fact that there are – and will continue to be – severe consequences of that policy whether they were intended or not.

    If you have lived with someone who does have a mental illness that isn’t easily treated – or someone refusing treatment, you might better understand why I’m not advocating for “community supports” right off the bat….

    • ellend permalink
      January 9, 2011 11:47 pm

      I understand where you are coming from. Even when someone has demonstrated they are a danger to themselves or others, you can’t force treatment – at least not in the long term. As soon as the individual acts sane, they are released wihout any required follow-up that I know of. Furthermore, due to privacy acts, doctors aren’t allowed to fill in family members on diagnosis or treatment unless the individual consents.

  5. alarryyk permalink
    January 9, 2011 5:16 pm

    So what is your solution? You seem to argue that the policy of deinstitutionalization is to blame for something nefarious. From the title I could assume you are laying blame on this policy for political shootings? Are you advocating for ‘reinstitutionalization’?…isn’t that what is already happening since prison populations have high proportions of ‘mentally disordered offenders’? What about advocating for the ‘community supports’ that were supposed to come with deinstitutionalization to finally be prioritized and funded?

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