Deinstitutionalization of the Mentally Ill
Deinstitutionalization, the process of closing many state institutions began in the 1950s following the release of many anti-psychotic drugs. This process led to other methods of treatments for the mentally ill, which are better suited for their needs. According to some, institutionalization harms most mentally ill people and better care programs have been developed throughout the years. Unfortunately, these programs were not completely well thought out or implemented. The process of deinstitutionalization is intended to give more hope to the mentally ill whom institutions were harming. While this process was well intended based on the promising future of these drugs, it appears to have failed. Many state run institutions were closed down and released the mentally ill onto the streets. Some believe that institutions caused more harm to the mentally ill, who should be able to make their own choices and lead their lives independently outside the institution. The programs thought to replace care given in institutions were not nearly adequate. These programs, attempts to place the mentally ill back in society to be helped by the community members, day programs, and medications were not fully implemented to the full extent needed to replace institutions. This process led to an overwhelming number of mentally ill loose in society, becoming criminals due to lack of treatment.
Psychotherapy is, to many people, an ineffective treatment. Some psychotherapy often harms the conditions of patients, in a similar manner that institutionalization is said to harm patients. The mentally ill are also not considered for malpractice, thus the therapy is not always perfected or doctors are not always well trained yet still perform without risk of doing something to harm a patient. Continually, many definitions and treatments for psychotherapy broaden the scope of mental illnesses so much that almost anyone is considered to be mentally ill (Roleff 72). A treatment designed to work for most of the population, according to many results, cannot possibly tailor to the seriously mentally ill.
Another misconception is that electroconvulsive therapy (ECT) is an effective method of treating many types of mental illnesses and should be implemented more often. When asked, 98% of patients themselves claimed that they would undergo another round of ECT if they were to reexperience their illness. This age-old method, developed in 1938, is considered by numerous doctors to be safe and effective, especially as a treatment for depression (Roleff 155). The memory loss associated with ECT should not, according to many, be significant in changing one’s opinion regarding the effectiveness of the procedure. Often times, it is stated that the loss of memory does not affect a person’s motor skills and thus should be safely used to treat mental illnesses.
Improperly cared for, the mentally ill can be a threat to society. According to statistics, due to deinstitutionalization, approximately 763,000 people who would have been in mental institutions approximately 40 years ago are living in today’s society (Roleff 72). This has caused numerous problems with increases in crimes. Unfortunately, the mentally ill are being handled as criminals. It is actually significantly cheaper to care for a mentally ill person in a mental institution where better care is provided than a prison, which is not specifically suited for a mentally ill person’s needs. Institutions offer appropriate care for the mentally ill where they can be monitored and live in a safe environment. Releasing them into society leads to more crimes and many mentally ill persons who cannot provide for themselves and thus become homeless.
ECT, while sometimes proven effective, is rarely successfully completed without side effects. Often times, people who undergo ECT will be victims of worse mental illnesses than they were prior to it. ECT is a process, which pulses electricity into a patient’s head in order to induce a brief seizure. Over the past few decades, the process has changed from placing electrodes on a patient’s head to one that involves using short acting intravenous barbiturates(Roleff 148). Thus, modern ECT is much more severe than before. Newer ECT also uses more intense electrical currents to induce seizures. Some doctors use a higher dosage than is actually needed. Bilateral ECT, for example, is the most damaging and is 2.5 times the amount that is needed to actually induce a seizure.
ECT destroys brain cells and causes the brain to discharge energy. The shock administered overwhelms the brain and causes the brain to need an increased level of oxygen both during and after the shock. This raises blood pressure, which causes hemorrhaging in the brain. This hemorrhaging many times leads to death. Also, as the brain is using the oxygen, tissues and nerve cells are starved of oxygen and can die. Even patients under anesthesia experience this blood pressure increase. Shock also damages the blood-brain barrier, which leads to swelling in the brain. Studies also prove that each successive treatment causes new injuries and more damage. Most often, doctors tend to administer 6-12 treatments in a few weeks, which can cause life-threatening results to the patients, with no benefit to them (Roleff 159).
Following ECT, the chemical composition of a patient’s brain is changed, which thus leads to many side effects. Most suffer irreversible memory loss and chronic mental dysfunction. Based on autopsies and other data, ECT causes brain damage. Any therapeutic effect evaporates after four weeks and patients return to their original status, or worse. Damage occurs most often on the non-dormant side of the brain. Amnesia, a very common side effect, affects people’s lives. Years of training and memories are deleted. Many times, the patient is impaired of the ability to focus, concentrate, make sense of complex situations, remember new things, or find their way around. All of these basic skills are lost due to ECT.
Unfortunately, these side effects are not balanced out by any psychological improvements from ECT. Many patients, approximately 30-40%, experience severe mental effects affect ECT. 20-30% experience moderate mental effects and 4-10% experience slight mental effects. The most common and severe mental effects often include feelings of remoteness, suicidal tendencies, fears of doctors/hospitals, personality changes, impaired organization skills, loss of past memories, and impaired present memory (Roleff 172). Other effects, which are not as common, include panic attacks, agoraphobia, claustrophobia, and many others. Studies from as early as 1942 show that brain damage results from ECT. With no significant benefits to patients, ECT should not be acknowledged as an acceptable use for treatment of the mentally ill.
Psychotherapy is often mistaken for an ineffective treatment for the mentally ill. In actuality, most patients find it to be extremely helpful. The longer they receive therapy, the more improvement they experience. Psychotherapy is used to treat anxiety, panic, and phobias. In a study, 44% of people who felt “very poor” prior to undergoing psychotherapy said that they felt “good” after treatment (Roleff 149). Overall, almost everyone in the study improved and their lives were made less troubling. When asked, the patients also claimed that psychiatrist, psychologists, and even social workers were all supportive, insightful, and very easy to confide in. Family doctors were seen as less useful, but that is expected since they are not professionally trained in the area of psychology and psychotherapy. Most experienced an overall boost to their confidence and self esteem and the psychotherapy helped them function in their daily lives. Patients said they enjoyed life more and understood themselves better after undergoing psychotherapy.
The mentally ill are often treated as criminals. Due to deinstitutionalization and the closing of state run mental hospitals, the mentally ill often go untreated and remain in society. Closed mental institutions released mentally ill people into society. “While the massive shift of mentally ill individuals from mental hospitals to prisons and jails was never intended by criminal justice or mental health officials, its continuation represents failure by these systems” (“From PrisonsâÂ?¦”) With the lack of large facilities, community homes were expected to be opened to care for the mentally ill. Unfortunately, many of these homes were never opened, thus creating today’s most sever problem regarding the mentally ill. Without proper treatment, they commit crimes and a form of transinstutionalization has emerged. In this case, mentally ill have been transferred from mental institutions into the prisons of America. Today, a large majority of prison inmates are considered mentally ill. With proper care and treatment, a large percentage would not remain in society, be placed safely in institutions, and not be subjected to prison conditions.
The mentally ill are considered criminals for the actions they do, but many times they are acting because they do not have proper care and are seriously ill people. Left untreated, the mentally ill unknowingly commit crimes, which cause harm to others and could have been prevented with treatment. It is argued that the mentally ill are placed in jails to avoid further criminal actions. What is needed is not imprisonment, but institutionalization. Placing mentally ill in proper conditions where they can be cared for their disease and not treated as evil criminals. It is only because they are left untreated by poor programs and no institutions that their illnesses drive them to commit crimes. According to Cocco, “Andrea Yates is not alone in her insanity” (Cocco no pg). Numerous people are jailed for crimes they commit only because there is no place in America to put them and no one is willing to treat them. This must be changed.
Mental illness is also not covered for by health insurance and thus makes it extremely difficult for those who need medical attention to receive it. Mental illnesses are diseases in the mind and should be considered and treated as such. In the same manner that a physical illness is treated and covered for by insurance, mental illnesses require the same care and respect.
Prison cannot be considered as a solution to the growing problem of mental illness in America. When released, these former inmates are homeless, without jobs, and cannot care for themselves. This generally leads for the unstable person to commit another crime simply because of lack of treatment created by today’s society and government. In 1998, a census states that 238,800 people in America’s jails are considered mentally ill (From PrisonsâÂ?¦). In truth, this number is likely to be much higher because the census was conducted by jail wardens who cannot properly diagnose a person as mentally ill or not. The cost for caring for a mentally ill person in a psychiatric hospital is estimated to be $40,000 per year. A mentally ill prison inmate will cost the government approximately $60,000 (“From PrisonsâÂ?¦”).
A revision of society’s system for handling the mentally ill needs to be done. The government has inadequately handled deinstitutionalization. Releasing patients may not have been a bad plan to handle the mentally ill, but the lack of treatment that followed up made it extremely threatening to society and harmed the mentally ill. Conditions in many institutions were unsanitary and did not properly care for the mentally ill, however, the manner in which this was handled has not be sufficient to providing care. The antipsychotic drugs, which were thought to become a replacement for intuition care, are not as effective as originally planned. Institutionalization, when revised, can be an extremely effective method at handling the mentally ill(Call for Better Coverage..). Health insurance companies and HMOs need to cover mental illness in the same manner that they cover physical illnesses in order to give everyone the opportunity to be treated. Society needs to respect the mentally ill and acknowledge mental illness as a serious condition, which requires treatment and cannot be ignored.
A revision of the methods for treating the mentally ill is clearly needed to eliminate harmful treatments like electroconvulsive therapy, promote safe and effective treatments like psychotherapy, and resolve the institutionalization problem in the United States. By reevaluating the system, the mentally ill can receive the better treatment that they deserve. Although the mentally ill seem very different from most, they still are entitled to humane treatments and rights. Advancements in the treatment of the mentally ill should not stop now. Much advancement is still possible and the future of the mentally ill should continue to improve.
Works Cited
Bosco, Dominick. Bedlam: A Year in the Life of a Mental Hospital. New York, NY: Carol
Publishing Group, 1992, p 131.
Call For Better Coverage for Mentally Ill. Volume 3, Number 44, 3/28/02.
http://www.applesforhealth.com/mentalhealth/cfbcmeni3.html.
Cocco, Marie. “We Must Stop Treating the Mentally Ill as Criminals.” Newsday. March 19,
2002.
From Prisons to Hospitals – And Back: The Civilization of Mental Illness.
http://dmhmrs.chr.state.ky.us/mh/gnu/files/criminization%20of%20mentally%20ill.htm. 4/3/03.
Roleff, Tamara and Luara Egendorf. Mental Illness: Opposing Viewpoints. San Diego,
California: Greenhaver Press, Inc, 2002. p 69-79, 146-177.
Bibliography
Bosco, Dominick. Bedlam: A Year in the Life of a Mental Hospital. New York, NY: Carol
Publishing Group, 1992, p 131.
Call For Better Coverage for Mentally Ill. Volume 3, Number 44, 3/28/02.
http://www.applesforhealth.com/mentalhealth/cfbcmeni3.html.
Cocco, Marie. “We Must Stop Treating the Mentally Ill as Criminals.” Newsday. March 19,
2002.
From Prisons to Hospitals – And Back: The Civilization of Mental Illness.
http://dmhmrs.chr.state.ky.us/mh/gnu/files/criminization%20of%20mentally%20ill.htm. 4/3/03.
Hurley, Jennifer. Mental Health. San Diego, California: Greenhaver Press, Inc, 1999, p 86-89.
Roleff, Tamara and Luara Egendorf. Mental Illness: Opposing Viewpoints. San Diego,
California: Greenhaver Press, Inc, 2002. p 69-79, 146-177.
