Mental Health Services "Slipping Through the Cracks"

This is a controversial and emotional blog post. It is my opinion based on my 25+ years of experience in the field of psychology.

The recent school shooting in Connecticut has given politicians another reason to push gun control. So many people in social media outlets like Facebook have been at each other’s throats arguing about this issue. However, I’m here to tell you that guns are not the issue. Cracks (and sometimes canyons) in services to the mental health patients are really to blame.

When I started going to college, I began working at the Stockton Developmental Center, which was a locked facility that had been around for years housing some of the most mentally disabled people in our community including the “criminally insane.” I had seen disabled people in public, but I had never seen people like these. Many of them were nonverbal and were no better than animals. I’m not saying that to be mean, it’s just the facts. They were infants in adult bodies. It was difficult to keep clothes on them and some even ate their own feces. Imagine a two year old mind in a large, adult male body. During my employment there, I saw many staff members sent to the hospital after patient rampages. I myself was hit, kicked, scratched, and bit several times. One time, a patient bit me in the face because I told him it wasn’t time to smoke yet.

These people needed constant care and supervision. They received three meals a day, had a warm bed, clean clothes, daily showers, activities, medical and dental care. They were not fit to be in the community. Not because we were mean as a society, but because they were dangerous and could not care for their basic needs. The problem was that the people making the rules didn’t actually work with the patients. We were given programs designed to make their days seem “normal.” Meaning, they were made to get up early, eat, walk to another facility on grounds (if they could walk), do different jobs or leisure activities, go back to their units for lunch and back to the “work” facilities in the afternoon. I spent much of my time on the floor holding rampaging clients down or trying to avoid getting beat up. Why? Because they weren’t normal. You wouldn’t plan a day like that for a 12 month old, but the powers that be insisted on using the patients’ chronological age not their mental ages. They made silly rules like the patients couldn’t watch cartoons because that wasn’t age appropriate. I still watch cartoons. Stupid.

The politicians and other people involved in de-institutionalization in the 1980’s were reacting on feelings and not reality. “Those people shouldn’t be locked up.” “They deserve to be free.” So, they turned them out and closed many of the developmental centers. Some of the worst went to the few centers still open while many were sent to care homes unequipped to deal with these severely disabled patients. Many of the mentally ill patients were turned out on the streets unable to care for themselves. Help was available, but they had to be responsible enough to access it for themselves. Politicians said they had the right to refuse treatment. It was an uneducated decision that had horrible repercussions.

While I was working on my graduate degree, I started working for a program that provided behavioral services to severely mentally ill adults diagnosed with schizophrenia. What I learned working with this population could not be contained in this blog, but I will tell you this – when they were sent to us, they were psychotic and unable to care for themselves. With treatment and medication, they improved significantly and would readily acknowledge the fact that they were incapable of making decisions about treatment when they were in that state. They couldn’t even provide for their basic needs much less find their way to mental health. The people who came to us were there mostly due to suicidal or homicidal behaviors. The rest were left to suffer because they were not deemed a danger to themselves or others. I beg to differ.

As a professional in psychology, it makes me sick to walk around downtown (San Francisco is especially horrible) and see these poor people walking around in the winter without shoes, no coats, no way to care for themselves. Who in the hell thinks it’s their “right” to live that way? If they had the proper treatment, they wouldn’t choose to live like that. I know. I’ve seen it firsthand.

I understand the ideal of allowing people to refuse treatment (or not seek it for whatever reason), but we don’t do lobotomies or drill holes in people’s heads to let out demons. Today’s professionals in psychology are much more capable of treating patients and helping them live better lives. Sometimes, they are not well enough to make that decision for themselves. Developmental centers were not warm and fuzzy, but they provided for people’s basic needs and gave them the medical care the needed. They were certainly preferable to living on the streets.

Mental health care here in our county is affordable. We have a vast network of mental health programs here, but the patient has to seek out that care. Unless they injure themselves or someone else, treatment will not be forced on them even if they need it. In some states, even the most basic mental health services are not available, and families struggle with mentally ill family members looking for help they’ll never get.

We have to address mental health issues in this country. We have to provide for those among us who are not able of caring for themselves. Families and care homes are not equipped to deal with extreme aggressive behaviors, and their pleas for help fall on deaf ears. Politicians and others want to make it an issue of gun control, but I can’t tell you how many people I have seen injured by mentally ill patients using their fists, knives, and even a three pronged garden tool. Many mentally ill patients are harmless (to others if not themselves). If they are psychotic, and focused on hurting someone, they will use whatever is available to them. I will say it again – we have to address the mental health issues in this country. Until we do, we will continue to experience tragedies like school shootings and other acts of violence by those mentally ill people who have “slipped through the cracks.” Gun control alone is not enough.