A Medical Catch-22
It has become commonplace to see and hear media reports about police interactions with mentally ill people. Yet it is not uncommon for correctional officers and officials to voice concerns that our jails have become de facto mental health hospitals, with more people than ever before incarcerated with—and sometimes because of—mental health problems. Correctional personnel continuously remind us they are neither trained nor funded for these types of responsibilities.
Mental health funding has faced the budgeting sword in many states over the past couple of years. While the social implications are tragic, there is also a significant cost. Law enforcement and emergency services are not designed to provide mental health services to patients on a prolonged basis. The needs of the chronically mentally ill quickly overwhelm those systems and become very expensive to address.
Releasing patients from the psychiatric wing of a jail, a crisis center, or a psychiatric hospital without ensuring that treatment is continuously maintained is a profound medical error, with risk to patient and community—not to mention a waste of taxpayer’s money. There is an astonishing recidivism rate among repeat offenders with serious mental illness, even though parole or probation conditions usually mandate follow-up treatment. Even when effective medications are dispensed, many patients suffer from anosognosia (impaired awareness of illness) and subsequently do not continue their medications or follow-up care.
According to the Treatment Advocacy Center, anosognosia is the single largest reason that individuals with schizophrenia and bipolar disorder do not take their medications. It is caused by damage to specific parts of the brain, especially the right hemisphere, and affects approximately 50% of individuals with schizophrenia and 40% of individuals with bipolar disorder.3
Another major factor in noncompliance is alcohol and substance abuse; this further complicates treatment of the seriously ill. Commonly, such patients revert back to abusing drugs or alcohol. It is clear that abuse of these substances mars one’s ability to appreciate symptoms, to make proper judgments, and to have the insight necessary to recognize one’s dysfunctional behavior.
The National Alliance on Mental Illness estimates the cost of untreated mental illness to be more than $100 million annually. Ignoring the needs of the mentally ill contributes to and fosters:
• An inability to maintain employment
• An increased burden on law enforcement
• Overcrowding of cases in an already strained legal system
• Stressed jail facilities
• Overburdening of local crisis centers
• An increase of the homeless population in our communities.4
The plight of mentally ill patients in this country is heartbreaking. Of course, no single answer or approach will fix this problem. It will take multiple funded agencies working together with clinicians and caseworkers to provide the necessary continuation of care for the chronically mentally ill to correct this catch-22.
I’d love to hear from you if you have comments about this editorial. E-mail me at PAeditor@qhc.com. CR
