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EDITORIAL: Time to rethink treatment of some mental illness?

Daily Oklahoman - 12/18/2018

Dec. 18--IN politics, unintended consequences can outweigh the good intentions of a policy. There's reason to think some of the nation's most seriously mentally ill individuals may be worse off today because of some impacts of the Americans with Disability Act that weren't necessarily intended by that law's supporters.

D.J. Jaffe, executive director of Mental Illness Policy Org, makes that case, and his arguments deserve serious consideration. Although the ADA is associated with many good outcomes, certain provisions may have left some people worse off and merit revision.

While some groups estimate up to 50 percent of people may have a diagnosable mental illness during their lifetime, Mental Illness Policy Org focuses on the 4 percent of adults "who are most seriously ill, mainly suffering from schizophrenia and treatment-resistant forms of bipolar disorder," according to the group's website.

Citing recent coverage in The New York Times, Jaffe notes civil liberties advocates have pressured various entities into signing ADA consent decrees that ended in the release of seriously mentally ill individuals from adult homes, which Jaffe describes as "a residence where mentally ill can get intensive care, in environments less restrictive than psychiatric hospitals." But independent living didn't end well in several prominent cases outlined by the Times. Police found one man with schizophrenia living in an apartment filled with rotten, spoiled food and feces "ground into the carpet." Another woman became homeless.

Among some activists, the default presumption is that any form of institutionalized living is automatically the worst option for treating those with mental illness. Jaffe contends this has led some activists to "push states to move thousands of mentally ill people out of adult homes and hospitals that provide intensive services and into independent living ..."

But for those with the most serious forms of mental illness, Jaffe argues some form of institutionalized care is far better. The failure rate for those pushed into independent living, he says, may be as high as 50 percent, according to clinicians "and others on the front lines."

In many instances, Jaffe points out that the seriously mentally ill are still institutionalized, but in a very different setting.

"Ten times as many seriously mentally ill people are now incarcerated as hospitalized," Jaffe writes.

That's a problem seen in Oklahoma as well, where officials report that an astounding number of individuals locked behind bars suffer from some form of mental illness. The trend of incarcerating the mentally ill has occurred alongside the closing of at least 42 state psychiatric hospitals nationwide since 1999.

"Creating more psychiatric beds will help reduce reliance on streets, jails, prisons and morgues as our overflow valve," Jaffe writes.

The involuntary commitment of an individual to psychiatric care isn't to be taken lightly. But one must question if it's more compassionate to abstain from such commitments if the result is prison for the most seriously ill. While most people with mental illness don't need any form of institutionalization, Jaffe makes a strong case that for a subset of the most seriously ill, the failure to force treatment is a failure to care.

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