Discrimination and the Mentally Ill

 Stigma and discrimination are the principal obstacles to treatment for the mentally ill. For the most severely ill, there are other stumbling blocks to treatment, the laws that prevent treating individuals that need higher care; the IMD exclusion law is one such law.  Failure to recognize and treat these persons until they become dangerous although preserving their constitutional rights violates their right to treatment. These laws and our failure to treat individuals with schizophrenia and manic-depressive illness are the utmost discrimination against those with mental illnesses.
 

 Stigma is created by the headlines which depict the mentally ill, during times of crises, committing violent crimes and not by the statistics which show that a large number of them have been released from hospitals without the proper treatment time that it takes for stabilization of their disorders.
 

 The negative attitudes toward people with mental illnesses increased greatly after people read newspaper articles reporting violent crimes by the mentally ill according to studies that have been done.  It is futile and out of place to expect the stigma of mental illness to be changed by the news and entertainment media with pleas to help the severely mentally ill. 
  

 The government must tackle over 30 years of the disastrous deinstitutionalization policy if they hope to win the battle of mental illness stigma and solve the nation's mental illness crisis. Hundreds of thousands of defenseless Americans are living a pitiful existence on city streets, underground in subway tunnels or in jails and prisons because of the misguided efforts of civil rights advocates to keep the severely ill out of hospitals and therefore out of treatment.
  

 These grievously ill persons in our cities are grim reminders of the failure of deinstitutionalization. They are seen huddling in the cold in makeshift cardboard box dwellings, carrying on conversations with invisible companions, wearing filthy, rags for clothing, urinating and defecating on sidewalks or threatening passersby. They frequently are seen on stretchers as victims of suicide or violent crime, or in handcuffs for committing violent acts against others.
  

 All of this occurs while government officials who in blind ignorance do nothing but punish those without the insight to help themselves; without the right to long term treatment to be stabilized in a setting less harsh than the streets. The consequences of failing to treat these illnesses are devastating peoples lives until they become soothing less than human in the publics eyes.  Americans with untreated severe mental illnesses represent less than one percent of our population, and yet they commit almost 1,000 homicides in the United States each year. At least one-third of the estimated 600,000 homeless suffer from schizophrenia or manic-depressive illness, and 28 percent of them forage for some of their food in garbage cans. About 170,000 individuals are in prison and suffer from these illnesses, costing American taxpayers billions per year.
  

Delaying treatment only results in permanent damage, including increased treatment resistance, worsening severity of symptoms, increased hospitalizations and delayed remission of symptoms.  Persons suffering from severe psychiatric illnesses are frequently victimized.  Studies show that many women with untreated schizophrenia have been raped. Suicide rates for these individuals are 10 to 15 times higher than the general population.

The inadequate psychiatric hospitals and the closure of the state hospitals have only served to compound the devastation. Most state laws today prohibit treating individuals over their objection unless they pose an immediate danger to themselves. Most of the people who are untreated do not have the insight to know that they need treatment; not being aware that they have an illness causes them to refuse the treatment that could end their misery,

 It has been proven that outpatient compliance is effective in ensuring treatment compliance; the challenge remains in getting them to utilize what is their answer to their problem without the revolving-door syndrome of hospital admissions, readmissions, abandonment to the streets and incarceration that plague those not receiving treatment.

Adequate care in psychiatric hospitals for long term treatment also must be available. A large number of the 3.5 million people suffering from schizophrenia and manic-depressive illness require long-term hospitalization which means hospitalization in state psychiatric hospitals. This critical need is not being met, since we have lost most of our state psychiatric hospitals since 1955.

 It is time to reform the laws that prohibit long term hospitalization for those in need.  People with mental illnesses are not to be blamed for having a disorder; they should not be penalized for an illness that is through no fault of their own.  The discrimination and stigma against the mentally ill must be cleared from the minds of the ignorant public.  Their fellow citizens are being denied the right to a life free from shame and turmoil; that deserve a life with dignity and equality.

The Chronic Mentally Ill

Who are the chronic mentally ill; individuals who suffer from one of several diseases affecting the brain, the most essential part of human beings. The causes are still unknown, but are probably multiple. There is no cure, but, effective treatment does exist. People with serious mental illness are significantly functionally impaired by the illness for an indefinite period of time. At least 1% of the population has a serious mental illness. The problems of these persons and their families are compounded by centuries old stigma, the prejudice still persists.

Symptoms of chronic/serious mental illness:

Acute symptoms: Distorted perceptions; loss of contact with reality; delusions; hallucinations; disordered; disorganized and confused thinking; unstable and inappropriate emotions. ; Bizarre behavior; impaired judgment.

Residual or deficit symptoms, several of these usually present most of the time: vulnerability to certain kinds of stress; extreme dependency sometimes combined with hostility; difficulty with interpersonal relationships; deficient coping skills; poor transfer of learning; fear of new situations; restricted emotional response and lack of enjoyment; reduced speech and impaired abstract thinking; reduced ability to pay attention; slowness; apathy; lack of motivation; phobic avoidance of situations; sensitivity to stimulation.

 Common for anybody who learns that they have a serious, chronic, incurable illness:

General stress response with fear; grief; denial and impatience; anger; guilt and self-blame; depression; hopeless, helplessness; regression to earlier levels of functioning; preoccupation with self; immaturity.

This includes loss of normal role functioning and normal family, community functioning. Social breakdown syndrome can be a side effect of any treatment that removes the person from their usual social environment.

Coping and adaptation what is hoped for and is a possible outcome of treatment, rehabilitation, family support and self-help. Acceptance and hope; interest in the illness and its treatment active cooperation with treatment and rehabilitation; lifestyle modifications is what is attempted to achieve.

In general, patients need:

Indivilualiged treatment; Continuity of relationships with staff with a smooth transition between, and coordination among, programs and treatment components.

.Patient education and full understanding about the illness and its treatment; leading to informed consent; responsible patient role; safe and comfortable care and surroundings with adequate privacy and desired amount of contact with others; plans for crises; support and education of family and significant others.

 Compliance with care with appropriate medication by a psychiatrist and treatment team who understand the illness and its treatment; careful monitoring of beneficial effects and side effects. Elimination of unnecessary drugs; alcohol, caffeine, marijuana, etc.; symptom monitoring by patient and others.  Adequate rest and regular, planned, exercise; a balanced, nutritional diet.

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A therapeutic teamwork with a person which involves support; varying degree of support depending on need, respect, reality orientation is the goal of therapy.

Being actively, comfortably and purposeful busy; a relaxed atmosphere; a regular daily routine; including evenings, weekends and holidays; behavioral approach using natural consequences. Minimization of the handicap. If alcohol/drug use is a problem, attention to dependencies should be integrated with other treatment; psychosocial and occupational rehabilitation. Communication and problem solving skills for patient and significant others; construction of supportive social network; prevent or reverse social breakdown syndrome;  help with daily living; money management, transportation, housing, etc.

All of these issues need to be addressed in order for the person to live a more fulfilling, rewarding life.  Chronic sever mental illness can be managed with as little stress and debilitating effects as possible.  With the cooperation of the person, doctor and treatment team long term hospitalization can be avoided.