Why We Shouldn't Institutionalize the Mentally Ill

Focus must be long-term treatment, housing alternatives, and—above all—funding.

Posted Aug 20, 2019

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When last summer I authored the Psychology Today blog post “One Flew Over the Cuckoo’s Nest to Silver Linings Playbook” about the evolution of mental health care and its impact on individuals and families, I never imagined our country would revisit the possibility of institutionalizing individuals with mental illness.

But just last week, President Trump spoke openly with reporters about this very subject in response to the back-to-back shootings in El Paso, Texas, and Dayton, Ohio. As reported by CNBC.com, he responded to a question about gun control, saying:

“These people are mentally ill, and nobody talks about that... I think we have to start building institutions again because, you know, if you look at the ’60s and ’70s, so many of these institutions were closed.”

While I would like to believe these comments will be ignored by the vast majority of lawmakers, political donors, and others with power, experts in the field must continue to explain why President Trump’s thinking is misguided, misinformed, and a huge disservice to the 1 in 5 adults in this country who experience severe mental illness each year.

As I’ve written previously, the mental health institutions President Trump refers to closed for good reason. Underfunded, poorly staffed, and ill-regulated, they served more as warehouses for people with mental illness than as treatment facilities. Individuals were chained to radiators, given largely untested anti-psychotic drugs with terrible side effects, and subjected to poorly administered electroconvulsive therapy.

It was inhumane. It spurred a public backlash. We must never revisit those days again.

Today, federal and state laws uphold the fundamental right of competent adults to refuse mental health treatment. Such statutes set an extremely high bar for any kind of involuntary commitment or care. They require hospitals to obtain a court order to administer treatment over a patient’s objection.

This evolution, however, has come with its own challenges. Patients with mental illnesses that can make it all but impossible to recognize their own diagnoses (i.e., schizophrenia, bipolar disorder) frequently refuse critical treatment, including stabilizing medication. They are often in and out of hospitals routinely, returning again and again to family homes where they might be better for some time before their next crisis. This cycle can make relationships toxic, sometimes worsening mental health conditions and presenting often insurmountable challenges to families.

But such individuals are very rarely perpetrators of violence. They are far more likely to be the victims at the hands of others. According to the American Mental Health Counselors Association, only 3 to 5 percent of all violence—including, but not limited to, firearm violence—is attributed to serious mental illness. Yet the rates of violent crime victimization are 12 times higher among the population of persons with serious mental illness than among the overall U.S. population.

Working with the families of such suffering individuals has made it abundantly clear our mental health system remains terribly broken. But it won’t be fixed by institutions. Rather, this country needs to devote real funding to early intervention, long-term treatment, housing alternatives, and community programs for those with serious mental health diagnoses.

It has to consider whether the pendulum has swung too far in the direction of patient rights and whether we can do better for individuals by modifying certain legal standards and confidentiality laws that make it extremely challenging for caretaking families to obtain treatment for loved ones and provide critical long-term stability.

Further, we must call out those who make lives infinitely harder for those already suffering from mental health issues by using careless and/or calculated language. Words matter. When they’re used poorly, they can reinforce stigma and our society’s worst assumptions. Mental illness does not cause violence; stoking fear and hate certainly does. Sadly, the evidence is the countless lives lost in tragedy upon tragedy, all across the country.

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