New Approach Needed In Care For The Mentally Ill

Check out my piece at the Cincinnati Enquirer.

There is a division in thinking among mental health service providers and civil rights activists that has led to stagnation rather than solutions.

We have advocates for civil liberties who have decided that principle should overcome pragmatism when it comes to involuntary committal and treatment of mentally ill individuals. The threat that untreated severely mentally ill individuals pose to themselves and others is viewed as secondary to the principled assertion that all should be able to self determine. This is the position that is endorsed by law and ethical standards in the United States.

On the other hand we have people who believe that severely mentally ill individuals are incapable of self determination while under the influence of their illness, and should be - in the name of their own well being and the well being of others - able to be committed or forced to receive treatment, so that their ability to self determine can be returned to them.

Both of these positions are principled and can be understood from various vantage points. Protecting the rights of those who are least able to advocate for themselves is a hallmark of the human services and liberal movements and should continue to be so. The principle that underlies the current law and popular thinking is admirable; but it has left a vacuum in care for individuals who are unable to self determine under the burden of their mental health issues.

Cincinnati's Drop Inn Center has a safe shelter for individuals experiencing homelessness to stay in, and - hopefully - to receive further appropriate services. A large portion of the population at the safe shelter could be classified as the "most difficult to serve." These are individuals who are experiencing various degrees of behavioral decline as a function of either substance abuse or mental illness. Among this population is a sub-group of individuals whose behavior is such that - for the safety and peace of mind of other residents of this shelter - they must be asked to leave until they have received treatment that would allow them to function passably within the community.

When these individuals are not in the safe shelter, they are roaming the streets. They're sleeping under bridges, on benches, in doorways, or in the jail house, because their behavior has caused them to break a law that has led to their arrest. It is possible for mental health agencies or police to "put a hold" on a person (requiring police to take them to the hospital for observation for up to 72 hours), but treatment cannot be administered without permission. Often these individuals are released to the street for the cycle to begin again, often only stopping when a severe enough crime is committed to warrant sending them to prison for prolonged periods of time.

This is unacceptable, but the solution to this problem need not be a full reversal of important civil rights victories.

What is needed is a forum. That's what I hope to achieve in my city. A forum where all of the players from all of the human services and civil rights organizations sit down and seek to address this unfortunate - and unintended - consequence of progress.

The solution may be something as simple as an extension of the allowed hold time in the psychiatric ward at the local hospital to the creation of more housing options with wrap-around services for those suffering from severe mental illness. Maybe our governing bodies should direct more funds toward our city's safe shelters so that we can adequately staff them with trained psychiatric staff. Maybe a middle ground can be found on the issue of involuntary committal and treatment. These are just a few ideas.

Whatever the solution is, it won't be discovered in silence. Hopefully by mobilizing a base of concerned service providers and advocates, we can start a discussion that will lead to real solutions for the populations we care for, and the communities we live and work in.