In 1970, shortly after graduation, I got my first job as a psychiatric social worker at the Elgin State Hospital, Illinois Department of Mental Health. I was assigned to a ward that was originally called ‘the farm colony’. Years earlier, the unit was part of a working dairy and truck farm. Much of the food consumed by the patients at the hospital came from the fields and barns of the farm colony and was actually produced by the patients who were supervised by hospital staff and the resident farmer.
In the 1960s, in an attempt to reduce costs, the state began a program to discharge long-term patients to the community. By the time I went to work there, all of the agricultural activity had ceased, and the unit was renamed ‘the residual unit’. The average stay for the men in this group was 30 years. They had become totally institutionalized and had no survival skills if placed outside of the hospital. They were, nevertheless, discharged back to Chicago where most of them originally came from. Their survival rate averaged less than a year. The first week working on the ward, I was tasked with interviewing potential candidates for discharge.
The very first man that I sat down to talk with was callously referred to in his file as a 65 year old, ‘burned out’ schizophrenic. I’ll never forget that day. “Well Mr. ————-, I would like to talk to you about discharge to the community.” His wide eyes met mine and he said, “Discharge? You mean, outside? ….Back to Chicago?” I said yes. With that, he got up out of his chair, placed his hands on my desk and said, “Mr…. you’re crazy!” This is how it went for the next two years. At that point I had to walk away from this job. I could not ethically continue. By sending them to Chicago ‘half-way houses’ with minimum supervision it meant a death sentence for many of them. In a 1978 Scientific American article I found, it states, “The resident population of large mental health hospitals has been reduced by 2/3 in 20 years, but chronic patients are being discharged to a lonely existence in hostile communities without adequate care.”
Fast forward to present day. It continues to fall to police to be the ‘first responders’ for this population. Many people suffering from chronic mental illness in the United States face the same horrible fate as they did in the 60s and 70s. “Police departments in the 194 U.S. cities with a population of 100,000 or more were surveyed in 1996 to identify strategies they used to obtain input from the mental health system about dealing with mentally ill persons. A total of 174 departments responded (90 percent). Ninety-six departments had no specialized response for dealing with mentally ill persons.
Among the 78 departments with special programs, three basic strategies were found: a police-based specialized police response, a police-based specialized mental health response, and a mental-health-based specialized mental health response. At least two-thirds of all departments, even those with no specialized response program, rated themselves as moderately or very effective in dealing with mentally ill persons in crisis.” ps.psychiatryonline.org. A review the current literature shows that many law-enforcement agencies are given insufficient training identifying, managing, and referring mentally ill persons. It is clear that the police are being tasked with a responsibility they are clearly not trained to deal with.
With this in mind, it is time that we look for another model in dealing with chronic mentally ill people in our communities. When we talk about defunding police, I think that another term needs to be substituted. To effectively work with this population, a team needs to be established which includes mental health professionals, the clergy, and the police. “The police often fulfill the role of gatekeeper in deciding whether a person with mental illness who has come to their attention should enter the mental health system or the criminal justice system. Criminalization may result if this role is not performed appropriately.”
It seems reasonable to suggest that a team comprised of a police officer, a mental health professional, and clergy could work together as a kind of triage unit designed to properly assess and deal with emergency situations. Patently blaming the police for mishandling these situations is shortsighted. “From the standpoint of the police, it is clear that [many] officers need and want rapid on-site assistance from mental health professionals when they are called on to deal with difficult or complex situations involving persons with mental illness who are acutely psychotic, behaving bizarrely, or exhibiting violent behavior or persons who have attempted suicide or made a suicidal gesture.”
All the members of such a team should be psychologically screened before being asked to respond to a mental health crisis situation. Clearly, a complete restructuring needs to happen in order to avoid continuing disaster. The blame game is not an option. If we fall into the blame trap, one thing becomes clear. If the only tool in your toolbox is a hammer, every problem looks like a nail. The entire team needs to be trained in mental health response techniques and be free from racial prejudice and negative preconceptions regarding mental health. Establishing this approach, it becomes a win-win situation. Instead of defunding, let's consider refunding and restructuring.
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