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The Mental Health System in America is Broken

In many states, people who are delusional, paranoid or hearing voices must hit rock bottom -- be dangerous to themselves or others -- before the system will intervene to help them.
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The family of the Virginia Tech gunman who killed 32 people has released his mental health records to a panel investigating the shootings -- something the government was powerless to do under overly protective privacy statutes. It's about time.

The public needs to know every step of the path taken by Seung-Hui Cho on his way to the worst school shooting in American history. And while gun laws and campus security deserve scrutiny, a central focus of investigation needs to be the functioning of the mental health system.

Had Cho received decent care for his obvious pathology -- indeed if Virginia had an adequate and functioning mental health system -- it is likely that the horrific events of April 14 could have been averted. But the mental health system in America is broken.

In a nationwide grading in 2006 by the National Alliance for Mental Illness, America as a whole and Virginia in particular merited a "D" for its woefully lacking mental health care system. It is a system in which, a presidential commission concluded in 2002, fewer than a third of Americans with mental illness receive any treatment.

Cho is just one example of the system's dysfunction.

A judge had ordered Cho into outpatient care after a brief psychiatric hospitalization in December 2005. But the community mental health system made no attempt to make sure he complied or to report back to the judge when he didn't, as the law mandates. The clinic involved didn't even know it was responsible to do so.

That lapse was predictable and common -- with a crucial exception. Most times, people with mental illness themselves are the victims.

An under-funded system means long waiting lists to be seen at inadequately staffed mental health centers. It means being served in a system with too few psychiatrists with too little time who are hampered by too little insurance coverage. It means being turned out of too few hospital beds too soon.

In many states and in Virginia especially, people who are delusional, paranoid or hearing voices must hit rock bottom -- be dangerous to themselves or others -- before the system will intervene to help them. Once hospitalized, however, stays are short -- under four days on average for Virginia's uninsured -- and support for people once they go home is all-but nonexistent.

This is a recipe for cyclical breakdown and a waste of health-care dollars. In Virginia, 16 percent of mental patients were readmitted to psychiatric units within a month of discharge in 2001 and 2002, and 25 percent were readmitted within three months. Aggressive community care would not only avoid untold human suffering; it would save the state $6,300 annually per repeat hospitalization.

Overwhelmed and under-built, the mental health system has a safety valve that has allowed its problems to fester: jails and prisons. These days, when people with mental illness unravel -- when, for example, they thrash at police during efforts to subdue them or become disruptive by virtue of psychosis -- they are labeled criminals and taken to the slammer. Many climb a ladder of petty, illness-driven offenses straight to the hard time of state prisons.

That's where the beds are. In the 1990s, Virginia built 18 new prisons and closed 1,400 mental hospital beds. Across America, state spending on prisons spending tripled in the last 25 years while spending on mental health care rose by about a fifth.

And if you thought the era of shuttered hospital beds was over, consider that America lost another 57,000 psychiatric beds from 1990 to 2000. As a result, from 1992 to 2003, American hospital emergency rooms saw a 56 percent increase in people experiencing psychiatric crisis. It's time to stop the bloodletting.

In Iowa in 2000, a woman named Shayne Eggen began to exhibit classic signs of a schizophrenic break. As is typical from coast to coast, officials rebuffed attempts by her family to hospitalize her. She set a fire, attacked her boyfriend and went to prison. There, in a solitary confinement unit where she had been kept for four months, Shayne chewed a hole in her cheek, attempted to bite her finger off and blinded herself. Shayne was no criminal and she deserved better than she got. There are many more like her.

In his horrific rant, delivered on tape to NBC News, Cho said, "You had a hundred billion chances and ways to avoid today, but you decided to spill my blood." He was wrong in so many ways. His actions, which are not typical in any way of people with mental illness, cannot be excused by pathology.

But there are, indeed, ways to reach people like him -- if Virginia and America would put its energy and its money into healing the sick. America needs to provide adequate insurance coverage for mental illnesses and community care that includes in-home support; it needs to build decent housing for the mentally disabled.

Little has changed since 2002 when President Bush's New Freedom Commission on Mental Health expressed "the united belief that America's mental health service delivery system is in shambles." In the wake of Virginia Tech, are we finally going to do something about it?