My despair about the neglect of the severely ill in the U.S. has been described in many previous blogs. The most despairing was titled "World's Best and Worst Places To Be Mentally Ill" -- with (you guessed it) the U.S. being the worst.
A new report issued today by The Treatment Advocacy Center documents the sad news that the worst has been getting even worse.
The numbers are shocking. Per capita, the U.S. now has only 3.5% as many state hospital beds as it did 60 years ago. We have closed over 500,000 beds, without providing sufficient community services and adequate housing to pick up the slack.
And of the paltry 37,559 beds that remain nationwide, half are really part of the correctional system, not at all available for ordinary patents unless they commit a crime.
Incredibly, the number of beds constantly keeps dropping (there are 17% fewer since 2010)- going from ridiculously inadequate to almost none. The TAC report is appropriately subtitled: "Going, going, gone."
Bed reduction would have been somewhat more tolerable had the U.S. followed the practice of many other more civilized counties -- replacing the lost psychiatric beds with a full range of community services and supported housing and work. But no, we have defunded the community services almost as drastically as we closed the beds. We rank 29th among OECD countries on inpatient beds and I would guess do no better, or perhaps even worse, on outpatient care.
The lack of treatment and housing for psychiatric patients pushes them into other systems that are uniquely ill equipped to meet their needs. Cops are now first responders when a patient screams in the night, urinates in public (having no place else to go), or robs a sandwich from a food store. Emergency rooms are backed up and without crisis care, the last resort often is jail.
The severely ill do especially poorly in the criminal system that we have unjustly imposed upon them. Someone with a mental illness is 16 times more likely to be shot by a cop, than someone without. They are the most likely to be put in solitary confinement, be raped or beaten up.
The TAC report is loaded with astounding statistics and valuable recommendations. No one reading it can believe the current non-system makes sense, either programatically or fiscally. It is cruel and costly to consign the mentally ill to jail or the streets; much more humane and cost-effective to provide decent housing and timely psychiatric services.
The trick is going from here to there -- closing prison beds and opening community psychiatric services. This isn't rocket science -- many other countries have gotten it right and we were much better ourselves thirty years ago before the states privatized and offloaded their responsibility for the mentally ill.
And our federal agencies have also been a colossal flop. The Substance Abuse and Mental Health Agency has pretty much wasted its enormous $3.7 billion/year budget on frivolous projects and does almost nothing to rescue the severely ill. The National Institute of Mental health has bet almost its entire budget for the past 20 years on exotic neuroscience projects that have great intellectual interest, but so far have not helped a single patient.
The Treatment Advocacy Center has been the lonely voice of the voiceless and the staunch defender of the defenseless. Its reports document our shame and should inspire the practical steps needed to end the neglect.
Allen Frances is a professor emeritus at Duke University and was the chairman of the DSM-IV task force.