Discussion: Mental Illness

I said it so well (I think) at Science Based Medicine that I thought I’d repost my comment on the treatment of the mentally ill here.

The treatment of mentally ill people is a huge problem where I am (Eastern Canada). If the severely anosognosic mentally ill aren’t institutionalized, they typically end up criminalized. Unfortunately, the criminal justice system is as unequipped to deal with the mentally ill as the community in which they failed to thrive. It was a noble pursuit to decrease institutionalization and mistreatment of the mentally ill, but it was foolish to do so without adequate social and community support.

The examples of violence that Dr. Hall provides are extreme, to be sure, but not outside the realm of reality. Having worked at a mental health institution in the past, I can anecdotally confirm that families, patients, and communities have these fears and they are not always unjustified.

Patients who are chronically ill and can’t manage in the community have to stay in the hospital with acutely ill patients who agitate them. Patients who are not violently ill (for example, anxiety and depression) are on the same floor as violent psychotic patients, which contributes to their symptoms. Patients in general get fewer visitors than on medical floors because people are afraid to visit an acute mental health facility. Communities don’t want “those people” living in special care homes in their neighbourhoods because of the false assumption that all people with psychosis are dangerous. Dangerous mentally ill people end up in prisons because of a lack of available beds in forensic institutions.

The system for the mentally ill is broken. Low budgets, lack of community support, and social stigma contribute to criminalizing and isolating mentally ill people. People have plenty of patience for the fatigue someone with mono, for example, but when someone has depression they can be seen as “lazy” or “weak”. An infection we understand, a personality trait we have trouble with because “why can’t they just cheer up?”

I agree with Dr. Hall. We can definitely do better, but we have to get off our butts and write our local government. Make noise. It’s the only way this will change.

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