According to the CDC, “More than 1 in 5 US adults live with a mental illness.” Some have anxiety or PTSD (post-traumatic stress disorder), while others may suffer from bipolar disorder or schizophrenia, to name just a few of the problems faced by tens of millions of Americans. Why have we forsaken so many mentally ill patients?
Violence and Mentally Ill Patients?
You have no doubt heard the expression that “Everybody talks about the weather, but nobody does anything about it.” The same thing could be said about mental illness. We do not seem to have the will to commit the necessary resources to actually help people in distress.
Whenever there is a tragic event such as a mass shooting, many politicians like to blame the violence on mental illness. It’s a well-rehearsed strategy for passing the buck. Our leaders seem to think that if they blame mental illness, they can escape any responsibility for mass shootings.
A very thorough examination of the research and medical literature by the Department of Psychiatry at Columbia University reveals that:
“The public tends to link serious mental illnesses, like schizophrenia or psychotic disorders, with violence and mass shootings. But serious mental illness—specifically psychosis—is not a key factor in most mass shootings or other types of mass murder. Approximately 5% of mass shootings are related to severe mental illness.”
The report points out that:
“Persons with mental illness, moreover, are far more likely to be victims of violence than to perpetrate it.”
Jordan Neely’s Violent Death:
Jordan Neely was killed on a New York City subway because he was yelling and throwing trash. He was homeless and had been in and out of hospitals with diagnoses of schizophrenia and post-traumatic stress disorder (PTSD) for more than a decade.
When Mr. Neely got on the subway, he said he was hungry and thirsty. He was killed after being put in a chokehold by a Marine veteran.
The Marine’s law firm provided a statement:
“We hope that out of this awful tragedy will come a new commitment by our elected officials to address the mental health crisis on our streets and subways.”
That is a frequent message. Yet we rarely see any action.
Many Homeless People Are Also Mentally Ill Patients:
According to the 2022 Annual Homelessness Assessment Report (AHAR) to Congress:
“On a single night in 2022, roughly 582,500 people were experiencing homelessness in the United States.”
“Homelessness slightly increased nationwide. Between 2020 and 2022, the overall number of people experiencing homelessness increased by less than one percent (1,996 people)… However, between 2021 and 2022, sheltered homelessness increased by seven percent, or 22,504 people.”
Experts estimate that roughly one fourth of homeless people in the United States suffer from mental illness. They are often incarcerated for petty crimes or left to languish in emergency rooms for days. Despite all the hand wringing about increasing numbers of unsheltered people, the system offers few solutions.
Whatever Happened to Hospitalized Mentally Ill Patients?
Early in the 20th century, many people with severe mental illness were provided asylum in state mental institutions. These hospitals were far from perfect, but they did offer food, shelter, security and a degree of care. Some of the facilities even provided an opportunity for simple work.
I had first-hand experience at just such an institution. During the late 1960s I worked in the Neuropharmacology Laboratory at the New Jersey Neuro-Psychiatric Institute in Skillman, NJ. It later became the North Princeton Developmental Center.
Dr. Carl Pfeiffer, MD, PhD, was the head of our lab. Prior to that, he was Chairman of the Department of Pharmacology at Emory University. His curiosity and background in biochemistry led him to think differently about mental illness. His book, Nutrition and Mental Illness: An Orthomolecular Approach to Balancing Body Chemistry remains controversial to this day. He believed that minerals were important and that food additives were dangerous (Mental and Elemental Nutrients: A Physician’s Guide to Nutrition and Health Care).
The patients at the Institute were given clean clothes, a bed, three meals a day and a safe environment. Like most institutions of the day, it was far from perfect. Nevertheless, the peaceful, campus-like facilities were far safer than the mean streets of most cities.
Deinstitutionalization or the “Revolving Door” Policy
During the 1960s, many states implemented a “deinstitutionalization” policy. Keeping people hospitalized was thought to be cruel, even if they could not care for themselves.
The idea was for them to get care in their local communities. That, however, rarely materialized, primarily because states, counties and municipalities didn’t invest in local care. Federal subsidies designed to support individuals with severe mental illness were inadequate.
Instead, families had to struggle to help their loved ones. Many were unable to do so effectively. As a result, their ill family members often had to be hospitalized repeatedly. That is how the “revolving door” policy was named. Chronically mentally ill patients would be admitted to psychiatric units and then quickly put back on the street where there was little, if any, follow-up care.
One of the reasons so many experts embraced this model was the development of medicines to treat mental illness. Antipsychotics, anti-depressants, anti-anxiety agents and other pharmaceuticals were supposed to enable patients to resume a relatively normal life.
Why Didn’t Drugs Cure Mentally Ill Patients?
Sometimes medications can make a big difference, but they are not cures. They do not work for everyone, and they are rarely enough in and of themselves. Even a person who is no longer incapacitated by hallucinations or severe depression thanks to a medication still needs therapy, social support, a job and a place to live.
Neither a jail cell nor a tent in a homeless encampment is conducive to recovery from mental illness. Police are usually ill-equipped to help someone in the midst of a mental health crisis.
Drug-Induced Side Effects and Mentally Ill Patients:
In addition to the lack of resources, there are drug side effects to consider. Like other medicines, antipsychotics have some serious adverse effects.
Perhaps one of the most noticeable is tardive dyskinesia, a movement disorder triggered by use of medications like chlorpromazine or haloperidol.
People may have uncontrollable movements of their face such as blinking or smacking their lips. Other adverse reactions include weight gain, diabetes, high cholesterol, heart rhythm changes, dizziness and impaired judgment. Occasionally, such reactions may prove lethal.
Tardive Dyskinesia (TD) Can Be Disastrous:
Christine shared her mother’s experience with TD:
“My mom was on trifluoperazine for many years and developed Tardive Dyskinesia. Unfortunately, the very early symptoms were not recognized as such and thought to be just part of aging, dementia, and eventually the start of Parkinson’s Disease.
“We were fortunate to be referred to a specialist of internal medicine and clinical pharmacology who recognized the TD symptoms. He was able to wean her off the medication that caused it, trifluoperazine, after a period of 10 months. She improved somewhat, but sadly it was too late by the time the medication was discontinued. The permanent brain damage was done.
“It is my understanding that tardive dyskinesia is drug-induced brain damage caused by prolonged, un-monitored and over-use of these types of antipsychotic medications. If it is recognized as such, and caught early enough it can be prevented. We were grateful to be able to see the specialist and get a proper diagnosis before any more wrong medications were added, that, in our experience, only made the complex effects of tardive dyskinesia worse.
“I am glad to see this disorder finally being recognized!”
Melissa has been on a roller-coaster:
“I had been taking Mellaril [thioridazine) and risperidone, and a few months later was diagnosed with epilepsy and taken to the hospital in an ambulance. For 3.5 years I tried every antiseizure med and did EEG studies in and out of hospital and then had EKG with EEG and the combination of meds caused ventricular tachycardia and long QT syndrome. So, I wasn’t really having epilepsy. With long QTs you can only take a few antipsychotics. The one they have me on is ABILIFY.
“OMG, I don’t think my husband, psychiatrist and cardiologist seem to get it in their heads. I would rather have a pacemaker/defib combo than take Abilify. I can’t sleep; hair falling out; insomnia; aggressive; agitated; grumpy; depressed yet anxious. I can hardly be around people without feeling like I am jumping out of my skin! It’s ruining all of my relationships.
“I tried Latuda [lurasidone], which was supposed to be safe. For two weeks, I stayed in bed, curled up in a ball and suicidal. I could barely get up to go to the bathroom and cried constantly. So my doctors put me back on Abilify. My tardive dyskinesia is getting so bad that I can’t even wear glasses, and I have bite sores in my mouth because my jaw hurts so much. It has ruined my life.”
Patricia describes withdrawal on aripiprazole (Abilify):
“My brother has had an ugly regimen of antipsychotic meds over the past 25 years due to a nervous breakdown–a breakdown that was actually unavoidable at the time.
“Now he is off most medications with the exception of aripiprazole. He got down from 20 mg to 2mg. But no matter how small the dosage, he absolutely cannot live without it. The withdrawal process caused him permanent tardive dyskinesia. However, the remaining 2mg is so powerful that without it he automatically becomes aggressive, sad, argumentative and inappropriate. A totally different man! What a horrible life sentence for anyone.”
You can learn more about Abilify (aripiprazole) and tardive dyskinesia at this link.
Ignoring Mentally Ill Patients:
Politicians who blame social problems on mental illness have not been willing to fund facilities to treat these conditions. We need more beds and more therapists. We need a far better understanding of the causes behind mental illness and we need more effective and safer medications.
Even more important, we need to offer people with serious mental illness the opportunity for rehabilitation. Community outreach, supported employment, housing and mental health clubhouses could make a big difference in most communities.
What Do You Think?
We would like to hear from you, our readers! Have you or your family been touched by mental illness? How good were the services and support you were offered? What about medications? Please share your thoughts in the comment section below.