The Coming Holocaust of the Helpless

Cutting Medicaid Could Condemn the Mentally Ill to Death

I spent just under four years in an Assertive Community Treatment program. Assertive Community Treatment (ACT) is built to provide support services to those whose care from more traditional mental health services has failed to help. It has been endorsed by the National Alliance for the Mentally Ill because intensive research has shown that it works, something that cannot be said for more common, less rigorous approaches.

ACT provides its services directly and is tailored to meet each individual’s specific needs. ACT teams are multi-disciplinary, comprised of psychiatrists, nurses, psychologists, social workers, peer advocates, substance abuse counselors and occupational therapists. These team members deliver services that are chosen by the recipient. Goals are set and adjustments made as those goals change. With one clinician for every ten recipients, services are offered for as long as they are needed 24-hours a day, seven days a week.

While I had suffered from mental illness since I was 12, in my late twenties my malady worsened significantly. I entered ACT at age 27, after several hospitalizations had done little to treat psychosis. Rather than putting me back in a hospital or expecting me to make distant appointments, my ACT team brought treatment and support into the shoddy apartments where I lived during those years. They delivered medication to my home so I never missed a dose. When I had to go in for any care, one of my supports picked me up and brought me in. There was a very real sense that we were collaborating on a project of vital importance: building a sound structure for the rest of my life. After a year or so the hallucinations faded into the background and became manageable on a day to day basis. A few more years into care and my head began to clear of delusions. I found myself existing in a reality like that of my treatment team.

Much of the cost for all this was picked up by Medicaid. My living expenses were paid by Social Security Disability. As we enter into a new world where cuts may gut these vital programs, I find myself overwhelmed with a tide of sadness. I am not angry that an extinction level event could soon sweep across the millions in our nation who are utterly helpless. Instead, I want to weep for the friends I knew and the friends who treated those friends. I can see the bodies of suicides floating in rivers and frozen corpses on sidewalks of the newly homeless.

A few years into ACT, an older social worker on my team who had been with the ACT program for decades told me that he had never seen someone in ACT and on Social Security get out of the program and off government assistance and reenter society as a fully functional and tax paying adult. Through self discipline, rigorous participation in therapies of all kinds and some luck, I have done exactly over the course of the ten years since I entered ACT. But that I could do as much is no longer a point of personal pride. Instead I think of all those who I knew, good people in ACT who cannot help themselves, and by admission of their caregivers, will never be able to help themselves. How can we as a society take away Medicaid, perhaps take away ACT altogether and let these people die in the streets or fester unjustly in prisons?

I know the names and faces. They are not line items on a budget. What is coming if mental health care is gutted may well be the extermination by neglect of humans who will never care for themselves. All that seems left is to pray to a God who may be just a delusion that my vision of the incidental euthanasia remains a haunting hallucination rather than actual American carnage.