The Crazy Ones
Americas Mental Health Crisis
By John A. Romero
Robin Williams was found dead by apparent suicide on August 11, 2014. Williams’ struggles with depression, substance abuse, and thoughts of suicide were no secret. Williams himself had publicly admitted to thoughts of suicide and had even incorporated the dark complexities of his life into his stand-up comedy routine. Still, news of the beloved actor’s suicide rippled like a shockwave around the globe. As an Academy Award winning actor and as a comedic genius Williams had been the envy of experienced and aspiring entertainers alike.
The National Suicide Prevention Lifeline saw the greatest number of calls in its history the day after Williams’ death was announced. Program Director John Draper believes that Williams’ suicide did not necessarily create a crisis as much as it revealed a crisis. Also, virtually every entertainment and news program on television and radio paid tribute to Williams. As a result and perhaps for only a brief time, there is an increased awareness and a willingness to talk about a problem often shrouded in shame – mental illness.
Bruce Levine, author and practicing psychologist, is a man who dares to talk about what could be wrong with psychotherapy and psychiatry today. In his article entitled Why the Rise of Mental Illness? Levine adds his unique perspective to the so-called mental illness epidemic in the United States. Summarizing a book by Marcia Angell, Levine reports that severe, disabling mental illness has dramatically increased in the United States. In one decade (i.e., 1997 to 2007), the tally of adults so severely disabled by mental disorders that they qualify for government benefits increased from 1 in 184 to 1 in 76. The problem is even worse for children. Based on the criteria established by the American Psychiatric Association, 46 percent of Americans will have a diagnosable mental illness at some point during their lives.
According to the Centers for Disease Control and Prevention, antidepressants are the third-most used class of medications among all age groups and the most frequently used class of medications used by Americans ages 18 to 44. Overall the use of antidepressants has increased by 400 percent over the last two decades. During this same period, the suicide rate among Americans ages 35 to 64 increased from 13.7 suicides per 100,000 population in 1999 to 17.6 per 100,000 in 2010.
While representing a small subset of the mentally ill, the most seriously ill psychiatric patients compete for about the same number of state hospital beds per capita as were available in the 1850s. Between 2005 and 2010, the number of state psychiatric hospital beds shrank from 50,509 to 43,318. Thirteen states closed 25 percent or more of their state psychiatric hospital beds. New Mexico and Minnesota reduced their state hospital psychiatric beds by more than fifty percent.
As a result, a seriously mentally ill person is more likely to be locked up in jail than in a mental hospital. Jail may sound like a reasonable solution, but it’s not. Mentally ill people filling our jails is strong evidence of law enforcement bearing the burden for a failed mental health system. Early release is the solution of choice when jails and prisons are over capacity. Police, as they are apt to do, rise to the challenge arresting and re-arresting offenders – each time with a possibility of a violent encounter.
Deinstitutionalization of the mentally ill began in the 1960s. Legal reforms and the curtailment of federal funding gave many mentally ill persons the right to live free in the community and they were often untreated. Most manifestations of mental illness are simply not illegal. The problem is not with all mentally ill persons. The problem is with a small minority of the treated and untreated mentally ill.
The relationship that police departments have with a community can become easily strained, especially as it relates to violent encounters with the mentally ill. Mental illness that results in a deadly encounter with the police may be a tiny fraction of all mental illness; however, it is estimated that more than half of the people shot by police every year suffered from mental illness.
When the mentally ill wreak havoc at a school or university, we hold a candle light vigil and remember the victims fondly. We may even talk about access to guns and how the police could have or should have intervened sooner. When police officers resort to deadly force, especially upon a person who suffers from mental illness, the community is outraged. Sometimes the protests are warranted – police officers are not perfect. One thing is certain, however, police officers can be disciplined, fired or incarcerated – and another police officer will still be responding to the next violent mental patient radio call.
If we pretend that the problem is only about guns or only about police shootings and if we are blind to a system that is obviously broken, one must wonder – aren’t we the crazy ones?
