In the 1970’s my father was a pharmacist at the Gowanda Psychiatric Center south of Buffalo. During his time there the great de-institutionalization of the mentally ill took place. The emphasis was on returning the mentally ill to the community rather than warehousing them in institutions. What was promised was community based mental health services that would be easy to access and would provide programs and support services in the local community.
My father was torn about this plan. He approached the Assistant Director of the facility, well respected in the facility and in the state, and asked what he thought of the proposal. “Well” he mused over half of the people here could be sent out to the community tonight and with proper services would never pose a danger to themselves and to others. The others need a higher level of care than can be provided in the community. The only difficulty is that we cannot definitively tell one half from the other!” In the 30 years since some strides have been made in telling the difference between the groups. But the promise of adequate mental health services and programs in the local community has not really materialized. Cuts to these types of programs have been the norm. And access to services have diminished over the years.
Mental heath services are the poor step-children of the health care system. The coverage for mental health services in most insurance contracts is sparse and services limited in order to provide other more “popular” features. A good friend with PTSD did not have insurance coverage with a fairly good employer based plan to provide the weekly counseling that was necessary and the family struggled to pay these costs even on a sliding fee scale.
The result is the tragedy we saw played out last week in Arizona, and previously in other American communities, as mentally ill people were not given the treatment that in hindsight we can see they needed and resorted to violence to get noticed and notoriety.
While we cannot assign direct blame to this cobbled system of mental health services we should be able to realize that even in a time of budget cuts on the national and state levels it serves no one to reduces mental health services and programs. The result of such cuts is lives lost in depression, delusion, fear and isolation of many caught in the grips of mental illness, and occasionally high profile tragedy visited on a few in our communities.