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Fact Sheet


HOMELESSNESS, INCARCERATION, EPISODES OF VIOLENCE:
WAY OF LIFE FOR ALMOST HALF OF AMERICANS WITH UNTREATED SEVERE MENTAL ILLNESS

National Disgrace:
Millions of Americans with Serious Brain Disorders Go Untreated

An estimated 4.5 million Americans today suffer from the severest forms of brain disorders, schizophrenia and manic-depressive illness (2.2 million people suffer from schizophrenia and 2.3 million suffer from bipolar disorder). According to the National Advisory Mental Health Council, an estimated 40 percent of these individuals, or 1.8 million people, are not receiving treatment on any given day, resulting in homelessness, incarceration, and violence. The reasons for this are many, including economic factors, the failure of deinstitutionalization, civil liberty issues as well as the effects of the illnesses themselves.

Economic factors and the failure of deinstitutionalization are the two leading causes of today’s crisis situation. A greedy game of musical chairs, or cost shifting by state and local governments to the federal government, especially to Medicaid, has played a pivotal role. As a result, individuals with serious brain disorders have been dumped out of psychiatric hospitals and shoved into nursing homes and general hospitals (many of which offer worse care than the psychiatric hospitals from which they were discharged), and forced onto the streets and into jails.

Since its beginnings in 1955, deinstitutionalization has been more about political correctness than scientific knowledge. When deinstitutionalization began there had been no scientifically sound studies conducted on how to best reintroduce individuals with the severest brain diseases back in to the community. In addition, there have been very few services available to these individuals when they are released into the community.

Battles in the nation’s courtrooms over individual civil rights also have helped to further jeopardize America’s most vulnerable citizens. Civil liberty advocates have changed state laws to such an extent that it is now virtually impossible to assist in the treatment of psychotic individuals unless they first pose extreme and imminent danger to themselves or society.

Adding to this crisis are the illnesses themselves. Schizophrenia and manic-depressive illness greatly impair self-awareness for many people so they do not realize they are sick and in need of treatment. Unfortunately, today’s state mental health systems and treatment laws – that oversee the care and treatment these individuals receive – play right into the vulnerability of these devastating diseases with the effect that far too many people remain imprisoned by their illness.

 

Federal Dollars Fuel Disjointed, Uncoordinated Care

Prior to the 1960s, when federal funds for psychiatric care became available, the public psychiatric care system was almost completely run by the states, often in partnership with local counties or cities. Since then, the public psychiatric care system has become a hodgepodge of categorical programs funded by myriad federal, state, and local sources. The primary question that drives the system is not "what does the patient need?" but rather "what will federal programs pay for?"

 

Violence Real Issue for Untreated Severe Brain Disorders

Violent episodes by individuals with untreated schizophrenia and manic-depressive illness have risen dramatically, now accounting for at least 1,000 homicides out of 20,000 total murders committed annually in the United States. According to a 1994 Department of Justice, Bureau of Justice Statistics Special Report, "Murder in Families," 4.3 percent of homicide committed in 1988 were by people with a history of untreated mental illness (study based on 20,860 murders nationwide.) An NIMH report indicated that severe and persistent mental illness is a factor in 9%-15% of violent acts. Recent studies have confirmed that the association between violence and untreated brain disorders continues to be widespread:

  • A 1990 study of families with a seriously ill family member reported that 11 percent of the ill individuals had physically assaulted another person in the previous year.
  • In 1992, sociologist Henry Steadman studied individuals discharged from psychiatric hospitals. He found that 27 percent of released patients reported at least one violent act within four months of discharge.
  • Another 1992 study, by Bruce Link of Columbia University School of Public Health, reported that seriously ill individuals living in the community were three times as likely to use weapons or to "hurt someone badly" as the general population.
  • A 1998 MacArthur Foundation study found that people with serious brain disorders committed twice as many acts of violence in the period immediately prior to their hospitalization, when they were not taking medication, compared with the post-hospitalization period when most of them were receiving assisted treatment. (The study showed a 50 percent reduction in rate of violence among those treated for their illness. Roughly 15.8 percent of individuals with a severe brain disorder committed an act of violence prior to hospitalized treatment, compared with only 7.9 percent of these same individuals post-treatment.)
  • There are three primary predictors of violence, including:
    • History of past violence, whether or not a person has a serious brain disorder;
    • Drug and alcohol abuse, whether or not a person has a serious brain disorder; and
    • Serious brain disorder combined with a failure to take medication.*
  • Other indicators of potential violence include:
    • Neurological impairment;
    • Type of delusions (i.e., paranoid delusions – feeling that others are out to harm the individual and a feeling that their mind is dominated by forces beyond their control or that thoughts are being put in their head); and
    • Type of hallucinations (i.e., command hallucinations).

 

(*Note: While failure to take medication is one of the top three predictors of violence, civil rights lawyers have continuously expanded the rights of those with a lack of insight into their illness to refuse to take medication. Past history of violence is another major predictor of violent behavior, yet in many states these same civil rights attorneys have restricted testimony regarding past episodes of violence in determining the present need for hospitalization and assisted treatment.)

 


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