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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 todays 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 nations courtrooms over individual civil rights also have helped to further jeopardize Americas 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, todays 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
Beginning in 1955 with the widespread introduction of the first, effective antipsychotic medication chlorpromazine, or Thorazine, the stage was set for moving patients out of hospital settings. The pace of deinstitutionalization accelerated significantly following the enactment of Medicaid and Medicare a decade later. While in state hospitals, patients were the fiscal responsibility of the states, but by discharging them, the states effectively shifted the majority of that responsibility to the federal government.
In 1965, the federal government specifically excluded Medicaid payments for patients in state psychiatric hospitals and other "institutions for the treatment of mental diseases," or IMDs, to accomplish two goals: 1) to foster deinstitutionalization; and 2) to shift the costs back to the states which were viewed by the federal government as traditionally responsible for such care. States proceeded to transfer massive numbers of patients from state hospitals to nursing homes and the community where Medicaid reimbursement was available. (Note: IMDs were defined by the federal government as "institutions or residences in which more than 16 individuals reside, at least half of who have a primary psychiatric diagnosis.")
Because of incentives created by federal programs, hundreds of thousands of patients who technically have been deinstitutionalized have in reality been transinstitutionalized to nursing homes and other similar institutions where federal funds pay most of the costs. These alternative institutions, however, lack the full range of services needed to adequately care for persons with severe brain disorders.
At any given time there are more individuals with schizophrenia who are homeless and living on the streets or incarcerated in jails and prisons than there are in hospitals:
Violence Real Issue for Untreated Severe Brain Disorders (*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.)
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:
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