By Curtis C. Mooney
You do not have to be a danger to yourself or someone else to be treated for cancer or a heart attack. Why must a person in the agony of a mental breakdown, whose illness prevents him from recognizing the condition, be required to be a danger to himself or someone else before receiving appropriate treatment?
We once had state hospitals to provide acute and long-term treatment for the mentally ill. In Texas today, there are less than 3,000 psychiatric state hospital beds for a population of 30,000,000. Over half of those beds are set aside for persons who have committed a crime and must be restored to sanity before they can stand trial. Dallas County is suing the state because of the inordinate amount of time 300 mentally ill persons who have committed a crime have been waiting in jail for a bed in the state hospital.
Today only a few days in a community hospital's psychiatric ward to stabilize and change medications is available for the thousands of other mentally ill persons needing help. That brief hospitalization is available to those who voluntarily agree to go to the hospital. However, suppose their mental illness causes the individual to resist hospitalization. In that case, they can only be admitted to a hospital if they are an immediate threat to themselves or someone else based on their behavior or statements witnessed by the evaluator or first responder. Unless a court has ordered placement, which is rare, these individuals can not be hospitalized against their will. If they are persuaded to go to the hospital, they can petition to sign themselves out, and within three to five business days, the hospital must release them. New medications typically take weeks to reach full effect, so the person is back home, and the family must cope with all behaviors that are not life-threatening to themselves or someone else.
Depending upon the illness, coping by the family can be a tremendous burden. I have a friend with bipolar disorder who, when manic, becomes the opposite of the person he is in real life. He becomes obsessed with an idea and directs all his energy toward achieving it despite the consequences for himself or the family. My friend's wife is now trying to obtain guardianship to facilitate better treatment and guard against the financial ramifications his illness causes. It is not an easy task, but she spends her days dealing with the next crisis he has set in motion. My friend has been hospitalized five times in the last three years, and chances are he may eventually need care beyond what his family can provide. Their resources are limited; any assisted, nursing, or memory care will wipe out their savings before Medicaid picks up the cost. Many families will face these exact circumstances as they seek to cope with dementia or other illnesses requiring significant care.
Texas has built a new state hospital in Houston, and a new one is also in the works for DFW. The problem is that the state is so far behind it will take years to catch up. There is also a shortage of psychiatrists and related professionals. The state found this a significant problem when it completed a new facility in south Texas but could not find enough staff to open it. More federal funding by expanding Medicaid in the state would provide resources to increase mental health services. In addition, recognizing that mental illness treatment should be on par with physical illness would go a long way toward delivering appropriate care.
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