For this post’s purpose, I define a severe mental illness as a chronic medical condition that affects behavior, insight and judgment.
A filthy young man, confused and raging on Market Street, collapses at an intersection and rolls into traffic.
The police arrive.
An officer drags him to the curb and asks him if he has plans to hurt himself or anyone else. The young man shakes his head no.
The officer asks if he knows his way to the local soup kitchen and homeless shelter.
The young man shakes his head, yes.
Because he affirms that he is not an immediate danger to himself or others and claims he knows where to get food and shelter, the officers have no legal basis to mandate treatment.
The police drive off, and the young man rolls back into traffic.
The police cannot stop a sick and confused young man from obstructing traffic because it would violate his rights.
In 1963, President Kennedy signed the visionary Mental Health Centers Act, which authorized funding for a community-based care system in every state and county.
“I am proposing a new approach to mental illness and to mental retardation. This approach is designed, in large measure, to use Federal resources to stimulate state, local, and private action. When carried out, reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment, and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.” President John Fitzgerald Kennedy
In 1965, Congress approved the Medicaid Act, which offered higher reimbursement rates for community-based care, later the Supplemental Security Income (SSI) program provided financial support for people with mental illness who were trying to live in the community.
Passed in 1967, the Lanterman Petris Short Act prohibits involuntary civil commitments for the mentally ill in California unless a person is an immediate danger to himself and others, or is gravely disabled, generally defined as unable to access or make use of food and shelter.
The Community Mental Health System was supposed to replace or serve as an adjunct to State Hospitals.
By 1967 most cities in the United States had an active community mental health system.
That changed in the 1980’s.
The Lanterman-Petris Short Act fails in seven of its nine intents.
It does not end the inappropriate involuntary commitment of persons with mental health disorders because inadequately staffed for-profit prisons replaced the State Hospitals.
It does not provide prompt evaluation and treatment of mental health disorders because treatment resources are underfunded or don’t exist.
It does not guarantee or protect public safety.
It does not protect persons with mental health disorders from criminal acts because homelessness increases crime risk.
It does not provide services in the least restrictive setting appropriate to the needs of each person receiving services because there are no services.
In theory, people with mental illnesses have the ‘right’ to the services and supports we need to live like people without disabilities, but we can’t access services and supports that don’t exist.
For people with serious mental illnesses, the Lanterman Petris-Short Act is an excuse to deny treatment, and the Americans with Disabilities Act is a joke.
We don’t need access ramps; we need access.
Schizophrenia and Alzheimer’s disease have a similar set of symptoms, but no one would say an Alzheimer’s patient has a human right to wander our cities in a daze.
No one would say an Alzheimer’s patient deserves to suffer.
Mental illness is not a civil rights issue.
Mental illness is not a moral failure.
Mental illness is not a result of toxic thinking.
Mental illness is not a choice.
© Rob Goldstein 2020