Anybody who’s been an administrator in a community mental health system in America in the past three decades knows the drill. During bust times, state governments actually come close to doing a good job with members of society who are at their most vulnerable. Services are — while never fully-funded — well-funded, and for the most part, there’s enough staff to cover the huge need in communities for mental health care for the poor.
But when budgets tighten, the first place governors look to cut are social services. High on the list of social services to be cut are mental health services, because they are often people intensive. Nevermind that most of those people are poorly trained “aides” or others who often have little direct education or experience with people with mental illness.
Governors and state legislatures do this because they know few people complain when government has to cut services to the poor. Sure, a few advocates and agencies may get up in arms about the cuts, but they quickly get drowned out by the fact that nobody wants their taxes to go up and cuts have to be made somewhere.
So as Massachusetts considers more cuts to mental health services, the New York Times yesterday took a look at a tragic case that occurred earlier this year, when someone who was suffering from schizophrenia allegedly brutally beat and murdered his group home counselor and aide, Stephanie Moulton.
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 19 May 2013
|
The system worked as designed – and somebody died.
This is, of course, not a new problem. De-institutionalization took hold in the 80′s as a response to civil rights concerns. Advocates for disability rights pushed for integration and full participation in society, something they believed could not be achieved in institutions. All in all, a worthy and noble goal. Sadly, over the course of the last 25 years or so, de-institutionalization became mainly about money. Resources that were to be shifted to community treatment never got there. Political trends resulted in a dismantling of government provided services and an emphasis on private, so called non-profit agencies. These agencies have a lower staff to patient ratio and thus more patients for fewer workers, pay employees significantly less with minimal benefits, and often have high turnover of younger, generally less well educated staff who get some experience and move on to the few remaining government jobs or get out of the field altogether. The irony is that de-institutionalization has really served no one particularly well. Many former psychiatric inpatients found themselves inmates, as the Corrections systems took over from the mental health system when these individuals were unable to successfully navigate in the community and wound up in trouble with the law. Communities saw increases in homeless populations and, often, crime. Families experienced increased stress in desperately trying to find services for their mentally ill relatives. Taxpayers failed to see a reduction in taxes as resources were shifted to much more expensive correctional services. (In New York, this was a highly visible process as former psychiatric and developmental centers were converted directly into prisons.) In this context, violence is not only unsurprising, it is predictable. Stephanie Moulton is not the first nor will she be the last victim. In February, 2008, Dr. Kathryn Faughey (http://raybepko.blogspot.com/2008/03/casualties-of-failed-system.html) was murdered in her New York City office by David Tarloff, a psychotic patient who couldn’t find his intended target and killed her instead. Two days later and a thousand miles away, Steven Kazmierczak walked into a college classroom and opened fire, killing Daniel Parmeter, Catalina Garcia, Ryanne Mace, Julianna Gehant, and Gale Dubowski before killing himself. What did the killers have in common? Both had long histories of mental illness, revolving door hospitalizations, and repeated refusal of medication.
The system worked as designed – and somebody died.
Great piece, Dr Grohol, and yet I’ll wager little will be said per the thread. Maybe it is because what else can be added to a process that is more and more devoid of responsible and consistent attention to a population that does affect society repeatedly and outwardly, the Giffords shooting as a prime example. You are right about the political reaction/response to cutting mental health care monies. The population affected does not vote as a sizeable block, so there really is little consequence for politicians to go after this segment of the population.
Yeah, until they mistakenly and unfortunately start shooting politicians! You would think the incident in January might wake some people up in DC. But, bigger things took over their attention after the shooting.
Let us hope history does not repeat itself painfully.
Speaking as a person that suffers from depression and anxiety. Either they want to drug you till you cannot even hold your head up, or institutionalize you, which doesn’t do anything for you much either. I take my meds, I get sleep, I do everything I have been taught to do. What we need is the authorities to actually listen to us when we tell them that we are being harassed. No one wants to hear it, they always try to say it is our fault. No there are people that, once they know you have a sickness, that will harass, and bully you, if they cannot make you do something that you know that you either are not able to do, or know that it is not good for you to do. We need compassionate, understanding people to work with us, did you hear that, Work With Us, not against us. Maybe in their training they need to be taught that what we need is compassion, and actual caring, rather than scorn, and bullying by the very people that are supposed to help us. Also why is it that no one believes what we say, just because we are sick, doesn’t mean we cannot reason, and see life clearly, most of us see much more clearly, for the simple reason that we have suffered, and therefore look at things differently than someone that hasn’t. We see reality so much more than most people, I really believe this. I have been through so much in my life that it has changed, and molded me, to see life as a very precious, and special thing that God has given us, and to try to protect it, but, what I see is most people take life for granted, and therefore when dealing with people like me, just assume we aren’t important in the scheme of life. So they treat us accordingly.
Vicki I have enjoyed reading your comments. I have suffered from depression for over 39 years. A lot has change but not to the point that we are heard. They only listen when it come to their jobs being threaten. I have been an advocate for the last 25 years and sad to say the only way some of us are heard it to speak out to each other. I just finished advocating for someone that was indeed bullied, she fought back through the Ohio Civil Rights, and we won. Never stop speaking out it will pay off. God bless you and keep your spirits up.
I thought the NYTimes gave outstanding coverage to possible factors that may have led to Stephanie Moulton’s tragic death. Unfortunately, the headline delivered a devastating blow to public understanding of schizophrenia and misrepresented its weak link to violence. In the Moulton case, the assailant’s reported violent criminal history, escalating paranoia, and possible drug use were crucial red flags. The Times stigmatizing headline “A Schizophrenic, a Slain Worker, Troubling Questions” reinforced a popular trend that turns schizophrenia into a catchall explanation for violence. It also dehumanizes the mentally ill murderer.
Dear Sir
I will tell you a little about my self before I ask a cuple of questions.
I’m Jean Atkinson I’m a carer for my husband who have many Metal heal problems who works volenty for many metal health groups in lancshire uk
the groups are called Together, Making Spaces Spice Net very soon I’m going to working along called link.
I will keep it to the point why I’m E-mailing you is that there are a lot off cuts that they are planing to do over here and that at present we are fighting to keep service going poeple with metal health problems. What I lookinmng for is ideas and how dose things run over there like how are podjets funded
1. Do you have such things as day centres for gruops that have metal health problem and if so how are there funded are they funded by the state or other.
2. Do you have support groups for carer and is there funding for such things like carers breaks to give carers a break and do you have rest bite for service uesers and once again if so how is that funded.
3.Do you have working groups that help poeple with metal health problems find work again how dose that work and how is that funded by the state over there.
4.Do you have social housing podjets over there again for poeple with metal health problems how are they run and how are they payed for.
5.Do you have any names of any Metal health organation in New York that deal with metal health and if so called you send me details of them and could you give me a little info about them
6 Is there state funding for poeple with metal health problems who are on some trpe of benefits some trpe of health care
The most inportant qusetion of the lot is are you guys over there facing the same problems over there that we are facing over here with the powers at be wanting to make cuts to metal health services and what are you guys doing about it.
And if so
My idea is to make links all over the world get all our heads togther find out what works with you guys how you have all made saving about trying to find other ways of funding podjets so we all can keep metal health sevices running.
What is another of my ideas is to set up a podjet that groups deal with metal health problems together do some brain stoming and see if we can work throght some off the problems that we all facing today
I’m really hoping that you can help me with this and I’m sorry about about the spelling I know I cant spell to safe my life however I hope you understand all I’m doing is my best to try and help
thank you how ever once again for reading this and your time
I look for wood to my reply
Jean Atkinson
Being in recovery from the harm done to me by the so-called mental health system and their over-reliance on Big PHARMA, especially since I am on the autism spectrum, and having the co-morbid conditions that are common on the spectrum, my own personal opinion is that 1) Generally, the public does not care what happens to the most vulnerable part of the population (whatever happened to the Hippocratic oath, especially with the words try to help, or at least do no harm) and 2) Benjamin Disraeli was right when he said “Those who do not study history are doomed to repeat it.”.
While I do understand that doctors don’t know everything (that is why libraries are important to the public in general), and doctors do deserve their wages for services rendered, most mental disorders such as schizophrenia, depression and bipolar disorder, which used to be quite rare, for many patients can be resolved with psychotherapy.
For me, at least, my issues are pretty much developmental, as well as environmental. I grew up in an era and in a household where spare the rod and spoil the child, as well as might makes right were the norm. I, and rest of my brothers were raised to not request help from anyone. I do not fault my parents, both of them are now deceased, for this attitude, as they were raised that way, and they were both from broken and dysfunctional homes, where physical, mental, verbal and psychological abuse were common.
As a Christian, and a child of God, I realize that I am not perfect, however,modern society, in general, demands perfection. However, if I had earlier psychological intervention and the proper coping skills, I would still be a productive member of society, rather than someone who is now so brain-damaged from psychotropic drugs I may never be “normal.” I take the full blame for not knowing what these drugs could do. I. Am not a doctor, so this is my opinion and my opinion only.