The article in the New York Times December 11, 2022 "A Doctor Has New York's Ear.On Mentally Ill" is the topic for this disquisition. Psychiatrist E. Fuller Torrey advocated mandatory mental health treatment for many years. In fact, he's been instrumental with the enactment of treatment laws in many states for the mentally ill. States have enacted mandatory treatment or Kendra's law based on the belief that mental illness and crime are one of the same. However, epidemiological research found about 4% of violent acts can be directly attributed to mental illness while many of them are low-level assaults such as in pushing, shoving and slapping people. Recently, Mayor Eric Adams of New York instituted a policy that sends people with untreated mental illness. to hospitals even if they posed no threat to others. Unfortunately, the article did not define mentally ill, treatment provided, particulars on how individuals would be selected with what criteria, by whom and carted away in what type of vehicles. If individuals did not want to cooperate, are they now criminals? Further, is there a plan to evaluate this policy ?
California, with Short-Doyle legislation, began closing state mental health hospitals In the 1970s. Funds were transferred to mental health treatment centers in county locations. These mental health facilities provided outpatient mental health services for the general population, and for the hospital patients that were being released into the community. The outpatient treatment was provided by psychiatrists, psychologists, MSW's, MFCC’s and licensed mental health workers . The psychiatrists prescribed psychotropic medication .The treatment program also incorporated individual and group therapy along with other structured experiences. Psychotropic medication was significant, and a major and necessary part of the treatment. Group homes,in the community, were also established to provide meals, housing, and staff on a 24-hour basis for these patients .
Mental illness refers to a wide range of symptoms and conditions that affect mood, thinking and behavior. There are many examples of mental illness with diagnoses found in the DSM - 5, the diagnostic bible. However, only a limited number of diagnoses found in the DSM 5 are covered by health or medical insurance. 3rd party payers discriminate. If a diagnosis can be treated by a pill, that condition likely qualifies for a limited number of treatment sessions. The motive is profit , not mental health for the insured. Therefore, what individuals, with what mental illness diagnosis, are to receive mandatory treatment in New York ? And, what are the particulars for the hospitalizations in New York?
As a psychologist in an outpatient treatment center and in private practice, I provided individual, couples and family psychotherapy therapy with a wide range of diagnosis’ . Included, in treatment, were foster care children. I also administered psycho diagnostic evaluations at residential group homes for adolescents; locked door facilities for adults; and for incarcerated prisoners referred for competency to stand trial. Psychotropic medication played a significant and necessary role in treatment , for some,even with side effects . Unfortunately, meds do reduce or minimize symptoms , but they do not reconstruct one's character or personality.
Mental illness is a broad category ,easily misunderstood and loosely used. Do we use an insurance definition of mental illness or the DSM-5 ? Even a schizophrenic reaction can be misunderstood. For a brief example, there is not only a wealth of symptoms and various types of schizophrenia but also they are not all mutually exclusive. They are not even separate or are even separate subtypes of the disease. Schizophrenics may have difficulty and misinterpret reality, sometimes exhibit delusions and hallucinations. Mood changes occur with loss of empathy with others and actions may be withdrawn, regressive and bizarre. Further, schizophrenia can be treated with individual and group psychotherapy, drugs, group homes,and structure as previously mentioned.
Briefly, precipitating factors for schizophrenia are a loss or threatened loss of a major source of gratification as well as a loss or threatened loss of basic security. The onset is often slow and insidious. Not being able to meet ordinary life demands becomes obvious. Many schizophrenics have lived as children within a pathological family organization. It's not uncommon for a potentially psychotic parent to be able to keep reasonably clinically well, by scapegoating one of their offspring - the identified patient or crazy .
One of the primary contributing factors for a schizophrenia diagnosis are the parents. Some parents are sadistic, neglectful, or indifferent to the child who then has no chance to internalize a stable parental image. Some parents don't realize their craziness and defend what they are doing , even though it’s inappropriate, wrong and unhealthy. Some parents are severely mentally ill and have also been reared in a dysfunctional family organization .
Last year, a 17-year-old from the state of Illinois, attended a political protest in another state. This boy, armed with an automatic weapon,had his accomplice mother drive him. She did drive him and he murdered. That mother was an accomplice and should have been charged too. Also, a teen in Michigan , killed four students at his high school. This time his parents were also charged. Parents of adolescents should be held accountable for their role in contributing to their killer children.
Currently, there are over 400,000 children and adolescents in foster care. These foster care children experience high rates of mental health disorders and are at an increased risk of experiencing negative long-term health outcomes as well. Further, the number of homeless in the United States is estimated at 552,830 and approximately 16 to 33% of these people are mentally ill.There is likely a significant and positive correlation between foster care children and adult homelessness. More than likely, there is a great percentage of mental illness with foster care, and homelessness significantly related to parenting conditions. Yes, sex is a psychological need, but rearing children is not. There is no manual on child rearing or who should be a parent. Parenting is complex, difficult to say the obvious. Socioeconomic conditions, divorce,political dysfunction, social media, Covid -19 add to fear, anxiety, threats to safety, security and wellbeing .
Parenting plays a significant role in increased numbers of the mentally ill’ What can be done about it ? A few suggestions: 1. Years ago, lepers were taken to Molokai. They were pushed overboard and had to swim to shore for their survival 2. We can continue the same policies and expect the same results 3. We could limit the number of children per family and legislate who should be allowed to be parents 4. We could encourage and support abortion 5. We could establish some form of a kibbutz with collective principles that would generate very different upbringing. 6. We could build more hospitals, more locked facilities and have police round up all the crazies 7. We could place clinicians in schools to help evaluate and recommend treatment and/or options for children and their families for those in need 8. We could evaluate current foster care and / or implement a new model when taking children from their parents. 9. We could invest in mental health and make it a priority.
In reality, our capitalistic socioeconomic system is predicated on profit for a minority. Historically, that has been the policy and enactment of those in power. Altruism, on the other hand, requires concern for others and enlightened thinking. The Dalai Lama once said "our prime purpose in this life is to help others.
Reference
Cameron, Norman. Personality Development And Psychopathology . A Dynamic Approach.
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