Monday, September 21, 2009

The mentally ill on the street

The following long blockquote is from Oliver Sachs's piece, published in the New York Review of Books, September 24 issue, titled "The Lost Virtue of the Asylum" [emphases mine]:
The movement for deinstitutionalization, starting as a trickle in the 1960s, became a flood by the 1980s, even though it was clear by then that it was creating as many problems as it solved. The enormous homeless population, the "sidewalk psychotics" in every major city, were stark evidence that no city had an adequate network of psychiatric clinics and halfway houses, or the infrastructure to deal with the hundreds of thousands of patients who had been turned away from the remaining state hospitals.

The anti-psychotic medications that had ushered in this wave of deinstitutionalization often turned out to be much less miraculous than originally hoped. They might lessen the "positive" symptoms of mental illness – the hallucinations and delusions of schizophrenia. But they did little for "negative" symptoms – the apathy and passivity, the lack of motivation and ability to relate to others – that were often more disabling than the positive symptoms. Indeed (at least in the manner they were originally used), the anti-psychotic drugs tended to lower energy and vitality and produce an apathy of their own. Sometimes there were intolerable side effects, movement disorders, like parkinsonism or tardive dyskinesia, which could persist for years after the medication had been stopped. And sometimes patients were unwilling to give up their psychoses, psychoses that gave meaning to their worlds and situated them at the center of these worlds. So it was common for patients to stop taking the anti-psychotic medicine they had been prescribed.

Thus many patients who were given anti-psychotic drugs and discharged had to be readmitted weeks or months later. I saw scores of such patients, many of whom said to me, in effect, "Bronx State is no picnic, but it is infinitely better than starving, freezing on the streets, or being knifed on the Bowery." the hospital, if nothing else, offered protection and safety – offered in a word, asylum.

By 1990 it was very clear that the system had overreacted, that the wholesale closings of state hospitals had proceeded far too rapidly, without any adequate alternatives in place. it was not wholesale closure that the state hospitals needed, but fixing: dealing with the overcrowding, the understaffing, the negligences and brutalities. For the chemical approach, while necessary, was not enough. We forgot the benign aspects of asylums, or perhaps we felt we could no longer afford to pay for them: the spaciousness and sense of community, the place for work and play, and for the gradual learning of social and vocational skills – a safe haven that state hospitals were well-equipped to provide.
In posting this, I'm not meaning to suggest we should go back to the way things were in the early 80s, when people were all-too-easily put in mental institutions, but we do need to correct today's situation where seriously mentally ill people are abandoned to the streets and left to try to subsist without any support at all.

One of the first programs, and probably THE VERY FIRST PROGRAM lost in Homeless World Sacramento when, in 2008, there was a flicker that the economy was going to tank was the VOA Outreach program to first identify seriously congnitively impaired people who were abandoned to the streets.

A significant percentage of homeless people are lost and alone, disoriented and abandoned, and they have no allies working to protect or rescue them. Woe the primary so-called homeless-advocacy agenciesLoaves & Fishes and VOA. They do not "step up" to address what should be the primary tasks of their mission. Loaves & Fishes does not have properly trained personnel in its Friendship Park. VOA, as I wrote, lopped off the most important program it had at the first whiff of economic hard times.

A related SacHo blogpost I hope you'll read, "The first-person dimension of homeless Sacramentans suffering from Schizophrenia."

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