For nearly as long as I’ve been writing this blog, which began in 2006, I’ve been talking about the need to institutionalize the addicted and the mentally ill, many are both. Mostly I’ve been a voice in the wilderness, not striking a lot of responsive chords in the wider public.
I am greatly heartened to read an article in today’s Politico which notes the tide is beginning to turn. Others are seeing that community treatment, supposedly the better alternative to in-patient care, doesn’t work for a variety of reasons. Begin with the fact many experiencing mental illness or addiction do not want treatment and, given the choice, will avoid it.
Our major alternative for treatment-resistant individuals has been imprisonment when their erratic behavior becomes more than a mere nuisance for society. I conclude societies’ tolerance for large numbers living rough on the mean streets and self-medicating with feel-good street drugs may be wearing thin.
Most mental illness we cannot "cure," that is, make it go away permanently. We can treat/suppress symptoms and help sufferers cope better with the distress they are feeling.
Support groups (AA, etc.) can help the addicted resist the pull of the substance they abuse. They wisely teach "You'll always be an addict, the only key to a decent life is abstinence."
Can we medicate many broken individuals such that they behave near-normally? Yes, certainly. Do those so medicated like the way they then feel? Do they prefer it to the high of street drugs? Often the answer is a clear no.
Perhaps one answer is inpatient warehousing with a clear choice, treatment or all the drugs you want but no Narcan. Translation, treatment or slow-motion suicide with the drugs of your choice.
Both, however, done somewhere other than the public street or square. We've proven that leaving these sad folks free-range is not an acceptable answer. This quote spoke volumes to me.
A person diagnosed with mental illness and substance use disorder needs inpatient care for doctors to stabilize them, argued Sen. Bill Cassidy (R-La.), a gastroenterologist and top member of the two committees with power over the policy.“The people who were so opposed to this because they still want to do it in an outpatient [facility], you wonder if they’ve ever actually lived with somebody who is seriously psychotic,” Cassidy said.
The Politico article is wrongly titled "Mental hospitals warehoused the sick. Congress wants to let them try again." Most of the mentally ill are not "sick" in the sense that they can be healed, with today's medical technology.
In many cases the appropriate, if politically incorrect, term would be "defective." Their brain is "miswired," probably since birth or traumatic brain injury.
Sadly we have no current ability to put it right. And candidly, very little prospect of doing so within the lifetime of anyone now drawing breath.
