How to correct the excesses of deinstitutionalization
Conservatives have lately wanted public policy to focus on the interests of families. This welcome development has brought important reforms to K–12 public education, among other things, but it has overlooked mental health, where families’ needs are profound. In that policy area, decades ago, families took on a central role as government scaled back asylum-based care for adults with serious mental illnesses such as schizophrenia and bipolar disorder. “Community integration” is now the goal of the American mental-health-care establishment. Providers want mentally ill adults to live, as much as possible, the same way other people do — to have a normal life. To reach that goal, someone, or some entity, has to help integrate them into communities, and that task more often than not falls to families. A seriously mentally ill adult without much family support will have a tougher time living anything like a normal life than one who does have such help.
Families bear great burdens under the community-integration regime. That severely troubled man you sometimes pass during your morning commute: Imagine being responsible for him. Imagine having to argue with him day in and day out over taking his meds, about why his attendance at that reputable day program has been dwindling, and whether the CIA is spying on him. The mentally ill have trouble holding down a job and performing basic tasks such as grocery shopping. They have difficulty interpreting social cues, so they may not grasp, for instance, that a person is kidding. Their personal hygiene can leave much to be desired. They can be convinced that celebrities or long-dead historical figures are their personal confidants and that total strangers are passionately in love with them. Though the failings of American mental-health care are often attributed to “stigma” about mental illness, a deficit of shame can be just as great a problem. Were mentally ill people more responsive to what other people thought of them, their lives and those of their family members might run more smoothly.
Continue reading the entire piece here at National Review
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Stephen Eide is a senior fellow at the Manhattan Institute.
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