THE INSANITY STEERING OUR MENTAL HEALTH SYSTEM

John Giordano, Doctor of Humane Letters, MAC, CAP

In 1963 President Kennedy sent Congress the first ever Presidential special message on mental health issues. In his missive, Kennedy pointed out that “mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more financial drain upon both the public treasury and the personal finances of the individual families than any other single condition.’

Based firmly in his experiences with his little sister Rosie who had a developmental disability, Kennedy believed mental illness was best treated close to home. He felt it was a disservice for both the patient and the family to separate the two. It was his vision to have local clinics in every city where people could be treated as an outpatient in the communities that they lived and worked as an alternative to institutionalization that was in place.

Congress quickly approved Kennedy’s Community Mental Health Act of 1963 (CMHA), a measure that provided federal grants to states for local community based mental health clinics.

Although well intended, CMHA was flawed and certainly did not have the desired effect Kennedy envisioned. At best, the CMHA is considered to be a mixed success.

About half of the proposed clinics were ever opened. The federal grants provided funds for building of local centers, but not the operating capital the centers needed to keep their doors open.

Many fiscal conservatives in states with large investments in mental institutions viewed CMHA as a way to cut costs. These states closed the doors to their most expensive hospitals and released patients en masse back to their community for local care without spending money on the community-based initiative. Other states quickly followed suit. Billions of mental health care dollars simply evaporated.

Patients did not do well as a result. What the fiscal conservatives missed in their calculations leading to releasing thousands upon thousands of schizophrenics and others with psychotic disorders back into their communities was the impact they’d have on society. The lucky ones ended up untreated with their families and in adult homes. The less fortunate were victimized and murdered while others went homeless begging on the streets for money without the medicine and supervision they so desperately needed. Many were – and continued to be – arrested and even killed by police for psychotic behavior viewed as criminal. Courts – that are inherently inadequately prepared to determine the sanity of a defendant – have had no options other than jail for the mentally ill.

The unacceptable results were seen immediately; but did little to slow deinstitutionalization. In fact, it had an opposite effect. With the passage of Medicaid in 1965, deinstitutionalization accelerated. At its peak in 1955 and with a total US population of 165,900,000 million people, there were 558,239 public (state and county) psychiatric beds. Today there are 37,679 beds for a population of nearly double that of 1955- 324,000,000 million Americans. But even this number is erroneous. The vast majority of the psychiatric beds today are reserved for long-term care (most are court-ordered) and not available for the admission of acutely psychotic patients.

93% of the psychiatric beds available for mentally ill Americans have vanished over the last sixty-years while the number of people with severe mental illness and the need for beds has been on the rise.

One could easily argue that deinstitutionalization never really occurred; but instead a shift in how America warehouses their mentally ill. There is a direct correlation between the closing of mental institutions across the country and the rise in prison populations. Places like Rikers Island in New York and the LA county Jail have evolved into the largest institutions for mentally ill people in the U.S. According to the Washington Post, “American prisons and jails housed an estimated 356,268 inmates with severe mental illness in 2012—on par with the population of Trenton, New Jersey.”

“10 times the number of severely mentally ill patients in the U.S. are warehoused in jails and prisons rather than under a doctor’s care in psychiatric hospitals!”

The situation is so severe in Chicago that the sheriff appointed a clinical psychologist to be head of Chicago’s Cook County Jail, the nation’s second-largest jail where a third of the inmates are mentally ill. Nneka Jones Tapia is the first and only mental health professional to be appointed to head a large jail.

John Snook, Executive Director of Treatment Advocacy Center (TAC), a nonprofit working to improve treatment for severe mental illness says; “the loss of those beds has left ‘the sickest of the sick’ without treatment.” 15 experts on psychiatric care in the United States were surveyed by ATC and nearly all agreed that 50 public psychiatric beds per 100,000 population were necessary for the hospitalization of individuals with serious psychiatric disorders. Currently there are approximately 12 beds per 100,000 or only 24% of the needed psychiatric beds.

In 2014 there were an estimated 9.8 million adults aged 18 or older in the United States with Serious Mental Illness (SMI) or 4.2% of all U.S. adults. Source: National Institute of Mental Health (NIMH)

According to Psychology Today Magazine, the major psychiatric illnesses are strongly influenced by genetic components; which means they are unlikely to change much in frequency over the years. Make no mistake, the mere fact that our population is growing indicates mental illness is on the rise and the lack of psychiatric beds and trained doctors and staff tells us we’re woefully ill equipped to effectively deal with the crisis at hand.

Moreover, the longer mental health issues go ignored, the more severe they become. Mental health advocates say the failure to treat severe mental illness can result in worsening symptoms and increase the likelihood that inpatient services will be needed.

There are some that believe the advancements in pharmaceuticals offset the need for some psychiatric beds. They believe that many of yesterday’s mental ill inpatients can be effectively treated as outpatients with antipsychotic drugs. There is some merit to their beliefs in cases of less severe mental illness. But that same person also needs supervision, psychological therapy and social supports to improve- which they simply are not getting mostly because of budget shortfalls. Consequently, many less severe mental ill patients are left on antipsychotic drugs far longer than needed if they were treated properly leading to greater susceptibility to side-effects, disease and dying long before their time.

Additionally, the efficacy of antipsychotic drugs is often punctuated with a bold question mark. Highly respected author Robert Whitaker, a medical writer and Pulitzer Prize finalist, wrote in his book; ‘Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill’ that when the World Health Organization (WHO) compared schizophrenics’ recovery rates in the U.S and in nations too poor to afford the latest psychopharmaceuticals, it found that a Third World patient was exponentially likelier than an American one to regain sanity.

Whitaker also points out in his book that dosages of antipsychotic drugs in the United States are higher than necessary. After visiting several mental hospitals, I can assure you his observations are spot on.

It’s been 55 years since President Kennedy’s historic Mental Illness presentation to Congress. Are we better off today that we were back then? Today we have a system that is steered by the pharmaceutical industry that is solely interested in profits. Consequently, we
have novel new treatments that I refer to as ‘lobotomy in a bottle,’ Americans are over-prescribed, 520,560 psychiatric beds have vanished, the criminal justice system has become the de facto mental health system, more mentally ill people are being shot and killed by police than ever before for psychotic behavior interpreted as criminal, a Third World patient is more likely than an American to regain sanity and we have an estimated 9.8 million adults with severe mental illness walking up and down our streets. What could possibly go wrong?! Personally, I don’t think the former president would even recognize what we have today as being remotely close to what he’d envisioned – in fact, I believe he’d view it as completely opposite.

Enough is enough already. It’s long past time to modernize how we treat people with mental illness in this country. We can no longer depend on our research hospitals and universities for answers as they’re owned by the pharmaceutical industry whose intentions are to pump out even more toxic pills so they can make more money. Instead we must turn to the advancements being made in alternative medicine if we are to give people with mental illness the help and dignity that every human being deserves.

Technological advancements have led to an exciting new area of neuroscience that is changing the way we think about the pathology of mental illness and how to effectively treat it. In our gut are microbes that colonize and form microbiome. World renowned scientists and researchers claim microbiome is the new frontier in neuroscience.

Recent studies have given scientists a more complete understanding of the relationship between the brain in our heads and second brain in our gut which is home to our immune system. These new studies that are available confirm what we’ve suspected all along. They reveal how our environment, stress, the foods we eat and other lifestyle choices impact the health of our gut; and as a consequence, influence our mental health and behavior with far greater ramifications than previously thought.

Every day the microbiome colony in our second brain is bombarded with potentially hundreds of harmful toxins that wreak havoc on our health. Add to that the declining nutrition in our foods and you have a recipe for an unhealthy gut. Simple changes in diet and adding exercise can have a big impact on our state of mind. New studies have shown that increasing the amount of “good” bacteria in the gut can relieve symptoms of depression and anxiety, lower stress reactivity, improve memory, and even lessen neuroticism and social anxiety.

Dr. Philip Burnet, an Associate Professor of Psychiatry at the University of Oxford stated in an article for Huffington Post that: “Anything that exerts a psychological effect, mediated by the microbiome, is potentially a psychobiotic. We wanted to increase awareness of the potential involvement of gut bacteria in the modulation of brain function, because the growth and perpetuation of microbial communities in our gut are influenced by so many factors in our lives. The concept of a psychobiotic will encourage us to make life choices that could ultimately reduce the incidence of mental disorders, and/or help boost the efficacy of current medication.”

If you or a loved one is suffering from some form or mental illness, I’d strongly recommend that you reach out to a reputable integrative medicine doctor. There are a lot of cutting-edge modalities based in these new findings that a reputable integrative medicine doctor will be aware of and can help you get on a better path.

John Giordano, Doctor of Humane Letters, MAC, CAP, is the President and Founder of the National Institute For Holistic Addiction Studies, Chaplain of the North Miami Police Department and is the Second Vice President of the Greater North Miami Chamber of Commerce. He is on the editorial board of the highly respected scientific Journal of Reward Deficiency Syndrome (JRDS) and has contributed to over 65 papers published in peer-reviewed scientific and medical journals. For the latest development in cutting-edge addiction treatment check out his website: www.holisticaddictioninfo.com