Homelessness and Mental Illness in the USA
A record number of Americans lives on the street, approximately a quarter in schizophrenia, bipolar disorder or other serious mental illnesses. The overwhelming majority represent no public danger, and research only combines 3% to 5% of the acts of violence with serious mental illnesses. However, President Donald Trump hires homeless with mental illnesses as a threat to public security. The solution, he says, is to commit more people in psychiatric hospitals and treatment programs against their will.
Involuntary Commitment
Trump published an executive order in July and encouraged the states to expand involuntary laws of commitment – a legal process that forces people who are considered a danger to themselves or others to provide inpatient psychiatric care. "Switching homeless to long-term institutional environments will restore public order," said Trump’s command. He too said in August he would support the government, which would reopen the “blatant institution” for people with serious mental illnesses.
Shortage of Psychiatric Hospital Beds
However, psychiatric hospital beds, treatment slots, and psychiatric employees have been in short supply for years. And Trump’s cuts this year against Medicaid, housing support, and psychological health programs will make it more difficult to add psychiatric beds and undermine his goal to increase the involuntary commitment. "The big problem is that the mental health system we have is very inadequate. It is underfunded and overloaded," said Jeffrey Swanson, professor of psychiatric and behavioral sciences at Duke University.
Assisted Outpatient Treatment
Trump’s command is not just about taking people to the hospital. He also wants states to expand assisted outpatient treatment (AOT)-a judicial program for people who are unable to live safely without being supervised by a judge. AOT programs offer therapy, medication, and other intensive services for people outside of a hospital. The expansion of AOT alone is not a silver ball, said Swanson. AOT effectiveness depends on the mating with affordable apartments, services, and other support, he said.
Criticism of Trump’s Policies
However, the Trump government has not promised a new federal money for AOT programs, psychiatric hospital beds, or other treatment. "Administration wants to force people to treat who may not exist. It is a bridge to nowhere," said Swanson. The forced hospital stay can be a critical instrument if someone is dangerous for themselves or others and is not willing to deal with treatments, say many legal, lawyers, and medical specialists.
History of Deinstitutionalization
Since the 1950s, America has worked to close psychiatric institutions. In 1955 there was more than 550,000 psychiatric and district districts. Today there is an estimated 36,000 psychiatric beds in state hospitals. Deinstitutionalization was driven by many forces, including the reports of the survivors of electric shock therapy and other abuse in state mental hospitals. It was also stimulated by the introduction of the antipsychotic chlorine promazine in the 1950s, the law on mental health of 1963 to finance a system of local centers for mental health care; changes in Medicaid; and groundbreaking court decisions and state civil rights laws.
Current State of Mental Health Care
Less than half of the community centers of the community proposed by the 1963 mental health were ever built. President Ronald Reagan in 1981 reduced federal financing for mental health programs by 25%. Homelessness growth in cities at the end of the 1970s, the states of budgets shift to mental health care to federal programs such as Medicaid. Today, people in the psychosis grips in emergency rooms are sometimes “discussed” and released on the street in days. But more often people with serious mental illnesses end up in prisons and prisons who have become the largest psychiatric institutions in the country.
Need for Comprehensive Investments
It is urgently needed, said Dominic Sisti, a professor of medical ethics at the University of Pennsylvania, comprehensive investments in mental health – first programs for apartments, financing for the development of a mental workforce, and an easily accessible and coordinated system of voluntary treatment that prevents itself from deteriorating on the streets. "It is very difficult for people to gain access to adequate mental health care," he said. "Our system has collapsed so completely because we refuse to invest in the care of people who are most vulnerable."
