Journalism in the Public Interest

50 Years After the Community Mental Health Act, the Best Reporting on Mental Health Care Today

How far have we come? Journalists take a hard look at our nation’s system of caring for the mentally ill.

President John F. Kennedy signs the Community Mental Health Act into law on Oct. 31, 1963. (Bill Allen/AP Photo)

Fifty years ago last week, President John F. Kennedy signed the Community Mental Health Act. The law signaled a shift in thinking about how we care for the mentally ill: instead of confining them into institutions, the act was supposed to create community mental health centers to provide support.

But studies on the prevalence of mental illness among inmates and the homeless (PDF) show many patients are ending up on the street or in jail, instead of served by the treatment centers envisioned in the law. The homes that do exist are often subject to loose laws and regulations, leaving already fragile patients vulnerable to further abuse and neglect.

How far have we come? Here are some important reads on the state of mental health care today. Additions? Tweet them with the hashtag #MuckReads, or leave them in the comments below.

Milwaukee County mental health system traps patients in cycle of emergency care, Milwaukee Journal Sentinel, June 2013

In Wisconsin, psychiatric patients are often put through a revolving door of treatment: Experience a breakdown. Get arrested and brought to the emergency ward. Be released just a few days later. Repeat. Overall, “one of every three persons treated at the [psychiatric] emergency room returns within 90 days.”

Schizophrenic. Killer. My Cousin., Mother Jones, May 2013

When a parent is faced with an ill, potentially violent child, where can they turn? Journalist Mac McClelland details how community outreach in the 1970s and 1980s allowed her aunt to stay “independent until the very end." Thirty-four years and billions of dollars in mental health cutbacks later, her cousin’s battle with schizophrenia came to a much more tragic conclusion.

Nevada buses hundreds of mentally ill patients to cities around country, Sacramento Bee, April 2013

Psychiatric patient James Flavy Coy Brown got off a bus in Sacramento with no money, no medication, and no idea why he was there. He’d been sent to the California capital from a hospital in Las Vegas, who had regularly been discharging patients and busing them across the country. Patients are only supposed to be sent to other states when there’s a clear plan for their care. But stories like Brown’s show how many patients fall through the cracks.

‘Boarding’ mentally ill becoming epidemic in Washington state, Seattle Times, October 2013

The number of available psychiatric beds in Washington state is shrinking. When those few spots are full, the state is increasingly turning to its emergency rooms and hospitals to “warehouse” the mentally ill. Patients are forced to wait an average of three days, but sometimes up to several months, without any psychological treatment.

Breakdown: In rural Minnesota, mental health safety net is in limbo, Minneapolis Star Tribune, October 2013

Minnesota ranked last in 2010 for psychiatric beds per capita. “The safety net is pretty much gone,” said one mental health worker. And a Star investigation found that the few community mental health centers that are available are often ill-equipped to cope with severe disorders.

At homes for the mentally ill, a sweeping breakdown in care, Miami Herald, February 2013

Even if Miamians struggling with mental illness avoid arrest, the county’s homes for the mentally ill can “still feel like a jail.” The Herald’s investigation revealed a wide range of abuse and neglect, from staff who were beating and raping residents to ignoring their severe medical needs. And like other assisted living facilities, a patchwork of lax oversight and regulation has allowed even repeat offenders to remain in operation.

Dallas psych ER staff accused of violence were kept on duty, Dallas Morning News, November 2011

Instead of emergency care, psych patients admitted to Parkland Memorial Hospital reported receiving beatings at the hands of staff. The Morning News found many staff members were hired despite a history of abuse, and allowed to keep their jobs even after the alleged beatings. “It’s supposed to be a safe place,” said one patient. “I felt like I was in prison.”

Walter Reed and Beyond: A Soldier’s Officer, Washington Post, December 2007

Anne Hull and Dana Priest spotlighted systemic mistreatment and neglect at Walter Reed Army Medical Center, and several other veterans health facilities across the country. Vets seeking psychological care faced dizzying bureaucracy and an under-resourced system buckling under high demand. Though Walter Reed was home to the army’s largest psychiatric department, there was no specific PTSD center, and patients rarely received individual attention. For more the treatment of US vets battling the traumas of war, see these key reads on PTSD.

The New Asylums, Frontline, May 2005

Frontline documents the movement of America’s mentally ill away from closing psychiatric hospitals, and into the nation’s jails and prisons. The result is a massive strain on the minds of afflicted inmates, and on the strapped prison system tasked with treating them. Check out our MuckReads roundup for more important coverage of mental illness behind bars.

Broken Homes, New York Times, April 2002

Adult homes for the severely mentally ill were meant to be an improvement over New York’s long-shuttered psychiatric wards. But a year-long investigation by the Timesfound a for-profit system neglecting vulnerable residents. The Timesinvestigation found nearly 1,000 deaths at 26 adult homes across the city from 1995 to 2001, including cases of suicide, death at the hands of other residents, death from treatable ailments, and patients left to die after “roasting in their rooms during heat waves.”

This fall, Pittsburgh Post-Gazette ran a series on the state of mental health services in the region, five years after the closing of a large state hospital, Mayview:

First story ran Sept. 22:

Amaris Elliott-Engel

Nov. 5, 2013, 5 p.m.

The Wall Street Journal did a good story about how jails are where the mentally ill are housed now:

NONE of the stories cited above will tell you the TRUTH. The bogus “Community Mental Health Act” was truly one of the first Federal “Trojan Horse” pieces of Federal legislation. Here’s how the SCAM ACTUALLY works: ( hint: google: “Hegellian Dialectic” for more background…)
First, a fake “problem” is identified, in this case, bogus “mental illnesses”. Millions of Americans are given these bogus “diagnoses”, and Billions of PILLS are sold for Pharma. The excuse to start closing State Psych Hospitals is all the DRUGS folks are now put on. At first, the scam SEEMS to be “working”, simply because the people are all grossly over-medicated on powerful tranquilizers, which also makes them more “manageable”...But, the drugs also cause even more brain damage than they “treat”, which in turn is used as the excuse to give them even MORE DRUGS, and to continue to drug even more people, which has the added benefit of requiring even more tax-funded EMPLOYMENT, and justifying more prisons being built because the crime rate is going up….More people on more drugs means more crime and dysfunction and more employment, and more gov’t power and control, as society breaks down… That’s the short version…. The ONLY good thing the pseudo-science of psychiatry has done in the last 50 years is remove “homosexuality” as a “mental illness” from the DSM…

Bradford comment is way off mark.  Psychiatry IS very undeveloped medicine, mostly because there are few research dollars.  While the pharmaceutical industry is a profit monger, they are not responsible for the limitations of the medical care and treatment of those with mental illness.
Our for-profit- only culture refuses to care for the disenfranchised, the low income and poverty class.  Our health care system is a nightmare.  The people in need are discarded.  Our humanity lacking. As a people we must balance profits with social needs. I have witnessed the maltreatment and abuse of the severely mentally ill…our process of warehousing them in prisons and jails is horrifying and harkens back to the dark ages.  I am appalled by our society’s inhumanity to all the needy and vulnerable among us.

Sorry, Barbara, but it is YOUR comment which shows your ignorance. First, you’re wrong about those “few research dollars”. The DRUG Companies - “Pharma” - spend many times more on marketing and advertising, than they do on research and development. And, there is virtually NO effort made, to collect, much less study, any significant data from all the MILLIONS of Rx’s each year… NO DATA…
And, you FAIL to ask the vital question: WHY? Why do we have an ever-larger population of “mental patients”, and “mental illness”? The pseudo-science of psychiatry currently claims that over 350+ “mental illnesses” exist, as outlined in their “DSM-V”, but there is NO medical test for ANY of them…WHY?... When folks are given DRUGS, there is rarely, if EVER, any attempt to do a comprehensive medical assessment….WHY?...... When millions of people are used as HUMAN GUINEA PIGS, by Pharma, of course their “humanity” will be disrespected…
So-called “mental illness” is exactly as real as a present from Santa Claus….

MINNESOTA last place for psychiatric beds?    Why then did the State not allow any more group homes to open.  Group home owners that provide excellent care, and have a long history of operating in this state were told no more homes years ago.  And we have no beds why?

Bradford, you are the person who believes that mental illness is not real.  So whatever reasons you have for thinking it isn’t real, is that you have been brainwashed by people who can’t deal with the idea on the fact that the brain can have a chemical imbalance?  Do you read books by Robert Whitaker and Thomas Szasz, MD?  Robert Whitaker is a reporter who is writes about what goes in with drug companies. He does bring up some good things but remember this, he is a reporter. In his second book, he stated that when asked if he was interested in the subject because of family history of mental illness and he said there was none that he knew of and he was reporting a series of stories in the first book. The second, in my opinion was to make money off people who truly believed everything in his first book.
Some people can’t handle the idea that mental illness is a real illness.  Thomas Szasz, MD was specialized in psychiatry.  He believed it to a myth.  I’m currently reading his book “The Myth of Mental Illness” and his writing makes little sense, has so far lacked much finding the ideals to prove this ideas.  I find his book amusing and repetitive, so far has used two sources for aide in his decision on the “myth.”
Can you explain to me how come people start hearing terrifying voices, visual hallucinations, distorted thinking, delusions or a host of other things that the general public don’t deal with?  And how why to if they have never taken illegal drug, legal drugs or drugs treat these disorders?  Also what are doctors to do with those who deal with these problems supposed to do?  Let them suffer?
I read books by Whitaker and bozo’s like Szasz because it is good to be informed what is being written that can harm people from getting help that they may need or because some people stop taking from taking medication after reading them.  Some people need meds and some don’t.  No one person is the same.
I think you are wrong in the fact that psychiatry is a pseudo-science and think your claim are not accurate in numbers.  They do test the medicine.  They have too.  They are test on animal first not people.  Drug companies don’t just come up with a formula for a drug off the top of their heads, there is research, testing on real “guinea pigs” (ask PETA), it takes a lot before it is able to be tried on people and then it is in a clinical trail.  When they do studies with new medication on people with a mental illness there is very specific criteria, double blind studies and so on.  It can take years and years before a new medication comes out.
People like you, the Robert Whitakers or the world and the last Dr.Thomas Szasz, and doctors like him just can deal with the idea the brain can have a thing such as a mental illness.  The brain runs the body and it can cause the body to be sick so why can’t the brain cause itself to be sick?
I find people that are anti-psychiatry, people who have a psych diagnoses, don’t take medication and yet still more than willing to collect their Social Security checks. 
So do you collect your Social Security check each month?  If so, there is your present from Santa Claus!

Barbara and Bradford, you are both right and you are both wrong. This article and the references its makes are about the “chronically mentally ill”. Chronic mental illnesses are a “neurochemical or neuroelectrical” disorders that have a biological or genetic origin. For now there is no cure, but drugs can help control the symptoms and sometimes can make some patients functional. Some, with medication, counseling, case management, support and attentive love, can live very successful lives. Some have gone on to having careers, families and do better than some “so called normal people”. Others are low functioning and need lots of monitoring, supervision and constant support. Even those who are high functioning do need to be on meds and have to be monitored. There are many movie stars, CEOs, creative and famous people who are bi-polar or schizophrenic.

The tragedy are those minorities who are not only mentally ill but also poor, abandoned, neglected and forgotten. Many are not receiving the continuum of comprehensive integrated care they need. And prisons become their only care, home and sometimes hope. But it is never a complete system of care as the purpose of prisons to is punish and remove a “dangerous or bad” person from society. Mentally ill person in is not always bad…as much as “mad”, but prison systems do not have the ability, skills and the system in place to deal with this. So the mentally unwell actually deteriorate further in these environments. When they need most understanding, patience and support they are getting “orders, commands and instructions”.

What is awful is when some of these patients, when they are on medication, have better self awareness, social awareness and articulation than the people who are working in these environments. Some of the patients, some, have higher intelligence than those who are giving them orders. That makes the whole thing even more difficult. The kind of commands, demands, ordering around and bullying around that goes on in many prisons is the opposite of what a fragile mind needs.

The rich can get $ 1,000 psychiatric sessions, expensive state of the art medications and treatments, and look and act like you both.

Looking at this program tells you a lot about the racism in our mental health systems. For many among the poor, minorities and immigrants prisons are the new asylums. The only place where they might get “some” treatment and some short term proper care.

What Bradford is talking about is the expansion of diagnosis in non-chronic mental ill health or difficulties that now drug companies are exploiting (some, not all) to sell more pills and make huge profits. There are lot of questions about “attention deficit disorders”, “autism”...where the symptoms are vague, or “purely behavioral and environmental”, which are getting over treated, mis treated or over-medicated.

For example, being depressed after someone close to dies, like a spouse or a sibling, is perfectly normal. But societies that do not provide “healing time and healing support” end up medicating such people. Similar victims of domestic violence get medicated when their anxieties or hyper vigilance are normal and helps protect them from their abusers. But the male dominated, macho, psychiatric system once treated these women as the problem and medicated them…sometimes driving them actually insane.

Kindly note the difference between chronic mental illness and non-chronic mental illness.

In fact good counseling, therapy, support and loving care can help 80% of problems that ordinary people, without chronic mental illness, face. But unfortunately those drug companies that have made psychotropic drugs and brain-candies their market targets and profit targets maybe manipulating diagnosis.

There are now medication for childhood restlessness, nail biting, sulking, tantrums…which might all be normal developmental issues for most children. But “some mental health businesses” might turn everything into problems and start medicating (and that too at an early age). That is very disconcerting.

There are parents who are anxious and stressed who are being medicated so they can focus, juggle and multitask better. Is this an unhealthy adjustment to an unhealthy society and its demands, or a normal adjustment to the pressures and reality of modern life?

Who is dysfunctional here? An environment that does not care for its poor, its disempowered, its sick and its struggling, or the individual who is expected to adjust, adapt and accommodate to ever increasing pressures, stressors and demands (that are not good for anybody’s health).

Lot of the environment inside and outside our prisons are sick. It is only when you travel abroad and see other mental health services, or more compassionate and connected societies…will Americans realize that there is something skewed, distorted and dysfunctional about their system…that can turn even the most sane person insane.

this “deinstitutionalization” of psych patients has only deepened the problem of mental illness.

Patients who 50 years ago were hospitalized and medicated are now on the street or in the neighborhood and not medicated.

this ‘feel” good legislation has setup a WHOLE line of subsequent societal failures.

.Mental illness very real and it is a chemical imbalance of the brain.
Mental health programs are not working for the most part. Inpatient/outpatient treatment programs have inexperienced workers, under payed, overworked.
Social workers/case managers rush patients through the system w/out real help. Educational/vocational programs simply are in place to give client’s something to do. Community group homes are filthy, understaffed, charge too much (being allowed to take 80% of a persons SSI check) leaving residents to make money in different ways like prostution.
Prisons are the psyche hospital w/out the benefits. The old Byberry Hospital in Philly offered music lessons, that’s unheard of today. When the hospitals were closed the money was to be used for community mental health but never was. Politicians got the money and used it for their own pet projects.

Tragic, societal failure as bad as elder abuse, and once again, old news with the stench of dog poop covered with newspaper.  Media cannot stay on top of every social failing of a so-called democracy that subordinates communitarian principles to individualism and a primitive conception of freedom.  But .. ., the level of attention given the state of the country’s mental health is akin to a collective denial of the consequences that follow the cost of macro-economic failure and individual insecurities.  Too many Americans are borderline psychotics and it’s a wonder that a greater number have not broken down; like the collapse of the Roman Empire, suspected from lead poisoning of wine goblets. Insanity coming out of excess.

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