The State of Mental Healthcare


I currently work in the community mental health setting.  A setting that is primarily funded by state and federal dollars and primarily serves low income, high need clients.   Clients that seek community mental health are usually those that are ill to the point their disorders and symptoms interfere with their ability to function in a work or school setting, many with a history of incarceration or hospitalization (in my experience there is little difference between these two, both revolving doors of shitting care and overmedication), but with regular care and appropriate support would be able to live like “normal” people.  Unfortunately, rarely is this care ever provided consistently or appropriately.

Since I started working in my field, I’ve pretty much rotated between working in schools (alternative and traditional) and community care.  But my disgust at how the system fucks some of, not only the most needy clients, but some that could have massive potential if they were given proper care.  Children with learning, behavior, and sensory integration disorders are routinely put on the back burner in schools, not receiving proper assessments or interventions.  They fall behind a little bit more every year until they are failing, their sense of self and identity become defined by failure.  The risk factors add up, one after another until they become absorbed by the mental health and education systems that failed them in the first place.

For individuals with chronic mental illness, thought disorders, personality disorders, severe emotional disorders, or developmental disabilities the bureaucracy  that is mental health is worse.  Wait lists of many community mental health centers number in the hundreds.  Social workers, whose caseloads should be no larger than about 20 in order for them to actually help the individuals they serve, are usually closer to 50-60.  Psychiatric hospitals deal with overcrowding by over-dosing clients on sedatives.  Hospitals rarely provide treatment, instead the have settled for assessment, stabilization, and providing guardians/family with a list of recommendations so vague they can hardly be followed.  That list usually includes a recommendation for individual therapy, psychiatric medication consultation, and case management….at those community mental health centers with the hundred person wait list.  This leaves a 3-6 month gap in treatment in which clients are left to their own devices.  Some, depending on the severity of their symptoms and the level of dedication of their support systems, can manage to go back to some semblance of a life, perhaps a job or school.  Others, however, cannot.  They will cycle in and out of crisis care and hospitalization, most end up in prison.  Millions self-medicate with street drugs, leading to addictions and worsening of the core symptoms.

Then you get to the systemic problems caused by this failed system.  Families are effected, parents, children, siblings, grandparents.  Because lack of treatment leaves them so ill they cannot hold a job, they are forced to go on disability.  Not only does that have an economic impact, but it leads to boredom and decreased motivation to get better.  Mentally ill individuals are viewed by others as lazy, dangerous, or stupid, which has an impact on their own self-image and sense that they can do something more with their lives.  Constant failed attempts at getting help lead many to give up.  Institutions and psychiatric hospitals that could have provided treatment (the level and kind of treatment provided is a completely separate issue) have been replaced by prisons.  Most mentally ill are still placed in general population, provided little to no treatment outside of medication, and eventually released with no resources.    Again, we cycle back to economic and family impacts.  The cycle repeats year after year.

Our culture likes to put mental health on the back burner.  As a society, we think the mentally ill are mentally ill.  They cannot be helped.  We think this because it is what we see.  Chronic mental illness equates to stupidity, laziness, and criminality.  But this comes from what the system has done to mental health care.  And it is also self-perpetuating.  If we think about the mentally ill as dirty, stupid, homeless criminals, we can accept their lack of care.  They are the “other.”  They’re not like us and they don’t deserve our federal dollars because they will always be that stupid, gross, crazy person.  So, it become easier for us to ignore or be okay with the lack of mental health care.  The media’s portayal of the shooter from the Colorado spree is perfect.  He was crazy, therefore he was dangerous and must be locked up.  This must also apply to all other crazy people.

There are thousands of trained therapists and social workers dying for work.  People go into this field wanting to help.  They have ideas and dedication, they just need the funding.  Every time I see a mental health center or service be closed down, funding cut, etc, I go a little crazy inside.  Where do politicians think this will save money?  They are leaving high need adults and children without care and vulnerable to everything I already talked about.  Funding cuts for mental health will lead to an increase in crime and dependence on federal disability money.  Many of the clients they put out want to work and want to contribute to society, but they need continuous support to be able to function.  With that support, they can do amazing things.

So, fuck you bureaucracy.  And shitty run around that causes crime and death.

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