[Article of Interest] When My Crazy Father Actually Lost His Mind
By Jeneen Interlandi
It was early December 2010. That August, my father, who was 69, became abruptly and deeply paranoid. Convinced that nameless people were trying to kill him, he slept no more than an hour or two a night and started drinking after five years of sobriety. When his suspicions grew to include his immediate family, he became violent and threatened suicide. At one point, he tried to jump out of the car as my mother was driving down the highway on the way to the doctor’s office. On another day, he poured motor oil over her windshield as she was pulling out of the garage. More than once, he hit her. More than once, he threatened to burn the house down.
In rare moments of lucidity, he would cry and apologize, confessing that he was terrified. He didn’t know what was happening to him. But we did. He was given a diagnosis of bipolar syndrome in 2005, during a similarly disturbing period. He rode out much of that episode in a state psychiatric hospital, and having him admitted again seemed the best way to keep him and my mother safe. His lucid moments would pass quickly. Once his switch flipped back to manic, he would refuse to even discuss the possibility that something was wrong, let alone consent to seeing a psychiatrist.
Until the late 19th century, mentally ill people were locked in prisons or left to wander the streets. Reformers, seeking a more humane response, created a vast system of state-run psychiatric hospitals. By the 1960s, however, the overcrowded, often disturbing conditions in those facilities had come to light. At the same time, new psychiatric medicines were being developed, all of which gave rise to a new reform effort. Deinstitutionalization, the systematic closure of state psychiatric hospitals, was codified by the Community Mental Health Centers Act of 1963 and supported by patients’ rights laws secured state by state. Chief among those laws were strict new standards: only people who posed an imminent danger to themselves or someone else could be committed to a psychiatric hospital or treated against their will. By treating the rest in the least-restrictive settings possible, the thinking went, we would protect the civil liberties of the mentally ill and hasten their recoveries. Surely community life was better for mental health than a cold, unfeeling institution.
But in the decades since, the sickest patients have begun turning up in jails and homeless shelters with a frequency that mirrors that of the late 1800s. “We’re protecting civil liberties at the expense of health and safety,” says Doris A. Fuller, the executive director of the Treatment Advocacy Center, a nonprofit group that lobbies for broader involuntary commitment standards. “Deinstitutionalization has gone way too far.” According to Fuller’s group, there was one public psychiatric bed for every 300 Americans in 1955; by 2012, that number was one for every 7,000. That’s less than a third of what is needed, the organization asserts. The recession has made matters worse: since late 2008, more than $1.5 billion has been cut from state mental health budgets across the country. In the past two years alone, 12 state hospitals with a total of nearly 4,000 beds have either closed or are in danger of closing.
Already patients in crisis can spend several days in an emergency room waiting for a psychiatric bed to become available. In New Jersey, it can take as long as five days; in Vermont — where, as Bloomberg News recently reported, there are virtually no state psychiatric beds left — severely mentally ill patients have been handcuffed to emergency-room beds. For lack of other options, many patients who clearly meet the imminent-danger standard are released. “The lack of resources has triggered a devolution of the standard,” says Robert Davison, executive director of the Mental Health Association of Essex County, a nonprofit group that connects patients to services in northern New Jersey. “Twenty years ago, ‘imminent danger’ meant what most people think it means. But now there’s this systemic push to divert people away from inpatient care, no matter how sick they are, because we know there’s no place to send them.”