Right to Fail: Abandoning the Mentally Ill

Right to Fail

PBS Frontline (2018)

Film Review

I disagree with the title of this documentary. It gives the impression the filmmakers disagree with a 2014 ruling in federal court granting New York mental patients the right to live independently (even if it leads to serious adverse consequences) – instead of being warehoused in poorly funded and managed group homes. The main adverse consequences the film identifies include homelessness, incarceration, physical abuse and death.

In my view, the problem isn’t that chronic mental patients need to remain in restrictive settings for their own good (as the title implies). The problem is New York is no different from any other state. No state lawmakers are willing to spend the necessary funds to ensure patients with chronic mental conditions receive the treatment and support they require to live meaningful lives.

In the film, ProPublica reporter Joaquin Sapien blames the decision to empty US mental hospitals in the fifties and sixties on their reputation for “warehousing” patients who could function better in the community. The real reasons for closing state mental hospitals were far more complex than this. In addition to a small patients’ rights movement, there was a much stronger movement by conservative state legislators to “privatize” mental health care. They saw an opportunity trim state budgets by closing state-run hospitals (and shutting down powerful the state unions that ran them ) and relying mainly on pharmaceutical control (newly created antipsychotic drugs) to control patients in the community.

In New York state, many were moved into for-profit “adult homes” or group homes, where their carers were poorly paid and received negligible training or oversight. During the ten years (2003-2014) the the lawsuit was in federal court, there were many examples of unchecked drug and alcohol abuse, pest infestation and physical abuse.

Following the 2014 ruling, approximately 4,000 residents became eligible to move into independent living with various non-profit organizations providing minimal support in the form of case management.

By 2018 when this film was made, 700 had moved into independent living. Of these 30 had died and 39 were forced to return to adult homes.

Sapien investigates the experience of three individual patients who had difficulty adjusting to independent living. The first has three failed attempts if living independently in an apartment. One relates to his benefits being cut off because the agency monitoring him lost track of where he lived, one relates to going off his medication and becoming psychotic, and one relates to a brutal beating by a roommate. Following a lengthy stay in the ICU and on a medical unit, the patient finally receives regular in-home support ad (four hours a day). He clearly thrives with this support, which, unfortunately, only has temporary funding.

The second patient dies of hypothermia after becoming psychotic and spending a night naked in the snow.

The third patient (who is diabetic) is returned to an adult home (at his own request) after he becomes severely dehydrated during a heatwave.

The full film can be viewed free at https://www.pbs.org/video/right-to-fail-fz7iaq/

America’s 1.4 Million Homeless Veterans

Shelter: America’s Homeless Veterans

Al Jazeeera (Barbara Koppel) 2017

Film Review

This heartbreaking documentary is about the  1.4 million US veterans who are either homeless or at imminent risk of homelessness, due to poverty, mental illness, alcoholism and/or drug addiction. An American vet commits suicide every 61 seconds.

With the demise of nearly all Veterans Administration programs (eg GI Bill of Rights) that helped World War II vets reintegrate into society, veterans of America’s permanent War on Terror are mostly left to their own devices.

Owing to an extreme shortage of female shelter beds, homeless female veterans are the most underserved. Many homeless female vets were raped while serving, some multiple times. Those who report their sexual assault to superior officers are frequently kicked out of the military.

25 Years Among the Poorest Children in America

Fire in the Ashes: Twenty-five Years Among the Poorest Children in America

by Jonathan Kozol

Crown Publishers (2012)

Book Review

Unlike Kozol’s prior books, which focus on the abysmal condition of inner city schools, Fire in the Ashes follows the families of specific children Kozol has befriended and their disastrous living conditions. The families he describes are either those he encountered at the Martinique Hotel homeless shelter in midtown Manhattan or those he met through an after school program at St Ann’s Episcopal Church in Mott Haven.

With a media annual income of $17,000 for a family of five, Mott Haven is the poorest neighborhood in the South Bronx and the poorest congressional district in the US. Official unemployment (which doesn’t count those who have given up and quit looking) is 14%.

The book poignantly describes the brutal living conditions the children and their families confront, including chronic malnutrition, chronic asthma (from asbestos and incinerators), sexual exploitation of mothers by shelter guards, grooming by gangs and drug dealers, untreated parental mental illness, repeated episodes of homelessness and overcrowded classrooms and schools (many of which have lost funding to private charter schools).

Kozol follows the children of eight African American and Hispanic families from primary school through adulthood, as they struggle with social service and educational systems that have virtually abandoned them.

Some of the children he befriends graduate from high school (and even college) and end up in long term employment. Others drop out and are swallowed up by the criminal justice system. In each case, the children who succeed do so because someone (a teacher, social worker, pastor or Kozol himself) offers financial assistance to ensure they received the educational support they needed.

Although Kozol (with the help of readers and supporters) has set up an Education Action Fund to assist students from desperately poor racially segregated neighborhoods like Mott Haven, he argues against this type of individual intervention as a long term solution.

The real answer, he maintains, is to provide public schools in neighborhoods like Mott Haven, with the best educational funding (instead of the worst), the smallest classes (at present most classes have over 30 pupils), and the best prepared and best paid teachers (instead of the least experienced, most poorly paid).

Doctoring LA’s Homeless

Street Medicine

Jonny Kahleyn-Dieb and Tomi Hinkannen (2008)

Film Review

Street Medicine is an extremely inspiring documentary about a medical outreach program in Los Angeles Country that sends doctors out to assist uninsured homeless patient whose illnesses prevent them from attended Venice Outpatient Clinic.

The most common medical problems the encounter are TB and other chest infections and severe skin infections and abscesses. Owing to severe mental health cutbacks, many also have mental illnesses.

The clinic receives one-third of its funding from Hollywood celebrities and the rest from federal-state Medicaid funding.

Immigrants for Sale

Immigrants for Sale

Directed by Axel Caballero (2012)

Film Review

Immigrants For Sale is a documentary about the $5 billion a year private detention industry. Corrections Corporation of America, The Geo Group, and the Management and Training Corporation run over 200 facilities across the US, a total of 150,000 bed spaces. Because these facilities are paid by the number of beds they fill, they have absolutely no incentive to speed up the legal process that might lead to detainees’ release. As one facility auctioneer puts it, thanks to harsh immigration laws and skyrocketing refugee numbers, there’s an “endless supply of product.”

The film closely examines the role of the American Legislative Exchange Council, a right wing corporate lobby group founded by the Koch brothers, in writing anti-immigrant legislation adopted by various states and championing the construction of new private detention facilities. In most cases, state legislators with cozy relationships with ALEC and industry lobbyists impose these monstrosities on local communities against their wishes.

The filmmakers interview detainees’ families, immigrant rights groups and even former correctional officers who describe scandalous human rights violations by CCA et al, as well as their failure to provide nutritional food or adequate medical care or toilet facilities.

As a psychiatrist I was most appalled by the negligent and abusive treatment of mentally ill detainees. Because these facilities earn $197 a night to house detainees, they have no motivation to identify detainees with mental illness and transfer them to more appropriate treatment facilities. Detainees have no legal right to legal representation and often their families have no idea where they are. Both make their situation even more precarious. One mentally ill detainee featured in the film was beaten (one beating required hospitalization) and humiliated by corrections officers for three years before his mother secured his release.

Fortunately there is growing grassroots resistance to the private detention industry. One community successfully blocked – through sustained protest activity – the construction of a new detention facility. Another, Littlewood Texas, has been bankrupted by their decision to help bankroll a private detention facility. It remains vacant and unsold to this day.

Invisible No Longer: Chicago’s Homeless

Street Life: Faces Uncovered

By Neal Karski, George Min, Tyler Dubiak and Scott Hilburn (2016)

Film Review

Street Life is a portrait of the Chicago’s homeless population. It begins by demolishing the myth that homelessness is a lifestyle choice. In addition to a wealth of statistics, the documentary includes interviews with homeless Chicagoans, social service workers, homeless advocates and random passersby. I found it intriguing that none of the women interviewed blamed the homeless for their predicament – while more than half the men did.

On any given night 750,000 Americans are homeless, and yearly 25-35 million spend some nights on the streets or in shelters. Worldwide 100 million people have no housing at all while one billion have grossly inadequate housing. Last year, over a million American children were homeless at some point.

In examining the causes of chronic homelessness, filmmakers identified the following breakdown (in Chicago):

• 48% suffer from chronic drug or alcohol addiction
• 32% are mentally ill
• 25% are victims of domestic violence
• 15% are unemployed veterans
• 4% have HIV or AIDS

Because the homeless make huge demands on the public health system, it costs taxpayers far less to pay for their housing than to leave them on the street. After starting a Permanent Supportive Housing program two years ago, Illinois lawmakers reduced emergency room visits by 40%, nursing home days by 975%, inpatient days by 83% and psychiatric services by 66%.

 

How Capitalism Causes Mental Illness

Capitalism and Mental Health: How the Market Makes Us Sick

Libertarian Socialist Rants (2016)

Film Review

This 22 minute documentary makes an excellent case that capitalism is the primary cause of most mental illness.

The film begins by demonstrating that capitalist bosses have no incentive whatsoever to keep their workers healthy. Ideally they want their workers to be just healthy enough to do their work. From an employer’s perspective, any excess of health is wasteful and dangerous. Workers who are too healthy generally get restive when they’re forced to work for an abusive and exploitative boss.

In general, the most docile workers are those who are moderately depressed and apathetic. If people stop being depressed, they want to either 1) quit their jobs or 2) rebel.

The film also identifies housing difficulties (homelessness and insecure or poorly maintained housing) as a major cause of anxiety disorders and alcohol and drug addiction. Margaret Thatcher’s austerity policies led to a rampant heroin epidemic, as million of Brits lost jobs and/or secure housing.

The film goes on to cite a wealth of studies linking work and accommodation stress to anxiety and addiction disorders.

Third World Mental Health Initiatives Put US to Shame

People and Power – Out of the Shadows

Al Jazeera (2015)

Film Review

Out of the Shadows celebrates the hard work of third world activists who have dedicated their lives to bringing mental health care to their countries. It presents a striking contrast to the neglect and abuse the mentally ill experience in the US.

Globally half a billion people suffer from mental disorders, such as depression, bipolar illness and schizophrenia – more than all AIDS, malaria and TB cases combined. Yet owing to profound stigma, publicly funded mental health services are virtually non-existent in many third world countries. India, for example, spends less than 1% of their health budget on mental health. And in Togo, mentally ill men and women are chained to trees.

The documentary highlights activist-created programs providing free mental health services (funded by private European and Canadian donors) in India, Benin, Ivory Cost, Burkina Faso and Jordan.

US Barbarism Towards the Mentally Ill: A Crime Against Humanity

This is Crazy: Criminalizing Mental Health

Brave New Films (2015)

Film Review

This documentary showcases US policies which are shutting down psychiatric hospitals and community mental health centers and warehousing America’s mentally ill in jails and prisons. It features in-depth interviews with two mentally ill women who survived lengthy incarcerations, as well as commentary by psychiatrists, mental health workers and prison reform advocates.

America’s barbaric treatment of the mentally ill constitutes a crime against humanity under international law. Sadly it’s not a new problem. Thanks to the steady cutbacks in mental health services and housing subsidies that began under Reagan, it was clear by the mid-eighties that most mentally ill Americans were ending up in jails and prisons and on the street.

In 2002, Bush junior made even deeper cuts in mental health funding to finance the wars in the Middle East. Meanwhile, thanks to the 2008 global economic scam (which effectively transferred billions in taxpayer dollars to billionaires), states cut an additional $5 billion in mental health services* and eliminated 4,500 psychiatric beds.

Police Harassment of the Mentally Ill

The documentary begins by highlighting the brutal treatment of the mentally ill at the hands of police. When I practiced in Seattle, police routinely underwent crisis intervention training that enabled them to recognize when suspects were psychotic and to appropriately de-escalate threats of violence. This training also made it far more likely mentally ill offenders ended up in treatment facilities – as opposed to jail or prison.

Thanks to ongoing budget cuts and the militarization of local policing, most cities have abandoned routine crisis intervention training. In recent years, it’s become common for cops to kill psychotic individuals when they create a disturbance on the street – either by shooting them or repeatedly tasering or beating them to death. The lucky ones end up with lengthy prison sentences.

To his credit, New York city mayor Bill De Blasio re-instituted crisis intervention training for New York cops in 2014.

Private Prisons (Housing 1/3 of Mentally Ill Offenders)Are the Worst

This is Crazy continues by examining the brutal treatment psychotic inmates receive from prison guards. There is often no effort, especially in private prisons, to ensure they receive their prescribed medication. Instead guards physically abuse them and put them in solitary confinement in a (mostly futile) effort to get them to comply.

Warehousing the mentally ill in jails and penitentiaries also rips of taxpayers – as it costs $15 billion more annually than outpatient mental health treatment.

Once mentally ill convicts are released from prison, they rarely get appropriate aftercare. Conventional probation services make no effort to ensure that they access housing or appropriate aftercare services. Many end up returning to the streets to live.

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*Between 2009 and 2012.