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/