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/

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.

*Between 2009 and 2012.