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Our insane mental health system

"Our insane mental health system" Continued...

Issue: "The audacity of real change," Aug. 23, 2008

WORLD: Why don't more patients who need medication take it?

TORREY: The single biggest reason why individuals with mental illnesses do not take medication is because they do not believe they are sick. Schizophrenia and bipolar disorder are diseases of the brain and the disease often affects the part of the brain we use to think about ourselves. We see this also in other patients with brain disease, especially in Alzheimer's disease, and in neurological terms it is called anosognosia. It is seen in approximately half of all patients with schizophrenia and bipolar disorder. Such patients, no matter how sick they are, deny that they are sick and refuse to take medication. Other reasons why some patients do not take medication include side effects and cost of the medication.

WORLD: What are the consequences of our failure to treat people with serious mental illnesses who need treatment?

TORREY: Horrendous. Beyond the problems of becoming homeless, incarcerated in jail or prison, and becoming violent, mentally ill people who are not being treated often become confused and thus easily victimized. Their judgment is impaired, leading them into potentially dangerous situations. A study of seriously mentally ill individuals in Los Angeles reported that two-thirds of them had been robbed or assaulted in the previous year. Suicide also occurs frequently among mentally ill persons who are not treated.There are additional consequences: For example, hospital emergency rooms are often crowded with mentally ill persons waiting for hospital beds. Many public libraries have become de facto centers for mentally ill persons who have nowhere else to go. Many public parks have been taken over by homeless mentally ill individuals.

WORLD: Are any religious groups helping?

TORREY: I volunteered in homeless shelters for 16 years and have visited shelters in many states. I have been consistently impressed by the quantity and quality of services for the homeless that are being provided by religious organizations. If not for them, we would be much worse off than we are.

WORLD: How do we fix the system?

TORREY: The system can be fixed but the first thing required will be leadership from federal, state, and local officials. Such leadership has been in very short supply. I do not know of a single governor, for example, who has made the treatment of individuals with serious mental illnesses a priority. At the federal level the Center for Mental Health Services, which theoretically should be providing leadership, is one of the least effective agencies in all of Washington, and that is saying a lot!

We need to focus on the sickest patients. Of the 4 million seriously mentally ill individuals in the United States, about 10 percent of them, or 400,000 patients, are homeless, in jails and prisons, and causing most of the problems. And about 10 percent of those, or 40,000 individuals, are overtly dangerous and need to be on mandated medication for the safety of themselves and others.

Marvin Olasky
Marvin Olasky

Marvin is editor in chief of WORLD News Group and the author of more than 20 books, including The Tragedy of American Compassion. Follow Marvin on Twitter @MarvinOlasky.

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