State needs to focus on mental health infrastructure | my point of view

As a New Mexico licensed psychologist with 30 years experience, I am concerned that more serious thought has not been given to how best future federal mental health funding might be used. I am writing this as an open letter to our legislators ahead of the 2022 legislature.

Since the 1980s, under the Reagan administration’s deinstitutionalization program, entire communities have suffered from the increasing presence of the mentally ill living on their streets, under bridges, in parks, in transitional houses, or in prisons.

Still, it would be historically inaccurate to blame the Reagan administration entirely for our country’s failure to provide necessary services to the mentally ill. Rather, it was based on liberal (or perhaps libertarian) ideas that were held before the 1980s. In my early training I had to read The Myth of Mental Illness by Thomas Szasz and an article by David Rosenhan, “On Being Sane in Insane Places”, both written by academic psychiatrists. The former argued that mental illness could best be defined as difficulties in social adjustment, while the latter provided dramatic evidence that inpatient professionals could not tell the difference between someone who genuinely had mental illness and someone who was faking symptoms , no matter how bad they may be. These writings were philosophical arguments that had unexpected implications.

Under the Reagan administration, cutting federal funding for mental institutions resulted in a windfall that was used to cut taxes. This turned out to be a one-off event that had serious side effects. In New Mexico we have had a barely functioning mental health system for decades. Most of us probably don’t remember that we had mental hospitals and treatment centers designed to provide individual treatment to those who could not successfully survive without community support.

Those of us who worked in the system could see what was otherwise not recognized as a problem, that prison had become the new standard of care for the mentally ill, which is pretty much no treatment at all. I worked at the Bernalillo County Detention Center, an experience that was the basis of an article I wrote for American Jails in the 1990s called Jail as a Psychiatric Emergency Room. There has also emerged a new reliance on courts to intervene in the mental health and substance abuse fields to distract offenders with the threat of punishment for failure to comply with a treatment program. Some did not fare better despite compliance.

The difficult reality of the lack of treatment programs is that most of those thought to be trained in the mental health field, including psychiatrists, nurses, psychologists, social workers and counselors, no longer have the direct clinical experience to Assess symptoms and work as a team to develop treatment plans that could result in their patients’ successful transition into the community.

Instead, as a result of deinstitutionalization, we have an almost underground community within our community, where the homeless, whose sole crime may have been eviction, live alongside addicts, sociopaths, and the insane. As different as they are, all can be identified as having a serious mental illness due to the extreme stress of living in constant uncertainty and threat. All of these people, despite their differences, might find themselves in the same place: in prison, although many of them are at least treated, and at best treated, in a way that allows them to do well in the community and perhaps find employment.

After 40 years of institutional neglect, every mental health program must triage to determine needs, with assessments made in jails, community health centers, hospitals, shelters, soup kitchens, motels, and just by combing the streets. Without such infrastructure, little will be accomplished to help both the community and the mentally ill.

Julian Lev, Ph.D., began his career at what was then Las Vegas Medical Center and was hospitalized in Washington state. He has extensive experience in psychological assessment and treatment.

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