The lunacy of the mental health care system

"That poor tormented girl -- and all the others like her."

Published May 31, 2000 7:01PM (EDT)

Who will care for the crazy?
BY J.B. ORENSTEIN (05/25/00)

Good God, what kind of hospital admits a proven suicide risk for ONE DAY AND A HALF and then turns her out just so she can go finish the job? Someone as ill as Rachel should have been kept in the hospital for at least a few weeks, long enough for her medication to start working, to build a rapport with a therapist, get a fix on the reasons for her despair and above all to stabilize. This is not hard to do; it does not require sophisticated or costly technology, just a bed and three meals a day in a safe place with a caring staff.

When you break your leg, the hospital doesn't insist on denying you crutches, pushing you out the door and commanding "Walk!" Yet we take the sickest mentally ill people -- many of whom are quite young and could have long, satisfying lives ahead of them if they only had a few weeks or months of decent care in a mental clinic -- and we basically tell them, "We know you're eager to kill yourself, go kill yourself, we don't care."

Inhuman. That is the only way to describe it. That poor tormented girl -- and all the others like her.

-- Bonnie Resnick

As a former psychotherapist, J.B. Orenstein brought back memories I hate to access.

When I was practicing outpatient psychotherapy, I saw cases like his referred by the local E.R. If the person had insurance, they were decidedly worse off. The managed-care companies were callous to the point of brutality. I had the same faceless rep tell me during one call that the client was "not sick enough," only to tell me in the next that she was "too sick" and not a candidate for outpatient work. When I asked her just exactly how "sick" a person should be to get help, she was not amused.

During my training, I worked at a private psychiatric hospital, and my goal was to find suitable placement for people as quickly as possible. Of course, "suitable placement" is the impossible dream, and I frequently had to send homeless people with schizophrenia diagnoses right back to the shelters from whence they came. It wasn't about where they might improve, it was about where we could push them when funding ran out.

I'm not in the mental health field anymore, and mine is much better now.

-- Meredith Finn

I think one of the problems of getting coverage for the mentally ill is contained in your title of the article. The word "crazy" marginalizes the mentally ill and makes it easier for people to think of them as the "other." People think "crazy" when they see the man on the corner in rags preaching about the end of the world, or the Charlie Manson type. They don't think of the mother who may be suffering from depression, a son who is bipolar or an adopted child suffering from an attachment disorder. But because of the stigma of the word "crazy," people are not willing to accept mental problems as what they are -- illnesses that can be controlled by medication and various types of therapy.

I believe that if people started recognizing mental health as part of physical health, they would be clamoring for parity in their health insurance.

-- Kerry Halva-Cash

I have an M.S. in counseling psychology and have been working for the past two years with mentally ill older adults at a community mental health clinic in San Francisco. I do agree, no one cares about the mentally ill. They can look bad, they may be scary and there is nothing touchy-feely one can attach to those poor people to make them look better.

We should all understand that each and every one of us may, at some point, require the help of a mental health professional. Like the flu or any other medical condition, no one is immune to the stresses of life. Mental illness is not as black and white as we pretend it to be, as much as we try to distance ourselves from the darkness of mental illness.

-- Anetta Kalk

By Letters to the Editor

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