A mental illness is a condition that impacts a person’s thinking, feeling or mood and may affect his or her ability to relate to others and function on a daily basis. Each person will have different experiences, even people with the same diagnosis. Recovery, including meaningful roles in social life, school and work, is possible, especially when you start treatment early and play a strong role in your own recovery process. A mental health condition isn’t the result of one event. Research suggests multiple, interlinking causes. Genetics, environment and lifestyle combine to influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events like being the victim of a crime. Biochemical processes and circuits as well as basic brain structure may play a role too. (https://www.nami.org/Learn-More/Mental-Health-Conditions#sthash.iJPr7LNd.dpuf).
SMI among people ages 18 and older is defined at the federal level as having, at any time during the past year, a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.
Severe and persistent mental illnesses are those that seriously limit an individuals’ ability to obtain employment, interact socially, or cope with every day events. Severe and persistent mental illnesses last so long and are so severe that they seriously interfere with a persons’ ability to take part in even minor life activities. Even with the use of psychotropic medications, individuals living with a severe and persistent mental illness may never really be free of symptoms. (https://www.samhsa.gov/disorders)
Stigma is one of the most important problems encountered by individuals with severe psychiatric disorders. It lowers self-esteem, contributes to disrupted family relationships, and adversely affects the ability to socialize, obtain housing, and become employed. In December 1999, the Surgeon General’s Report on Mental Health called stigma "powerful and pervasive," and the Secretary of Health and Human Services added: "Fear and stigma persist, resulting in lost opportunities for individuals to seek treatment and improve or recover." Multiple studies have also shown that the major cause of this stigma is the perception that some individuals with mental illnesses are dangerous. Given this fact, it seems self-evident that stigma will not be decreased until we decrease violent behavior committed by mentally ill persons, and this can only be done by ensuring that they receive treatment. Dr E. Fuller Torrey. Treatmentadvocacycenter.
Homelessness*Family Disruption*Abuse*Education Interruptions and More
The consequences of non-treatment for serious mental illness are devastating. Here are 2 articles on it
People with untreated psychiatric illnesses comprise one-third, or 200,000 people, of the estimated 600,000 homeless population. The quality of life for these individuals is abysmal. Many are victimized regularly. A recent study has found that 28 percent of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans and eight percent used garbage cans as a primary food source.
People with untreated serious brain disorders comprise approximately 16 percent of the total jail and prison inmate population, or nearly 300,000 individuals. These individuals are often incarcerated with misdemeanor charges, but sometimes with felony charges, caused by their psychotic thinking. People with untreated psychiatric illnesses spend twice as much time in jail than non-ill individuals and are more likely to commit suicide.
There are approximately 1,000 homicides – among the estimated 20,000 total homicides in the U.S. – committed each year by people with untreated schizophrenia and manic-depressive illness. According to a 1994 Department of Justice, Bureau of Justice Statistics Special Report, "Murder in Families," 4.3 percent of homicides committed in 1988 were by people with a history of untreated mental illness (study based on 20,860 murders nationwide).
The Department of Justice report also found:
A 1998 MacArthur Foundation study found that people with serious brain disorders committed twice as many acts of violence in the period immediately prior to their hospitalization, when they were not taking medication, compared with the post-hospitalization period when most of them were receiving assisted treatment. Important to note, the study showed a 50 percent reduction in rate of violence among those treated for their illness.
Most crimes against individuals with severe psychiatric disorders are not reported; in those instances in which they are reported officials often ignore them. Purse snatchings and the stealing of disability checks are common, and even rape or murder are not rare.
Suicide is the number one cause of premature death among people with schizophrenia, with an estimated 10 percent to 13 percent killing themselves. Suicide is even more pervasive in individuals with bipolar disorder, with 15 percent to 17 percent taking their own lives. The extreme depression and psychoses that can result due to lack of treatment are the usual causes of death in these sad cases. These suicide rates can be compared to the general population, which is approximately one percent.
The longer individuals with serious brain disorders go untreated, the more uncertain their prospects for long-term recovery become. Recent studies have suggested that early treatment may lead to better clinical outcomes, while delaying treatment leads to worse outcomes. For example:
Schizophrenia and manic-depressive illness are expensive diseases. A recent study found that the cost of schizophrenia alone was comparable to the cost of arthritis or coronary artery disease (D.J. Kupfer and F.E. Bloom, eds., Psychopharmacology: The Fourth Generation of Progress, 1995):
The costs included both direct costs of treatment as well as indirect costs such as lost productivity:
A significant percentage of government income benefits also go to people with severe mental illnesses. For example:
Schizophrenia and manic-depressive illness are thus major contributors to the escalating costs of state and federal programs.
Incarceration and Related Costs
It is a mistake to think that money is saved overall by not treating individuals with severe psychiatric disorders. Individuals who are untreated for their illness cost money by being incarcerated. For example, the total annual cost for these illnesses in jails and prisons is estimated by the Department of Justice Source Book on Criminal Justice Statistics (1996) to be $15 billion (based on an estimated cost of $50,000 per ill inmate per year, and 300,000 individuals with serious psychiatric disorders being incarcerated.)
Adding to this expense are court costs, police costs, social services costs, and ambulance and emergency room costs. A study of schizophrenia costs in England reported that "97 percent of direct costs are incurred by less than half the patients" and concluded that "treatments which reduce the dependence and disability of those most severely affected by schizophrenia are likely to have a large effect on the total cost of the disease to society and may, therefore, be cost-effective, even though they appear expensive initially." (Davies and Drummond, British Journal of Psychiatry, 165 (Suppl. 25): 18-21, 1994).
When calculating the fiscal costs of untreated severe psychiatric disorders, intangible costs must also be included: the deterioration of public transportation facilities, loss of use of public parks, disruption of public libraries, and losses due to suicide. The largest intangible cost, of course, is the effect on the family.
WAY OF LIFE FOR ALMOST HALF OF AMERICANS WITH UNTREATED SCHIZOOPHREMIA AND BIPOLAR
Millions of Americans with Serious Brain Disorders Go Untreated
An estimated 4.5 million Americans today suffer from two of the severest forms of brain disorders, schizophrenia and manic-depressive illness (2.2 million people suffer from schizophrenia and 2.3 million suffer from bipolar disorder). According to the National Advisory Mental Health Council, an estimated 40 percent of these individuals, or 1.8 million people, are not receiving treatment on any given day, resulting in homelessness, incarceration, and violence. The reasons for this are many, including economic factors, the failure of deinstitutionalization, civil liberty issues as well as the effects of the illnesses themselves.
Economic factors and the failure of deinstitutionalization are the two leading causes of today’s crisis situation. A greedy game of musical chairs, or cost shifting by state and local governments to the federal government, especially to Medicaid, has played a pivotal role. As a result, individuals with serious brain disorders have been dumped out of psychiatric hospitals and shoved into nursing homes and general hospitals (many of which offer worse care than the psychiatric hospitals from which they were discharged), and forced onto the streets and into jails.
Since its beginnings in 1955, deinstitutionalization has been more about political correctness than scientific knowledge. When deinstitutionalization began there had been no scientifically sound studies conducted on how to best reintroduce individuals with the severest brain diseases back in to the community. In addition, there have been very few services available to these individuals when they are released into the community.
Battles in the nation’s courtrooms over individual civil rights also have helped to further jeopardize America’s most vulnerable citizens. Civil liberty advocates have changed state laws to such an extent that it is now virtually impossible to assist in the treatment of psychotic individuals unless they first pose extreme and imminent danger to themselves or society.
Adding to this crisis are the illnesses themselves. Schizophrenia and manic-depressive illness greatly impair self-awareness for many people so they do not realize they are sick and in need of treatment. Unfortunately, today’s state mental health systems and treatment laws – that oversee the care and treatment these individuals receive – play right into the vulnerability of these devastating diseases with the effect that far too many people remain imprisoned by their illness.
Federal Dollars Fuel Disjointed, Uncoordinated Care
Prior to the 1960s, when federal funds for psychiatric care became available, the public psychiatric care system was almost completely run by the states, often in partnership with local counties or cities. Since then, the public psychiatric care system has become a hodgepodge of categorical programs funded by myriad federal, state, and local sources. The primary question that drives the system is not "what does the patient need?" but rather "what will federal programs pay for?"
Beginning in 1955 with the widespread introduction of the first, effective antipsychotic medication chlorpromazine, or Thorazine, the stage was set for moving patients out of hospital settings. The pace of deinstitutionalization accelerated significantly following the enactment of Medicaid and Medicare a decade later. While in state hospitals, patients were the fiscal responsibility of the states, but by discharging them, the states effectively shifted the majority of that responsibility to the federal government.
In 1965, the federal government specifically excluded Medicaid payments for patients in state psychiatric hospitals and other "institutions for the treatment of mental diseases," or IMDs, to accomplish two goals: 1) to foster deinstitutionalization; and 2) to shift the costs back to the states which were viewed by the federal government as traditionally responsible for such care. States proceeded to transfer massive numbers of patients from state hospitals to nursing homes and the community where Medicaid reimbursement was available. (Note: IMDs were defined by the federal government as "institutions or residences in which more than 16 individuals reside, at least half of who have a primary psychiatric diagnosis.")
Because of incentives created by federal programs, hundreds of thousands of patients who technically have been deinstitutionalized have in reality been transinstitutionalized to nursing homes and other similar institutions where federal funds pay most of the costs. These alternative institutions, however, lack the full range of services needed to adequately care for persons with severe brain disorders.
At any given time there are more individuals with schizophrenia who are homeless and living on the streets or incarcerated in jails and prisons than there are in hospitals:
Violent episodes by individuals with untreated schizophrenia and manic-depressive illness have risen dramatically, now accounting for at least 1,000 homicides out of 20,000 total murders committed annually in the United States. According to a 1994 Department of Justice, Bureau of Justice Statistics Special Report, "Murder in Families," 4.3 percent of homicide committed in 1988 were by people with a history of untreated mental illness (study based on 20,860 murders nationwide.) An NIMH report indicated that severe and persistent mental illness is a factor in 9%-15% of violent acts. Recent studies have confirmed that the association between violence and untreated brain disorders continues to be widespread:
(*Note: While failure to take medication is one of the top three predictors of violence, civil rights lawyers have continuously expanded the rights of those with a lack of insight into their illness to refuse to take medication. Past history of violence is another major predictor of violent behavior, yet in many states these same civil rights attorneys have restricted testimony regarding past episodes of violence in determining the present need for hospitalization and assisted treatment.)
Source: Dr. E. Fuller Torrey (Printed From http://www.mentalillnesspolicy.org/consequences/untreated.html)
24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. Your call is routed to the nearest crisis center in the national network of more than 150 crisis centers.
Also known as, the Treatment Referral Routing Service, this Helpline provides 24-hour free and confidential treatment referral and information about mental and/or substance use disorders, prevention, and recovery in English and Spanish.
Stress, anxiety, and other depression-like symptoms are common reactions after any natural or human-caused disaster. Call this toll-free number to be connected to the nearest crisis center for information, support, and counseling.
Connects veterans in crisis (and their families and friends) with qualified, caring Department of Veterans Affairs responders through a confidential, toll-free hotline, online chat, or text.
Assists employers and union representatives with policy development, drug testing, employee assistance, employee education, supervisor training, and program implementation.