Inside the System: How We’re Failing the Mentally Ill
Unable to fit more clients into groups without violating fire code, the staff held an after-hours meeting over Chinese take-out to rearrange the schedule to maximize billable hours. We overlapped the morning and afternoon programs. We raised the attendance requirements. The staff, many of whom had joined the Red House after their previous center shut down, clandestinely browsed for job openings. I wondered if I was on a sinking ship. I considered taking a leave of absence from Smith to think up another career path.
The trend is clear: treatment centers are shutting down. When they do close they leave staff unemployed and clients referred to the overcrowded and insecure programs still standing. Those who do not transition to another center lose access to treatment. Many former clients see an increase of symptoms of depression, anxiety, mood dysregulation, and psychosis. They seek care in inpatient units and nursing homes; become homeless; incarcerated; and ill.
Though community mental health centers rarely bring in a sizable profit, hospitals, jails, and shelters are markedly more expensive and provide far less effective and preventative treatment. This is a trend of “trans-institutionalization”over deinstitutionalization, after the closing of many psychiatric hospitals in the 1960’s and 1970’s drained state and federal budgets.
The National Alliance on Mental Illness (NAMI) estimates the cost of untreated mental illness from in the U.S. as more than $100 billion each year. A study by the National Institute of Mental Health (NIMH) suggests the annual loss is closer to $193 billion. But the costs aren’t cut-and-dry. NIMH director Dr. Thomas R. Insel writes of the study, “Lost earning potential, costs associated with treating coexisting conditions, social security payments, homelessness, and incarceration are just some of the indirect costs associated with mental illnesses that have been difficult to quantify.”
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… .She also notes that it’s “not uncommon” for a client to take her own life following the closing of a treatment center, which for many clients is the only place where they feel a sense of connection and belonging.