By Marcelle Mostert
I work on an assertive community treatment team, which is the most intensive level of outpatient care available for patients with mental illnesses. Our patients are individuals with a serious mental illness who either do not understand that they are ill and therefore don’t get treatment, or whose lives are so chaotic that they don’t follow through with treatment, or whose response to treatment is minimal. Almost all of them have histories of being traumatized.
While ACT programs are successful in reducing the number of days that patients stay in hospitals, they are less successful in helping them stay out of jails. Even though symptoms like mood swings, hallucinations and delusions may be under fair control, the brain-based impulsivity and poor judgment associated with serious mental illness often does not respond well to medication, leading to poor choices, drug use and arrests for what are usually nuisance crimes rather than violence.
What a recent News article did not bring up is that the New York State Office of Mental Health has essentially dropped the ball in providing care for our seriously mentally ill citizens. This problem is invisible because federal HIPAA privacy laws end up keeping the public from knowing about the abandonment of the seriously mentally ill.
The OMH no longer seems to believe in long-term care for patients who never get well enough to live successfully in the community. Beds continue to be cut at the Buffalo Psychiatric Center, releasing ever more vulnerable, and sometimes dangerous, individuals to the community. Incarceration is viewed as an acceptable way of dealing with these behavior problems.
The OMH does not seem to acknowledge the sad fact that despite all the new treatments in psychiatry, only one in seven persons with schizophrenia recovers well enough to function normally. My team feels frustrated when the Buffalo Psychiatric Center refers individuals who have spent weeks in the community compared with years in institutions. If we are successful keeping them in the community, they often live difficult lives, as the recent News article on abysmal conditions in a local rooming house demonstrated. Laws supporting patient autonomy, even in individuals with brain illness, make lives worse. I fear that treatment providers may become calloused because there are no good choices.
We do our best and do have some wonderful successes. I admire my patients for their ability to keep going despite the hand they were dealt.
But I feel for those family members who still maintain contact with a difficult and very ill family member and know there is no way to get that person asylum. The state needs to come up with creative new initiatives for dealing with the most severely mentally ill that minimize the need for incarceration.
Marcelle Mostert, M.D., lives in Buffalo.