Schizophrenic. Killer. My Cousin.
Continued from previous page
When in 1961 a joint commission of the American Medical and American Psychiatric associations recommended integrating the mentally ill into society, their plan depended on the establishment of local facilities where mentally ill people would receive outpatient care. Congress passed a law providing funding for these "community mental health centers" in 1963, and states, already under pressure from the patients' rights movement, downsized their mental hospitals faster than anyone had anticipated. Between Vietnam and an economic crisis and lack of political will, though, adequate funding for community services never came through. In 1980, Jimmy Carter signed the Mental Health Systems Act, aimed at filling the gap. But a year later Ronald Reagan, already known for eviscerating mental-health services as governor of California, took office and gutted it, then decreased federal mental-health spending 30 percent and shifted the burden to state and local governments. By 1985, the federal government covered just 11 percent of mental-health agency budgets. When the crucial community services that the mentally ill were supposed to receive as the hospitals closed failed to materialize, more and more of them ended up on the streets. By the mid-1980s, pretty much everyone in America agreed that deinstitutionalization was not going well.
"Homelessmentallyilldeinstitutionalized was one noun in the media at the time," says SAMHSA's Roth, who is the source of the oft-cited data point that a third of America's homeless people are seriously mentally ill (helping to rebut the misconception then that theyall were). In 1984, Dr. John A. Talbott, then president of the American Psychiatric Association, apologized for the association's role in the disaster. "The psychiatrists involved in the policymaking at that time certainly oversold community treatment," he said, "and our credibility today is probably damaged because of it."
"Think of it as haircuts," says Roth, who watched deinstitutionalization unfold in her 37 years as chief of evaluation and research at the Ohio Department of Mental Health. "In the age of the great gothic castle on the hill, mentally ill patients had everything taken care of. Health care, sleeping, eating, etc. When they got out, they were supposed to have everything. They got Medicare and Medicaid, but [policymakers] didn't think about food. And haircuts. Clothes. How to find a place to live." How to do laundry; how to grocery shop. How to ensure people who need meds take them. What to do with people who had too many behavioral problems to avoid being evicted six times in a row.
Fortunately for my aunt, she lived in a state that, as Roth explains, had some "very dedicated, very dogged" leaders at the Department of Mental Health who were determined to make Ohio a model for post-deinstitutionalization life. By the mid-'90s, my home state "was famous all over the country for all kinds of stuff," she says. Independent-living initiatives. Supported-employment programs. Supported education. Home-based services for kids. Active and excellent case management.
It was an excellent case manager who ultimately helped solve my aunt's housing crisis. Eleanor Dockry, a tiny woman with chin-length black hair and black-frame glasses, was assigned Terri's case through Pathways (now called Beacon Health), a nonprofit outpatient service provider supported by the county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) board—essentially the rump of what was supposed to have been the community-services network envisioned by the reformers of the '60s—and a slew of other community organizations. Though I met her for the first time just a few months ago, she took care of my aunt for 23 years, a life jacket. Eleanor knew that you could only be evicted from so many places before no landlord in Ohio would rent to you, so she sat my grandparents down. "I think if you could afford to buy something for her, that would be good," she said. My grandparents pulled the money together for a trailer in a mobile-home community near their house.