Commentary –

    Mentally Ill? Cure Thyself

By William A. Collins

Sure I’m troubled,

Plain to see;

But treatment’s just,

For one in three.

The good news is that mental illness has come out of the closet.

Unfortunately, the bad news is also that mental illness has come out of the closet. In the old days, Connecticut used to hide its patients away in warehouses when they got too sick for wandering around in public anymore. You can still see those giant old hospitals today, looming over the landscape in Newtown, Norwich, and Middletown. The first two are now closed.

They closed ostensibly because new medications and new therapies came along. At last, the mentally ill could be let out. Anyway, that was the accepted rationale. The driving force, however, was to save money. So, with great fanfare, and the opening of a few community clinics, patients were “deinstitutionalized” and sent out to find their own way in the world.

Now, like the old hospitals, those patients, too, are still visible today. True, many have blossomed with their new medications and community treatment, and have assumed normal roles in society. Many others, though, can be observed in jails, homeless shelters, emergency rooms, and under bridges. For them there is no treatment, no supervision, no medication, and no hope. For the state, this clever system has been a bonanza.

Yes, the folks in jail and emergency rooms are expensive, but their numbers aren’t huge. The ones in shelters are much cheaper, and the ones with family and under bridges don’t cost anything at all. But the best part is, with so few patients now under state care, patient advocates have less ability to sue.

It is a scheme born of genius. With sufferers now in the custody of desperate families or underfunded non-profits, advocates can seek only political redress, not legal. They may petition the legislature and the governor for bigger budgets, but not sue them. And there is even a wonderful defense against funding that request – the budget cap. That cap was shrewdly foisted onto the public through a referendum when funds were tight. Now, even when funds are plentiful, it still serves as a one-size-fits-all excuse as to why the state cannot increase expenditures. That means we’re not allowed to use those huge surpluses that keep rolling in.

We must instead give them back to the voters as rebates.

The result is that roughly only one out of three mentally ill people gets served. In fact, as the state approached the cap this year, the governor ordered a $3 million cut in mental health programs, just to be on the safe side. And his budget director reminded us that solving this problem requires more than simply dumping in money. That’s like saying there’s no point in bailing a leaky boat until all the leaks are fixed.

By then, of course, it’s on the bottom.

The leaks, luckily, are well defined. They were laid out in spades by the governor’s Blue Ribbon Commission last summer. And they looked familiar. They’d been described before by various red ribbon commissions and white ribbon commissions. Indeed, they were perfectly well known back when all those poor patients were booted out of the hospitals. But the goal then, as now, was not to cure people. It was to save money.

Other factors also thwart additional spending. One is the lingering stigma attached to mental illness. Another is the fact that it’s not contagious. Further, many local zoning boards don’t want a facility of that ilk in their town.

Thus, since HMOs try to avoid treating mental illness too, you can bet we’ll keep finding sick people in our jails, shelters, emergency rooms, and under our bridges for a long time to come.

(Columnist William A. Collins is a former state representative and a former mayor of Norwalk.)