Pundits like to say that America is suffering a “mental-health crisis.” They often point to the country’s anxious teenagers, depressed adults, and general sense of post-pandemic malaise to justify the claim. Each of those things is a problem; each, at least partially, is related to “mental health.” But another face of this crisis is too often forgotten.
Americans with serious mental illness—typically, but not exclusively, schizophrenia and bipolar disorder—have been failed by their fellow citizens and their government for centuries. First, the nation erected a network of asylums that, at their best, provided humane custodial care, but at their worst, abused and neglected powerless patients. Then, in a period of revolutionary fervor following World War II, it downsized or disbanded, rather than reformed, those facilities, discharging thousands of patients, some of whom were poorly equipped for community life.
In the decades that followed, those with serious mental illness released from state psychiatric hospitals were often left to deteriorate on street corners. Some were allowed to decompensate to the point of violence, even as civil libertarians boasted of the virtues of individual autonomy and community care.
Flash-forward to today. Our jails and prisons crowd with individuals who, 70 years ago, would have been asylum patients. Our city streets are overrun with people living in squalor, sleeping in frostbitten winter air and muttering nonsense to passersby. Children with the most serious mental disorders spend weeks in emergency rooms, awaiting a bed in one of the vanishingly few residential treatment facilities. Meantime, activists continue to agitate for further bed cuts and for an expanded focus on what can only be described as the “worried well.”
Functional children and adults struggling to cope with life’s demands face real challenges that we shouldn’t minimize. But in addressing America’s mental-health crisis, we ought to concentrate our energies on those with the most severe illnesses, who have been too long ignored.
The symposium that follows sketches the problems with our current approach to treating serious mental illness and proposes paths for reform. Contributions span several critical areas, including the dwindling mental-health workforce, the burgeoning homeless population, and the dearth of beds for people in need of short- and long-term residential services. Taken together, the pieces presented here form an agenda to help a population that makes urgent demands on the national conscience.
Photo by JOHANNES EISELE/AFP via Getty Images
