For my recent film work, I have traveled the United States studying homelessness and the fentanyl crisis. I have spoken with people on the street, witnessed overdose deaths, and visited programs doing outstanding work. I have met people with mental illness who told me that they wanted treatment but were unable to access it. I have also seen people who obviously needed treatment turn it down.
Visiting places like the streets of San Francisco would not fill most people with hope. Yet I am convinced that with bipartisan commitment, we can reduce homelessness and overdose deaths. To succeed, however, Democrats and Republicans will have to abandon some counterproductive commitments.
The political Left needs to rein in its support for “harm reduction” and its opposition to mental-health treatment. Activists too often demand that governments supply addicts with taxpayer-funded drug paraphernalia and create public locations where people can get high. Likewise, they often oppose efforts to compel needed mental-health treatment, or to condition addicts’ benefits on their entering recovery programs. Taking such positions makes it easy to get high but hard to get help. We should reverse that.
The political Right presents obstacles, too. Forty years ago, many Republicans—my party—failed to appreciate how mental illness can lead a person to experience homelessness. Though most conservatives today have a better understanding of mental illness, some Republicans still resist investment in addiction and mental-health treatment.
In sum: many Democrats will not push for treatment, and some Republicans will not pay for treatment. What would a better bipartisan consensus look like?
First, the parties must realize that, in responding to serious mental illness on the streets, lawyers wield too much power and medical professionals too little. Conservatorships, which transfer decision-making responsibility from a seriously mentally ill person in crisis to a responsible third party, can be a lifesaving tool, when done right. But the process can cost a fortune in legal fees and take so long that the person dies on the street before getting treatment. A rebalancing of power, away from judges and toward first responders, is in order.
Second, the parties must appreciate the value of involuntary care. During a recent visit to Seattle, I was with an EMS crew chief who was helping an overdose victim. The chief told me as he departed from the scene that, according to current law, involuntary treatment amounted to “kidnapping.” But the person in front of us was experiencing a fentanyl overdose—almost dead, barely responsive. This person did not have the requisite cognitive functioning to make a decision that could save his own life. To ensure that people requiring involuntary inpatient treatment have facilities in which to receive it, we have to end Medicaid’s “IMD exclusion,” which prevents hospitals with 16 or more non-geriatric adult psychiatric beds from getting Medicaid funds.
Many Americans feel despair over their government’s inability to address the mental-illness and homelessness crises. But I have met too many dedicated medical professionals and seen too many examples of recovery to share such gloom. I believe that progress is possible and that mental health can become a commonsense issue, rather than a partisan one.
Photo by Erin Clark/The Boston Globe via Getty Images
