Friday, October 4, 2019

E. Fuller Torrey, M.D., Details Mistakes That Led to Today’s Public Mental Health Crisis

American psychiatry and the public mental health system must work to correct policy mistakes of the past that have led to today’s public health travesty: criminalization of people with mental illness by placing them in jails and prisons and the failure to treat homeless individuals with serious mental illness (SMI).

So said E. Fuller Torrey, M.D. (pictured above), the keynote speaker at yesterday’s Opening Session of APA’s IPS: The Mental Health Services Conference in New York. Torrey, the founder of the Treatment Advocacy Center and associate director for research at the Stanley Medical Research Institute, has been a fierce advocate for people with SMI for five decades.

During his address, he detailed a history of tragic public policy blunders that led to the current crisis: the emptying of state psychiatric hospitals, passage of the Community Mental Health Act (CMHA) with no mandated provisions for care after people with SMI were discharged from state hospitals, and federal financial incentives that encouraged states to abdicate responsibility for this population.

“In summary, we emptied the state hospitals and provided federal fiscal incentives to make sure it happened,” Torrey said. “We began a new program of community mental health centers that was targeted to prevent mental illness but ignored patients being discharged from the state hospitals. And we partially federalized what had been a state and county responsibility with no provisions for the most seriously mentally ill.”

Torrey drew attention to a grim irony: The founders of APA 175 years ago were concerned about and discussed the practice of locking up people with mental illness in jails and prisons. These discussions were instigated by Dorothea Dix, who had been outraged by what she saw when she toured the prisons of Massachusetts. This year, Torrey said, a detention center in Georgia became the first jail to be accredited as a mental health facility by the National Commission on Correctional Health Care.

Torrey wondered, “What would Dorothea Dix say of us today?”

He emphasized that the motives that led to deinstitutionalization were good. And he noted that the process of emptying the state hospitals did not begin with the CMHA but with the introduction of chlorpromazine (Thorazine). However, he said, the vast majority of community mental health centers created by the CMHA, having no mandates to treat discharged patients, operated as private psychiatric clinics focused on prevention rather than treatment.

Torrey said IPS is a crucial venue for addressing the problems created by the past and looked to young psychiatrists in the audience for solutions. “Rarely have so many well-meaning people been so wrong,” Torrey said. “My generation made major mistakes in emptying the state hospitals without thinking about how to treat the seriously mentally ill in the community. It is up to the next generation to solve those problems.”

For related information, see the Psychiatric News articles “Mental Illness in America’s Jails Also Made Headlines 50 Years Ago” and “Signs of Problems With Access: Homelessness and Incarceration.”

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