Let’s do a better job caring for the mentally ill

Published 9:27 am Wednesday, June 3, 2015

By Elaine Smith

As a retired psychiatric social worker, I have followed the Albert Lea Tribune’s mental health series with interest. I began my career in 1961 when I went to work for Rochester State Hospital after having graduated with a Bachelor of Arts degree in sociology from the University of Minnesota. Back then, people with severe major mental illness were committed to state hospitals for many years, sometimes a lifetime. Then with the advent of psychotropic medications, they began discharging long-hospitalized people back to the community. That was my job — helping to prepare people for discharge and referring them to county social welfare departments for placement.

Elaine Smith

Elaine Smith

In 1963, I attended graduate school at the University of Denver and received my master’s degree in 1965 in social work. I ultimately went to work for Denver General Psychiatric Department and found myself working with the discharged patients from a Colorado state hospital. To my dismay, their boarding home living arrangements left much to be desired.

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In the 1960s, it seemed like the humane thing to do to de-institutionalize the mentally ill so they could lead a more normal life in the community. However, the community was not adequately prepared; in 2015, over 50 years later, the mentally ill are so much underserved, especially those with the most severe forms of mental illness such as schizophrenia, psychotic depression and bipolar mood disorder. Often these people do not recognize their illness. Such lack of insight is actually a symptom of the illness. Consequently, they do not seek help. This is a large reason why there are so many mentally ill people who do not receive help. Commitment laws have changed so that it is extremely difficult for family members to get treatment for their adult relatives who are in denial as they must be  “imminently (immediately) dangerous to self or others” in order to be court ordered into treatment. Contrary to stereotypes, most mentally ill people are not dangerous; though there are, of course, those few who have made headlines. Many people with major mental illness end up on the streets homeless or in prison. A large percentage of the prison population is mentally ill; in fact, prisons have become the alternative institution for those with major mental illness after the closing of most state hospitals.

As mentioned in the Tribune’s articles, most people believe that mental illness is caused by stress, weakness or lack of will power. The truth is that mental illness is a disease, one that is often genetically inherited as it tends to run in families. Many mental illnesses are the result of malfunctions in the brain or brain chemistry. It is not under individual control and it is not his or her fault.

In an ideal situation, commitment laws would be eased so that people with major mental illness could more easily be court ordered into treatment when they don’t recognize that they are ill and refuse treatment. The individual could be hospitalized, usually for a short time, and then followed closely by a local mental health team.  The patient would live at home or, since that is not usually the best option, in a living situation managed by the mental health center. Various living resources would be available including group homes with staff on site 24 hours a day, assisted living apartments, independent apartments and even nursing home placement with locked facilities. Individuals would usually be treated with medication, psychotherapy and case management services and taught general living skills. This would continue for as long as is needed, sometimes for a lifetime. But, they would be living in the community, could socialize there, go shopping, to the movies or whatever else they desire as appropriate.

Persons with major mental illness do respond to treatment and they get better, though are not always “cured.” It is a slow process and can take many years. I have known persons who have come to relate to their families much more appropriately and have learned to have reasonably satisfying lives. As a civilized society, we must do a better job for some of the sickest among us.

Please note that I have been writing about major and severe mental illness. Those with minor mental illnesses often have more insight that something is not quite right and are more willing to seek help. Commitment is rarely appropriate in such circumstances and these people usually live more normally in the community.


Elaine Smith is an Albert Lea resident.