(Feb. 8, 2017) The deinstitutionalization movement of the 1950s restored the civil liberties of people with serious mental illness, but it was a dangerously shortsighted plan. Patients were taken out of long-term mental health asylums and released into the community without adequate outpatient services in place to ensure continuity of care.
Today, as the nation’s few remaining psychiatric hospitals continue to shutter their doors, the resulting critical psych bed shortage leaves a giant mental illness treatment void.
A recent blog featured in Scientific American hits the nail on the head with its assessment of this dire situation and its support of community mental health interventions as a means of filling the void (“How community mental health care can make a major difference,” Scientific American, Jan. 24).
Nearly 20% of the hospital beds for the nation's most severely ill psychiatric patients have been eliminated since 2010, and just 3.5% of the state hospital beds that existed in 1955 remain open today, according to our 2016 report on the trends and consequences of eliminating state psychiatric beds.
“Mental health advocates point to a number of failures such as limited funding for outpatient care and a lack of political foresight that may have led to this situation” writes Nathaniel P. Morris , resident psychiatrist at the Stanford University School of Medicine, in a guest blog for Scientific American. “Yet emerging community-based approaches to mental health care are providing hope for the severely mentally ill….”
Assisted outpatient treatment (AOT)—court-supervised treatment within the community for patients with severe mental illness who meet specific criteria—is a life-saving, evidence-based practice. The way AOT works varies by state, but Morris offers a general example:
“Say a man with schizophrenia cycles in and out of hospitals, suffering from debilitating hallucinations, “ writes Morris. “He stabilizes on his medications when hospitalized and then refuses to follow up with any care after discharge. A treatment team might request a hearing, in which a judge determines whether the patient warrants AOT.
“A court-ordered treatment plan might include a care coordination team who meets with the patient, encourages him to attend follow-up care, and tracks whether he goes to appointments or takes medications. If the patient fails to do so, the law may empower authorities to pick him up and bring him to a medical evaluation.”
Forty-six states and the District of Columbia have enacted laws to authorize the use of AOT, but historically these laws have been underutilized and underfunded.
Fortunately, 44th President Barack Obama last December signed into law the landmark 21st Century Cures Act, bipartisan legislation that supports a number of mental health reforms, including millions in federal incentives for states to develop AOT programs.
The Cures Act strengthens and expands critical AOT programs through a grant reauthorization and funding increase for states to implement AOT and permits states to use Department of Justice grant funding for AOT in civil courts as an alternative to incarceration.
The deinstitutionalization movement, which continues today, has led many severely mentally ill people to be released from psychiatric care without the tools necessary to survive, let alone thrive.
AOT is a major tool in the toolbox helping people with serious mental illness access consistent mental health treatment and live safely within their communities.
“Some patients are best served by treatment options that blend oversight and freedom, that provide the structure of the asylum with a full life in the community,” argues Morris. “Just as we shouldn’t let patients with dementia wander the streets, we shouldn’t turn our backs on those with severe mental illness under the false impression of supporting autonomy.”
Read our page on promoting assisted outpatient treatment to learn more about AOT laws where you live.
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