In the mid-90s, I remember hearing that in my state, cancer research received $150/hospital bed, heart disease received $100/bed, and schizophrenia received $7/bed. My amateur theory on that was that the first two affect old, wealthy people, whereas the third affects young people with no power.
Here in Virginia, we recently had a pretty striking demonstration of what you're talking about. One of the leading politicians in the state, state senator Creigh Deeds, was attacked with a knife and nearly killed by his own son, Austin, who was 24. [1] After the attack, the son killed himself with a self-inflicted gunshot wound. Deeds was in dire condition, but survived.
It came out afterwards that Deeds' son, who had been diagnosed in the past with bipolar disorder, had undergone a psychiatric evaluation the day before the attack, and as a result of that evaluation had been placed under an emergency custody order. But Virginia law only gives mental health authorities six hours to find a bed to put the patient into in such cases; and in this case no bed could be found in that time, so Austin Deeds was sent home. [2]
This has naturally provoked a great deal of concern in these parts, both about how so little resources are available for mental health patients that a potentially violent one could be turned away for lack of an available bed, and about the ridiculously short 6-hour limit on how long such patients can be held. And rightly so -- if help had been available for Austin Deeds when he needed it, he might still be alive today, and his father might never have suffered such a horrific experience.
Deeds has recovered now, and upon his return to the legislature announced that he would be pushing hard for mental health reform in the state, garnering wide support. But it's telling that the issue had to strike at a political leader for anyone in the political class to care about it overmuch. One wonders how many other families in Virginia have suffered their own horror stories, their own tragedies, in total silence -- just because, since they weren't rich or powerful, nobody in a position to fix things could be bothered to care.
It's a complex issue. De-instiutionalization was driven both by cost concerns and advocacy for keeping the mentally ill in the community. At one time, the cops would use "searching for a bed" to detain people for excessive periods of time.
That advocacy was driven by the horrific conditions that became common. Google Willowbrook.
That sounds like a really positive result from a horrible occurrence. Mental health care is woefully underfunded in much of the US. Here in Florida they have 24 hours to place someone at a facility after they've been medically discharged, and they still have trouble. Most places that can take people have a very limited number of beds that are already filled, which in turn causes pressure to discharge people potentially prematurely to open up new beds.
The health insurance situation only exacerbates that: there might be 5 facilities in the area that can take people, but only 1 that can take the uninsured. Florida is one of the states that "wisely" chose not to do a Medicaid expansion, and so if you're poor but without a diagnosed, processed, shortlisted disability, you're uninsured. Hilariously federal subsidies for buying coverage only kick in if you're making some high percentage of the poverty line, which people with mental health issues often have trouble reaching a fraction of that.
Oh and to add to that for the one available facility they used the Room 101 description from Orwell's 1984 as inspiration. No windows. Smoothed concrete floors. Echoing cries and screams. Blood. Food barely fit for animal consumption. And of course nothing helpful like any sort of talk therapy. Psychiatrist in residence once a day for 30 minutes, allotting on average 30 seconds per patient. Sleeping in cots on the floor. Sitting against the wall for hours with nothing to do but stare. If you've never experienced it before it becomes pretty clear pretty quick how much meaningful care is provided to unprivileged people suffering from mental health issues in this country.
Also it's in part because mental illnesses still come with a huge stigmatization in this country (USA). If you're diagnosed with schizophrenia, you're not normal, and something is wrong with you. Even though mentally ill people are more likely to be taken advantage of than commit a crime because of their illness, society does not trust you if you're schizophrenic. In fact many people make fun of the mentally ill or totally ignore them. If you live in the bay area you don't have to look far for proof, just look out your window. When I visited I was surprised to see so little thought given to the countless, clearly mentally ill homeless people in almost every part of San Francisco. I can feel some of you scrambling to justify how it's somehow their fault, how it's okay to not care that they are mentally ill and homeless, that they somehow chose that life. I do it, too, because it's part of our cultural programming.
Someone fairly close to me is affected by the illness, and I've discovered it's not something you can just talk about. If someone close to you has heart disease, you'll get sympathy. If someone close to you has schizophrenia, it's almost shameful to talk about. It just doesn't get the same amount of sympathy.
What would be a good way to help a person who is mentally ill, homeless and is not fitting any structure like a hospital? I.e. if the person agrees to undergo treatment program, stay in the facility, etc. it's fine but what to do if they are not?
Homelessness is complicated, both the causes and the solutions. I am big on trying to light a single candle rather than curse the darkness. Here is my candle for homelessness:
I also speak out here and on Metafilter. My diagnosis is not a mental health issue, it is medical, but it is clear to me that it impacts my mental functioning. My answer for me is a) preserve as much agency for myself as possible and b) get my body well.
I have a cystic fibrosis. People accuse me of being mentally ill for thinking I can get well. I have been told that is not possible. It is possible. I have made ongoing forward progress for 13 years.
Unfortunately, most people do not believe me and the social fallout from that is pretty crazy-making.
Just because the answer is not easy or quick does not mean there is none. There are lots of ways to work on issues like homelessness and the mental health of other people. Each piece of the puzzle matters.
Well, if you look at cause of death, the first two are the big hitters in the US so that is part of the basis for more money. The history of funding treatment is pretty bad though.
It's not so much no power, it has been the lack of advocates because of the shame associated with all mental illnesses. A person with cancer can do the noble stand. A person with schizophrenia is much less capable of doing the needed advocacy. Things are changing as more people are pushing and not keeping quiet.
From a advocacy view, we better start putting this and brain problems in general front and center since we are living long enough that we need the understanding of treating the brain to use our longer lives well.
But we're not living long enough that we're all getting schizophrenia. We're living long enough that we're all getting cancer and heart disease. Even in the realm of mental illness, if the problem is "we're living long enough to develop new problems", wouldn't we want to focus on age-related problems?
You can still get schizophrenia in your old age. "23.5% of patients with schizophrenia developed the illness after the age of 40" Beyond that in the elderly it often get's lumped in with other form of Dementia and ignored.
IMO, finding real treatments for mental illness is probably the most important part of longevity research as a healthy body and a decayed mind is in some ways little different than a dead body.
If you could only develop schizophrenia young, it wouldn't make much sense to call it "age-unrelated". You can get chicken pox when you're old, too, and in fact it's particularly deadly to the elderly, but there's not much place in aging amelioration for anti-chicken-pox research. It's best addressed elsewhere (also, yes, basically solved already, but I'm trying to make a different point).
23.5% of schizophrenia sufferers is a minuscule quantity. What percentage of people over 40 develop schizophrenia? Over 60? What percentage of people over 60 develop one of "cancer or heart disease"?
> a healthy body and a decayed mind is in some ways little different than a dead body.
I don't disagree at all.
> finding real treatments for mental illness is probably the most important part of longevity research
No, the most important part of longevity research is getting the body to last. A dead body with a "healthy mind" (not clear what that would mean) doesn't qualify as longevous by any standard. Someone who won't go senile for 150 years is pointless if he dies at 82 like a normal person, and while that scenario is admittedly a kind of progress it (a) is undetectable, which makes research difficult, and (b) has no application at all until we can get the guy to live longer. Longer lifespans are more fundamental, are immediately visible, and have immediate application; they can take advantage of natural variation in the onset of mental failure.
Another aspect of mental illness is that it directly affects how you relate to someone as a person. It's a behavioral disorder, it affects the personality.
A person has heart disease or cancer. A person is schizophrenic, or bipolar, or manic, or psychopathic, or depressed.
It's like the aphorism "you have a body, you are a soul".
A person with cancer or heart disease may be concerned and occupied by the disease or condition, but it's not who they are.
I've had my own encounters with people suffering from various psychological conditions, and ultimately, it's simply very trying to be with them in many cases. It's worse if you're not aware of the condition at all. In several cases the information emerged later, with a very strong sense of "well, that explains a lot".
Worse is when the person turns on you, whether emotionally, physically, or by other means. And yes, I've had that happen as well.
I do have a great deal of sympathy for those suffering from such conditions, but my own self-preservation (and sanity-preservation) instincts also kick in after a time.
Much excellent discussion here, I might add, thanks all.
But are heart disease and cancer "somewhat more treatable" inherently, or because more resources have been devoted to finding and testing treatments that work for them?
Or both. Brain is arguably the most complex system in the human body, and understanding of how it works is, AFAIK (I'm not an MD or a scientist), still not very comprehensive, much less than, for example, the heart. Treating extremely complex system which we don't know how exactly it works and are very limited in experiments (pigs or mice can have hearts not unlike ours, but their brains probably differ much more and while one can observe heart disease in mice, I wonder how you could observe mental illness like schizophrenia?) would probably be not easy at all.
I think it's more that anyone can get cancer, or heart disease... But I am never going to get schizophrenia- I'm not crazy!
It's perfectly rational for a disease that can strike anyone to generate more fear (therefore funding) than one which everybody believes they're immune to.
