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.
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.
[1] http://www.washingtonpost.com/local/crime/virginia-state-sen...
[2] http://www.nbcwashington.com/news/local/Va-Senator-Recalls-S...