Mental Health System's Flaws Revealed by Charlotte Tram Homicide
In the realm of mental health care, a significant challenge lies in addressing the needs of individuals who do not accept psychiatric treatment, often referred to as "the untreated." This group, unfortunately, constitutes a portion of the population living with serious mental illnesses like schizophrenia or bipolar disorder, which affect around 6% of American adults.
While many individuals with serious mental illness accept and benefit from psychiatric treatment, usually in the form of anti-psychotics, the untreated population faces a higher risk of criminal activity, homelessness, and forced hospitalization. Anti-psychotics, while helpful, have an efficacy rate of around 50% in most studies, with a maximum of 87% after one year.
The larger problems, however, are getting patients to take their medications as prescribed, ensuring long-term compliance with treatment plans, and responding appropriately to medication-resistant mental illnesses. A shift away from the "recovery" paradigm is necessary to address these challenges, with a focus on creating lower-cost, long-term environments for people who do not recover from mental illness. These environments should be less medically focused, providing support and care that goes beyond just medication.
The cost of the current recovery-oriented psychiatric hospital system is approximately $180,000 per person per year. As we have lost up to 90% of our psychiatric bed capacity over the past few decades, finding new solutions is more important than ever.
The issue of public safety is also closely linked to mental health care. Untreated psychosis and schizophrenia, especially when combined with illegal drug use, are associated with higher risks of violence and criminal activity. The connection between crime and serious mental illness is recognized as real, and it is essential to find ways to ensure that individuals with mental health issues receive the care they need, rather than ending up in the criminal justice system.
Devon Kurtz, the director of public safety policy for the Cicero Institute, is advocating for changes in this area. While there is no direct information about his academic or institutional background, his focus on public safety policy in the context of mental health care is crucial. He emphasizes the need for psychiatrists to have broader latitude when individuals repeatedly refuse medication or their symptoms fail to improve with consistent dosage.
Moreover, a strict legal framework governs coercive medical interventions, such as involuntary administration of anti-psychotic medication. Courts require that patients receiving involuntary treatment be released to less restrictive environments as soon as their symptoms abate sufficiently. This balance between individual rights and public safety is a complex issue that requires careful consideration and ongoing dialogue.
Recent tragedies, such as the senseless murder of Iryna Zarutska on a Charlotte, North Carolina, light-rail train, underscore the urgency of finding solutions. As we navigate this complex landscape, it is essential to remember that mental health care is a fundamental human right, and every individual deserves access to the care they need.
Most Medicaid patients have no out-of-pocket costs for antipsychotics, making affordable care a possibility for many. However, ensuring that individuals seek and continue treatment remains a challenge. It is a call to action for all of us to work together to create a more compassionate and effective mental health care system.
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