Serious Efforts Needed to Fight Mental Illness

My 49-year-old brother is diagnosed as “schizoaffective.” This is a chronic mental illness consisting of bipolar (manic-depressive) disease with some symptoms of schizophrenia. Five years ago, he had fallen through the cracks in Kern County and was living on the streets in a Central Valley city. When he stopped taking his medications, his resultant psychosis led to a brief imprisonment.

I brought him to Orange County to offer greater assistance in navigating a county mental health system. Before this, I had no experience with the system in Orange County, but my sister and I knew that my brother needed family support.

More than 570,000 people with some form of mental illness live in Orange County. About 85,000 of these are severely mentally ill and disabled. Presently, about 30,000 of this group are under the supervision of the Health Care Agency, Behavioral Health Services.

Dr. William E. Callahan Jr., president of the Orange County Psychiatric Society, says that the optimum treatment for a chronic psychotic illness such as bipolar disease and schizophrenia should include, according to the situation, the following:

Appropriate psychotherapy and medication management, preferably by the same psychiatric physician, accompanied by family involvement. Both frequently can help the patient to become productive and return to society.

In addition, the patient ideally would obtain assistance in locating housing, job training, arranging for hospitalization if needed, and coordination with the family.

The reality is that a patient who suffers from a chronic psychotic mental illness in the HCA system is seen for a short consultation (15 minutes) by a psychiatrist who then prescribes medication. Assuming the patient is not psychotic, he or she then sees the psychiatrist every four to six weeks for another short consultation. The psychiatrist has absolutely no time to assist in intensive psychotherapy.

Care coordinators, many of whom are hard-working, conscientious employees, are generally overworked and handle huge caseloads. Because of this, many patients simply leave the system without getting assistance. Once off their medication, they descend into the depths of their illness. This in turn eventually leads to psychosis and either hospitalization, arrest, or in the worst case, suicide.

Finding adequate housing is another obstacle. Facilities in the county offer different levels of services and quality. For example, last August, my brother’s board and care failed for three weeks to give him his anti-psychotic medication. He became psychotic, but fortunately our family was able to have him involuntary committed to the hospital. It took him three months of treatment to become stabilized during which he was often terrorized by delusions. In addition, such homes are in short supply. Orange County has only 820 beds in a board-and-care setting.

Fortunately in Orange County, there are some nonprofit organizations that offer additional help. These include, among others, the Mental Health Assn. of Orange County, NAMI Orange County, HOMES Inc., and Get Involved for Mental Health. However, even the combined effort of the county and the nonprofits is not enough to provide adequate services.

Given the limitations, the county probably does reasonably well when compared to other counties of similar size. Many employees are top-notch, caring, compassionate and hard-working. Unfortunately, they are handicapped by a system that provides too little financial support. Measure H, now under legal attack by the Board of Supervisors, may provide some additional money to enhance and improve county services to the mentally ill.

The financial limitations experienced both in our public and nonprofit institutions are a direct result of our society’s tendency to continue to view mental illness in a harsh and unforgiving way. It is not popular to espouse the cause of mentally ill persons. Many of us still regard them as castoffs, lazy and good-for-nothing. Such attitudes are particularly unfortunate at a time when pharmaceutical companies are producing medications that enable seriously mentally ill patients to reach remission.

There is no rational justification for our community to continue to ignore these diseases. Our current indifference results in many being incarcerated for relatively minor crimes committed during a psychotic episode.

The irony is that we are willing to incarcerate a mentally ill person at a cost of about $25,000 a year while outpatient treatment through the county can be obtained for about $6,000. Treatment would allow that patient to avoid the commission of a crime in the first place.

This nation spends hundreds of millions of dollars in fighting various illnesses such as AIDS, breast cancer, diabetes and heart disease. We need the same type of dedicated effort to fight the scourge of mental illness. It is time for everyone, including the media, to address this problem.