justification for “what they’re for”…

Posted on Monday 1 September 2014

This is an extension of the last post and its comments, specifically:

  1. "and this graph suggests that the patients essentially moved next door into our prisons"
  2. " If there is ever a place where the parable of the blind men and the elephant fits like a glove, this is it"
  3. "I begin to wonder about diagnosis. How many have psychotic illnesses? Are these the homeless chronic patients who have been picked up for minor crimes? How many are primarily substance abusers?"
  4. "the time for decrying, blaming, or ignoring this has passed"
  5. "This effort should be lead by the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration"
We see the world through the lens of our own experience, our biases, our desires. What possible other sources can we rely on? So when we accuse the pharmaceutical industry of being driven by the wish to sell drugs, we are only stating the obvious. We are given to simplifying the motives of others while thinking that our own are complex, nuanced, well considered. It’s just what we do – over and over. Simplifying, discounting, blaming, even demonizing – all part of being human. And we enjoy nothing more that finding a like-minded cohort so we can all do it together. That cynical view I just expressed itself is an example of itself. We apply it to others, but rarely ourselves [see #2].

I posted a couple of graphics [what they’re for…] that paint the picture that chronic mental patients are being warehoused in correctional facilities because there’s no place else for them to go in the post-deinstitutionalization era. I believe that and I don’t think it’s a good thing. But I don’t really know how accurate those figures are and I really don’t know what the people who compiled those figures consider chronic mental illness. How much is substance abuse? How much is chronic psychosis? The figures I found are mostly compiled by the correctional institutions and subject to the bias of their feeling overwhelmed. In the comments to the last post, those questions were raised. We need accurate information, which is the only way to really understand the magnitude of this problem. And in-so-far as I can see, we don’t have it. And because of the variability of our states and state governments, it has to be a national information gathering for any accuracy.

When I read about it, there’s way too much "it has been estimated…" This is something we need to know, not estimate. And it’s science, epidemiology is what it’s called. And who should gather that kind of information? The CDC? The NIMH? SAMHSA? I expect they all have some version of that information, but it lags and if it’s in a usable form, I can’t locate it. That’s why I say, "This effort should be lead by the National Institute of Mental Health and the Substance Abuse and Mental Health Services Administration" [see #5]. Our NIMH has chased the very shaky World Health Organization data about the prevalence of mental illness and dire predictions of the future. But they’ve largely ignored this problem. And they haven’t taken the first step, defining the magnitude and nature of the problem. They’ve spent their time preoccupied with neuroscience and the monocle of psychopharmacology. The state of chronic mental health care in the US is the number one scientific question on the mental health table and prison is the logical place to start. In the comments, George Dawson says that the NIMH is a bad choice because it is a basic science organization. I happen to think epidemiology is a basic science par excellence. Likewise, the CDC, our traditional infectious disease tracker, needs to join in the gathering and tracking mainly because of proven expertise. The fact that we don’t know the magnitude and nuances of this problem is to our shame, all of us – thus Dr. Frances’ title " The Hall of Shame – Who Is Failing the Severely Ill?" [see #1, #3, #5].

The essence of science is to find out answers, or the best answers, to things we don’t know. We [human-kind] don’t know how to deal with chronic psychosis effectively, and we never have. We thought we had at least separated the problem of chronic psychosis from antisocial behavior and criminality, but the charts above suggest that even that was not a solid conclusion. So I personally think we need to start where we are rather that indulge our natural propensity to ignore problems we don’t know what to do with, to blame the state of affairs on each other, or to self-righteously decry how things are without taking action [see #4].

George Dawson suggest that this problem is the result of the influence of Managed Care or perhaps government agencies dropping the ball. Sandra Steingard suggests the surge of substance abuse problems and an adherence to the medical model might be part of the problem. DJ Jaffe implies that the organizations that should be involved are off dealing with lesser more lucrative issues. I happen to think all of those things and that our governmental agencies have become playgrounds for idealogues. But it doesn’t really matter what we think is the cause of the problem [see #2]. All that actually matters is that what already looks like a massive problem is getting worse, and we don’t have a solid handle on the details needed to understand it. Maybe I’m in left field thinking existing agencies can figure out how to get us the information in a detailed and unbiased form and put us on the road to a best case solution, maybe we need a Task Force, a Manhattan Project, a NASA…

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