Commentary : Policy Makes Short Shrift of Mentally Ill

The county mental health system is proceeding with a misguided new policy that promises to pull the rug out from thousands of lower-income people who need and want mental health services.

The policy, rationalized by a supposed funding shortage, will effectively prohibit the county’s community mental health clinics from treating all but the most chronically or dangerously ill. If this policy is allowed to stand, I believe that we as a society will pay a tremendous price in both dollars and human lives.

In the future, we are told, the community mental health clinics will provide little or no “talking” therapy to their thousands of clients. Instead, most patients will find their treatment limited to a 15-minute visit with a psychiatrist and a prescription for expensive psychotropic medications--bought, incidentally, at taxpayer expense.

No longer will these people be able to meet with a qualified therapist and discuss their depression, their nightmares, their anxieties, their frustrations, their anger. No longer will these people have the opportunity to talk about the voices that urge them to kill themselves and others, or the panic that prevents them from walking into a grocery store.

Instead, they will be left to function as best they can, largely on their own, checking in once or twice a month to renew or adjust prescriptions.

But even these people will receive some sort of attention, limited though it may be. Numerous others whose problems are serious, but not life-threatening, will simply be turned away.

The community clinics will have no time for the couple on the verge of divorce, the man who exposes himself to young girls, the woman unable to hold a job because of her anxiety, the rebellious teen-ager flunking out of school, the woman who fears her own sexuality after being raped as a child, the military enlisted man who finds himself deeply depressed as his discharge date approaches, the woman who compulsively steals from department stores.

Family Services, which relies heavily on the community clinics to provide back-up assistance to families torn apart by violence, neglect, substance abuse and divorce, will be further overwhelmed.

There will be no place for those who have long made up the bulk of the community clinics’ caseload--the many people who are required by the courts and probation officers to undergo counseling. These people, who are often on the bottom rung of the economic ladder, cannot afford to seek counseling in the private sector. Without the low- or no-cost community clinics to turn to, they will be unable to satisfy the terms of their probation and will often wind up back in jail.

As a result, the prisons will become even more crowded, more families will be consigned to the welfare rolls and incarceration will end up costing taxpayers much, much more than therapy ever would. Worse, these troubled human beings will have lost an important opportunity to overcome their problems and lead healthy, productive lives. They may serve their time, but their obsessions and pathologies will go merrily on.

Along the way, we will have effectively dehumanized a very human and caring profession. Therapists in the county mental health system, already overworked, underpaid and burdened with paper work, will leave in droves as this policy takes us closer to a medical model that deprives people of counseling services that they need and deserve.

Is this what the public really wants? Is this the best we can do for those among us who are most in need of our compassion and support? Should we devote all our resources to the dangerously ill? Is it right to ignore the many average citizens who have limited finances but still need a little help to get through a difficult time?

These questions, which dramatically affect the public’s money, safety and access to counseling services, should be answered in open meetings where citizens and mental health workers can participate in the debate. Instead, the policies are being made and regulated behind closed doors by a few top-level administrators who have never manned the trenches of the community mental health system.