Every day, when I am walking to work, or just walking through the streets of downtown Washington, I encounter homeless people on the street. The homeless cover many categories, but prominent among them are those with serious mental illnesses. They know no boundaries of race or education; there was a prominent story last year in the Washington Post of a homeless man with schizophrenia who told a judge that he didn’t need a lawyer, that he was a lawyer. When the judge reacted with bemused skepticism, the man informed the judge—accurately—that they had been in the same class at Harvard Law School (which also included Chief Justice Roberts!)
I used to pass most of the people on the streets by studiously looking the other way, sometimes reacting with annoyance if someone was talking to himself or shouting. But after a difficult, 10-year journey of serious mental illness with my brilliant and talented son, which ended in tragedy, I have a different attitude. My son had, as an integral part of his illness, a phenomenon called anosygnosia, the inability to recognize you are ill. And given the laws and approaches in the country, since he was over 18 when he became ill, my wife and I were powerless to do anything to help. He did not end up homeless, or tased or shot by police, or abused or killed in jail or prison, which is the fate of many with serious mental illness. But he died at 34 from an accident shaped by his lack of judgment from his illness. I encountered in the worst possible way the tragic nature of these terrible brain diseases and the tragic failure of our policies to find ways to help reduce the pain and the costs, in money and heartache, that come with them.
Cultural dynamics and public-policy choices made my son’s problems, and those of others like him, much worse; our focus has been far more on less serious illnesses like anxiety and depression than on the most serious mental illnesses, and our deep and understandable concern about civil liberties has gone too far when it comes to those who either don’t recognize they are ill or have deep psychoses. For them, freedom of choice can mean homelessness, jail, or worse. Our commendable sensitivity to privacy also means that parents and other loved ones can be shut out of any role and knowledge of what their children, grandchildren, or siblings are encountering within the system.
In a larger sense, the roots of the current problems go back more than 50 years. One of the signature achievements of the John F. Kennedy administration was the Community Mental Health Act of 1963. Spurred by a broad and visceral reaction to the horrific conditions of those with serious mental illnesses warehoused in state mental hospitals, the president and Congress embraced a major reform: Release the patients and get them into community health centers, where they could get humane treatment and in most cases be able to live in their communities, with their families or on their own. The idea was to create a win-win—help people and save money by creating more efficient and cost-effective facilities.
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