Recovery From Schizophrenia: Psychiatry And Political Economy

268 DESEGREGATING SCHIZOPHRENIAAt that time, such ideas seemed to be impossible dreams. Now, as the last chaptershowed and as this one will show, they are well within reach. Seen from thisperspective, treatment becomes more than just a matter of providing services topatients and their relatives—it becomes social action, political lobbying andcommunity education directed towards the desegregation of a minority group.ESCAPING THE GHETTOThe ghettoes of the long-term mentally ill are the inner-city boarding homes,Skid Row missions, nursing homes and jails. How do we help them break out? InBoulder County the mental health center has never placed physically healthypeople with schizophrenia in nursing homes. The administrators of the centeractively discouraged local nursing home operators from opening wards forchronically ill psychiatric patients, arguing that nursing homes cannot provide anadequate quality of care and environment for such patients. Federal legislationnow prevents the expenditure of Medicaid funds to treat physically healthymentally ill people in nursing homes; this statute reduced one of the worst abusesof psychiatric patients in the US.An outreach team from the mental health center goes to the Boulder shelter forthe homeless every week, and when mentally ill people are located there or livingon the streets, efforts are made to provide treatment and find adequateaccommodation. Another outreach team goes to the local jail with a similarmission. 3Harmful and degrading though it is, large numbers of people suffering frompsychosis are ending up in US local jails (as described in Chapter 8). To cope withthis problem it is important that mental health agencies accept that the local jail ispart of their community and supply outreach services to the inmates. The objectof such programs should be to arrange the transfer of all inmates suffering from anacute psychotic disorder to an appropriate treatment setting. This goal requiresthe development of working relationships with criminal court judges. Only inthose rare instances when a judge will not release a mentally ill person because thecrime is too serious, or when an inmate with a psychotic illness refuses to betransferred to a treatment setting and is too mildly disturbed for involuntarymeasures, should we resort to treating people with psychosis behind bars. 4It has, in fact, become routine in most areas of the United States for peoplesuffering from psychosis to be treated in jail with antipsychotic drugs and to bedetained for extended periods—largely because the public mental hospitals arefilled to capacity and offer only brief care. Often the people with psychosis whospend most time in jail are those who have proved particularly difficult to treat incommunity programs. Special programs can be developed for some of thesementally ill offenders.