Bedlam is the Mental Healthcare Version of Fast Food Nation

Photo by Yeyo Salas on Unsplash

Bedlam, Dr. Kenneth Rosenberg’s raw, candid documentary on the mental health crisis in America is difficult to watch. But if you want to understand why America has tent cities in Los Angeles, San Francisco, New York, and elsewhere; If you want to understand why the majority of these individuals, even if given the opportunity of shelter refuse; or if you are just fed up by all the insanity on our streets, Bedlam explains how we got here.

“This is a 150-year-old disaster that ended up being the largest social disaster of the 20th century and now of the 21st century,” Rosenberg said.

The psychiatrist and Peabody Award-winning documentarian, has spent the last twenty years investigating how our country reached this mental healthcare tipping point. It’s not just one president, but the responsibility of 10 presidents who were misinformed or looking for ways to cut spending. It’s not just one federal or state regulation, but the compounding of laws that have straggled any chance of compassionate care, and the ability to properly and ethically treat those with serious mental illness.

There’s is not a soul alive who would deny that the state asylums of the 1950s and 1960s were anything less than an abomination. That abuse and mistreatment of the mentally ill scored so high on the horrific meter of life, every one of these facilities will never be missed. The barbaric treatment of electric shock therapy, lobotomies, insulin coma therapy are thankfully long gone. But in an eagerness to cleanse these memories from our consciousness, we threw the baby out with the bathwater.

Part of this shift happened through the unexpected discovery of Thorazine in the mid-1950s, an antipsychotic that would squelch psychosis and hallucinations, along with the revival of Lithium to manage mood disorders. These drugs were viewed as a panacea. Those suffering from severe mental illness finally had a chance to live outside the asylum walls. Over the next 70 years, pharmaceutical companies would tweak the drugs and re-patent them under new names; however, they were fundamentally the same, Rosenberg said. This approach, of course, more lucrative than funding research that addressed the root cause of the diseases.

Then in 1963 former President John F. Kennedy passed the Community Mental Health Act, with a focus on community-based treatment, rehabilitation, and prevention. The goal had been to develop 700 to 800 local community centers with federal funds. The long-term objective was to deinstitutionalize mental healthcare by creating a compassionate community care approach. And so, our problem began.

These drugs were not a magic bullet. They had significant side effects and required prescription management. After being discharged to the streets with a handful of meds, how were these individuals supposed to survive without continuity of care? They had no shelter, food, or employment. How was any of this supposed to work?

Although the goal was noble and humane, the follow-through was a travesty. Kennedy’s idealistic vision never came to fruition. Federal funds initially provided were withdrawn. Legislators decided that the onus should be put on the states to fund community-based care.

The states didn’t want nor did they have the funds to do so. In the 1970s when then California Gov. Ronald Reagan decided to take away the state’s federal funding for mental health, hospitals started closing and deinstitutionalization began in earnest. California became the “canary in the coal mine,” said Rosenberg. Today California has more people on the streets with severe mental illness than anywhere else in the nation.

In the 1950s state hospitals housed 558,000 patients, today 90% of those beds are gone. However, serious mental illness didn’t vanish with these beds. These diseases and the people suffering are still here. And so, our country needed a solution.

We could have passed mental health legislation to fund and build compassionate care hospitals. Facilities where those with severe mental illness could stabilize under proper medical care. Once stabilized, these individuals could have re-entered the community.

We could have passed legislation that would fund safety net programs pivotal to successful mental health outcomes. Recidivism rates would have dropped exponentially as would the cost of re-hospitalizations.

This would have required a bold stroke of courage from the medical community such as the American Psychiatric Association (APA) or state legislators, but nothing was done. Everyone brought into the notion that deinstitutionalization was the humane way to handle mental illness. Clearly, healthcare professionals must have known this was a somewhere-over-the- rainbow dream.

Instead, America took another route — we criminalized mental illness and replaced hospitals with prisons.

We decided that all these suffering, psychotic souls who ended up with repeated misdemeanors for petty crimes (because in their delusional state they had no wherewithal to understand their behavior) would be better off in a jail cell then getting help for being sick. The cliché “out of sight out of mind” worked for everyone until it didn’t.

The three largest jail facilities in our country, the Los Angeles County Jail, New York Riker’s Island Jail, and Chicago Cook County Jail are now the largest mental health facilities in our nation. One of the twin towers in the L.A. County Jail initially designed to house high-security criminals was repurposed for the mentally ill. According to then California Lt. Gov. Gavin Newsom, there are about as many people in the state’s prisons with mental illness as there were in the state’s hospitals in 1960. That number is 37,000.

Essentially, our prisons have become our 21st-century mental health hospitals. To rid our nation of this ugly solution, the documentary emphasizes we need more beds not more cells. We need to build more hospitals not more jails.

Fifteen-million American families are living with serious mental illness and the numbers are not improving. The amount of emotional heartache and frustration is immeasurable. The amount of economic and financial costs (direct and indirect) is pegged at $5 trillion, according to the National Institute of Health.

As one emergency room psychiatrist said, “The way we treat the mentally ill in this country is insane.”

Bedlam is streaming on PBS. The network is broadcasting the documentary for free through the end of October in support of mental health awareness.