Diagnosing America’s Mental Health Failures
The United States, and California in particular, has had a terrible record in helping people with mental illness. California Governor Gavin Newsom’s Proposition 1 in March was the state’s largest effort to address the crisis, but it barely passed. People agree there’s a problem, but they’re divided on the solutions. That’s why Alice Ferrer’s new book, American Madness: Fighting for Patients In A Broken Mental Health System, is so valuable.
Ferrer is a longtime clinical psychiatrist in the Bay Area. Her book provides a diagnostic approach to addressing the mental health crisis and is required reading for anyone in the Newsom Administration who is implementing Proposition 1.
Feller’s book is characterised by her personal experiences that allow readers to clearly understand the failures of a system: she found that at nearly every stage of her career — in medical school, hospitals, private practices and community clinics — systems that fail, almost intentionally, to deny people with serious mental health issues the treatment they need.
Ferrer highlights three factors that stand in the way of a solution.
What is most in need of treatment?
First, the mental health care system seems designed to minimize and prevent the acute medical care needed by people in mental crisis. The system empowers people whose medical and psychological problems prevent them from understanding their own needs. So if they don’t take the medication prescribed, that’s their choice. And if they don’t want to take the medication needed to stop them from walking down the street screaming, that’s one of “their” choices.
Feller cites progressive advocates who believe hospitals are as bad as prisons for the seriously mentally ill, and who argue that psychiatrists should not be trusted.
When I was interviewed by the media during the Proposition 1 campaign, I was told that the film One Flew Over the Cuckoo’s Nest The film created false and harmful stereotypes about mental health facilities. Feller reaches the same conclusion. She analyzes the film and contrasts it with the real-life events on which it is based. Ken Kesey’s portrayal of nurses tormenting patients whose only “problem” is their non-conformity has no basis in reality.
However, many progressives believe that the stereotype of the evil ratchet nurse is a reality today, which is why they encourage patients to avoid doctors and necessary treatment.
One may wonder why California and the Bay Area have so many homeless people with serious mental illnesses, when the system gives them “freedom.”
A money-driven health care system
Feller is not the first to lament how money influences medical decisions in the United States, but she highlights a pattern of “upcoding” by medical clinics that results in most, if not all, patients being diagnosed with “schizophrenia.” Why? Because that’s what gets them the most compensation from the government.
Feller shows how the money-driven system has seeped into Board and Care homes. I’ve been a supporter of Board and Care since the 1980s, when Leroy and Kathy Looper ran their home on Guerrero Street in San Francisco (it was called Chateau Agape and was featured in The New Yorker). I’ve long argued that San Francisco made a huge mistake by not subsidizing Board and Care, even though its decentralized model seems the best approach for people who cannot live independently.
But Feller shows how corporate chains have taken over Board and Care, and she never found the same compassion that Loops showed for its customers: Board and Care has too often become a detention center with no real treatment taking place.
Unresponsive bureaucracy
Dr. Feller’s efforts to learn more about patients from others through her multiple jobs are a third obstacle to success. She tells story after story of missing patients who desperately need and would benefit from her care. She is viewed as an outcast by others who are only willing to do the bare minimum to get paid.
Ferrer gives the example of someone who tried for months to get another doctor’s email address so she could contact him about a patient, but didn’t receive the first email until near her last day on the job.
Feller has left multiple jobs because she believes the health care system is broken. And the sad effect of this broken system is that it drives out dedicated and courageous doctors like Alice Feller. Those who want to stay in the system have to ignore the nonsense of bureaucracy, and so much of the best talent leaves.
Is there any hope?
However, Ferrer does take a deep dive into what has caused our mental health system to fail and explains what needs to be done to fix it. Many of the reforms she recommends seem surprisingly easy to implement.
Will you change billing procedures so that patients’ actual conditions are documented? Will you build communication between case managers, physicians, and others involved in the care process? Will you accept that severe mental illness often requires a medical response?
Ferrers American Madness It offers a roadmap for fixing our broken mental health system, and is a must-read for anyone interested in mental health reform.
Category: Book reviews
