Those with serious mental issues need 'asylum, in the good sense of the word'

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Editor's note: Today The Rochester Voice publishes its second of a four-part series on how and why those with mental health issues often end up in the penal system, what are some of the strategies posed to mitigate the problem and why all too often those strategies fail.

Today a look at one professor of psychiatry's vision that calls for restoring some degree of re-institutionalization - he calls it sanctuary - for those most severely ill.

Monday, New Hampshire's chief advocate for those suffering from mental health issues argues that re-institutionalization would be a bad thing and why funding for more community involvement and outreach is the only humane direction to take.

Tuesday, a look at what Strafford County and Rochester are doing to try to make the local Mental Health Court work for those in need.

About a month ago a person was arrested in Rochester for disorderly conduct for allegedly running into traffic at a busy downtown intersection multiple times during the afternoon and evening, the final two times after darkness had fallen.

They are still in jail, a fact that underscores the argument from a prominent Illinois psychiatrist and professor that people with severe mental health issues sometimes need more than counseling and meds.

"They need asylum, in the good sense of the word," declared Dr. Daniel Yohanna of the University of Chicago.

Dr. Daniel Yohanna (Courtesy photo)

In a 2013 article published in the AMA Journal of Ethics Yohanna likens his vision of what this "asylum" would look like to the ancient asylums of Greece and Rome where they were "a place where those who were persecuted could seek sanctuary and refuge. Those persons included debtors, criminals, mistreated slaves, and inhabitants of other states."

In a telephone interview with The Rochester Voice last week Yohanna noted that every state has laws that allow courts to order people into hospitals for their own safety.

"But this is a very underutilized procedure," he said, "However it sounds like this person should be hospitalized; the court should order treatment."

He said that what happens alternatively is that most wind up in the criminal justice system, where they languish in jail until they are ultimately found not fit to stand trial and released back on the street.

"That's no way to treat mental illness, to make them go through the criminal justice system," he said. "So we need more facilities for longer stays for this person, who needs asylum."

Another phenomenon that diminishes treatment outcomes is anosognosia, a condition that clouds an SMI sufferer's perceptions that they, in fact, are suffering from a psychosis.

"How do we help people that don't recognize they are ill?" Yohanna added. "This can be part of the disease."

Beside compromising orders to take meds or counseling, this also can place those afflicted at greater risk, he noted. "This person can do damage to others, even unintentionally," he noted.

Yohanna knows that there are many opposed to his stance like civil liberties advocates, but referring to the case in Rochester, he opined, "This is a (person) who is going to get hurt."

At its crux, Yohanna's argument is that the nation's prisons and jails should not be the largest provider of health services to the mentally ill.

"We need a protective setting for these individuals, not jail," he said.

To that end, Yohanna refers to the Treatment Advocacy Center., which says there should be 50 total mental health beds available for every 100,000 people.

"We used to have a half million state hospital beds nationwide (prior to deinstitutionalization in the 1960s). Now we have 100,000 across the entire country," Yohanna noted.

New Hampshire Hospital in Concord, the chief provider for the state for those with SMI, used to have 2,500 inpatient beds, according to John Broderick, Senior Director of External Affairs for Dartmouth Hitchcock Medical Center and the state's leading advocate for improving mental health strategies. Now they have anywhere from 130-140 beds on any given day, he said.

If New Hampshire followed the advice of the Treatment Advocacy Center, the Granite State would have some 650 beds.

To read Yohanna's 2013 article click here.

Tomorrow, New Hampshire's chief advocate for those suffering from mental health issues argues that re-institutionalization would be a bad thing and why funding for more community involvement and outreach is the only humane direction to take.

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