As it is now mid July and this thread is archived with the June contributions, I don't imagine anyone is reading this, but I have a little time on my hands this afternoon, So...
The trend to deinstitutionalize patients is generally a money driven decision and NOT based in our desire to advocate for the rights of our fellow man. When it becomes too damned expensive to warehouse people and/or "conventional" treatment modalities become too costly, we get creative. Or, the anal retentive, social control types allow folks like me to get creative.
We create viable, less restrictive, safer, and far less costly alternatives to the existing systems, but then when some authoritarian types have a brain fart and commit socially irresponsible acts of negligence and allow people to slip through the cracks, resulting in folks getting hurt, there is generally a public outcry and patients are then involuntarilly committed to place like Mid-Hudson Forensic, Kirby Forensic, or shipped off to the now popular and multiplying, Prison Psych Wards.
Here in New York State there were few Prisons with large psychiatric population, although it is debateable that most crime is a result of society's mental illness and our inhumanity towards our own fellow citizens. Most folks who commit acts of violence are generally folks who have had violence committed against them, live under horrendous conditions, are discriminated against and/or disenfranchised by the dominant culture of their community and as such react emotionally or out of a perceived survival necessity to provide for themselves and their families or for their protection.
It is interesting to note that folks who commit "White Collar" Crimes just because the feel entitled, and don't really have any pressing need to steal, embezzel, commit fraud, leverage stock deals etc... get a slap on the wrist from our lying, thieving politicians and judges because GREED is just normal and emotionally charged, outrageous acts of compassion or out of a need to survive and/or protect ourselves and our families are not "Normal" reactions to being screwed over and abused, neglected, starved, labeled, discriminated against, or attacked by our ANTI-SOCIAL Dominant SOCIETY.
Folks who are let out of the institutions as part of our more humane and far LESS COSTLY programs, are left without services, neglected, allowed to slip through the cracks when the cutbacks ineveitably follow the establishment of "CREATIVE, LESS COSTLY and LIBERAL" alternatives. Those less able to attend to their needs are then further isolated and alienated, refused employement and services and then end up back in the institution or a PRISON PSYCH WARD.
This works well for the "STATE" and the ANTI-SOCIAL Citizens of my STATE. It seems that whenever a "crime" is committed by a mental patient, there is a public outcry and the homeless mentally ill are swept off of the streets to places like "Jersey" or Connecticutt as there ain't no room at the inn in NYC, when the Street Crimes Units get into full swing. If they aren't shooting African Immigrant Street Vendors 19 times at point blank range (They actually fired 41 rounds) just because he's trying to accomodate them and is reaching for his wallet, they are rousting homeless mentally ill folks and running them into dangerous, overcrowded shelters, where they become victims of those street folks who prey upon them.
That's why most homeless folks would rather make their own accomodations and/or freeze to death on some cold nights in NY. Sleeping on subway grate to stay warm is often considered safer than the traditional alternative.
A few years ago a psychiatric patient known to the City of New York's Health and Hospital Corporation was experiencing relationship problems and his housing situation was unstable. He began experiencing anger and symptoms which he recognized as predictive and precipitive of a possible psychotic break. The patient attempted on four (4) occasions during a two week period to get himself voluntarilly admitted to two (2) different New York City Health and Hospital Corporation Psychiatric Units via their respective emergency departments. He was refused admission as the staff, I am told, didn't believe he needed to be admitted, and just thought he was a "skel who was lazy, and looking for free room and board..."
The patient did experience a break and a young woman was pushed in front of a subway train during one of the patient's psychotic breaks. The City was negligent. He attempted to get admitted, they refused him admission. He was sent to Mid Hudson and later to Prison as they convinced him he had committed that particular act of violence deliberately to get revenge for the CITY refusing his request to be admitted...
So, after being found Not Guilty By Reason Of Mental Illness, which generally is a LIFE SENTERNCE in New York, he was forced to further criminalize himself and plead guilty in hope of maybe someday being released from PRISON. They generally don't release folks who are involved in homocides and found NOT GUILTY BY REASON OF MENTAL ILLNESS.
Our savage society wants to punish folks for their inhumanity and negligence out of a sense of revenge. They attributed this individual's crime to revenge for their refusal to meet his demands. Actually, they refused to do their jobs, respect his medical needs, or respect the health and wellbeing of the entire community. The City was negligent, abusive and in a money driven, anti-mental patient rage, sought revenge for the injury and death of this individual which was directly attributable to their negligence. Yes, the inmate did commit the act, but the system was negligent and should have considered his request to be hospitalized, whether he expressed the need or documented the causes in a convincing way to the staff at the ER or not until the situation could be sorted out.
Most folks don't REQUEST to be admitted unless their is an obvious need of some sort. The need MAY NOT BE FOR HOSPITAL BASED CARE, and maybe financially or otherwise driven by circumstances faced by the patient, but until that is actually determined, it is incumbent upon the system to provide for both the safety of the individual seeking admissions as well as the potential safety of the public in the event they are WRONG!
Of course, then the patient needs to be redirected to the appropriate services to get their needs met in a safe, and in this case "COST EFFECTIVE" manner. These shifts in public opinion and policy are driven by both moral outrage, and money. Most decisions based upon a need to incarcerate, abuse, disenfranchise, imprison folks, or as in the past, LOBOTOMIZE, conduct FORCED STERILIZATIONS, CHEMICALLY RESTRAIN, PHYSICALLY RESTRAIN etc... often to the point of death, are embarked upon by ignorant people who fear their own darker thoughts, and are not intelligent or compassionate enough to attempt alternatives.
Most of us don't want anyone to be abused or imprisoned, but we don't want them in our neighborhoods with our children either, do we?
That's why the Padavan Bill exists in New York State. We can't open group homes for the mentally ill because the community has 2 years to lobby and engage in legal activity to prevent such homes from being placed in residential neighborhoods. They cite lowering of PROPERTY VALUES, and are afforded the opportunity to recommend alternative site selections in order to keep the mentally ill out of thier communities.
Of course, when it's their kids who are mentally ill it is a different story isn't it? So, alternatives are sought to get around the lengthy and costly legal battles which ensue over purchasing or leasing one damned suburban residence and modifying it to accomodate a handful of former patients. It's pathetic. Of course, Mentally Retarded and Developmentally Disabled Folks are far less dangerous, at least that is the public's perception. And so those projects are not hampered by legislative process in quite the same way.
We are all dangerous. I am a psychiatric RN, I've been a RN since leaving military service in 1983. Before becoming a RN I was part of the most effective killing force on the planet. I'm pretty damned dangerous. I studied war and researched the Operational Parameters of High Tech Warfare as an OPS/ADMIN/COMM specialist for the Pentagon, COMOPTEVFOR, NATO, etc... at one of the Navy's premier Weapons Research Facilities. I worked with Marines who guard Weapons of Mass Destruction as well. I also have a history of PTSD. Some folks would like to call it something else, but that is what it is. I have never been arrested, but have been discriminated against for years.
I am also the former DIRECTOR OF CONSUMER/RECIPIENT AFFAIRS for New York State's Office of Mental Health's Long Island Region (pop: 3 Million). I will not take their shit.
Hell, I may even kill 'em if they violate my constitutional rights again. Afterall, I served defending other people's rights and that constitution in a capacity as a government trained "Killer". I hope they don't piss me off again. I bet you do too!