“Mental illness is highly treatable, and many cases can be completely eliminated with effective treatment, or they can be managed effectively so that people can go on living rewarding and effective lives,” Dr. Mueser said.
“When someone’s mind is taken over by psychosis, the consequences are epic,” Dr. Rosenberg said. In lieu of jail, he advocates “therapeutic jurisprudence that leverages the mentally ill who tangle with the law toward health, not jail.”
He added, “We need to create laws that are more amenable to getting treatment for people who don’t know they’re sick, because people who don’t know they’re sick will fight against treatment. We also need more beds in a place that feels inviting, not a jail by another name.”
A major stumbling block is fear of two of the most effective treatments, especially for patients with severe mental illness who have failed to respond to other remedies: the drug clozapine and electroconvulsive therapy (ECT). As currently administered, the serious side effects of decades past are avoidable.
“Clozapine has been a miracle drug for many people, giving them a new lease on life,” Dr. Mueser said. “And ECT is not given to as many as would benefit from it. It still suffers from the very outdated depiction in the 1975 movie ‘One Flew Over the Cuckoo’s Nest.’”
Still, Dr. Rosenberg is optimistic. “Something unprecedented is happening in America,” he wrote. “We are no longer standing by helplessly as our family members get thrown away by society without care, taking outdated medicines, living in cells or on the streets.”
I can only hope he’s right, if not now then in the near future.
Meanwhile, there are resources that can help guide troubled families to needed services, like the National Alliance on Mental Illness. Dr. Rosenberg’s book also provides lots of practical advice both in accessing effective medical care and using the law. One suggestion I found intriguing is the creation of a psychiatric advance directive, a form for which is available at nrc-pad.org, to help guide families and therapists when a patient is in the throes of a psychotic episode.