Major Mental Illness & Violence: Quick Fix vs. Commitment to Care
The barriers created by some managed care practices to access decent mental
health care have to be considered in light of the due process protections
of the IVX Amendment of the U.S. Constitution as well as the Title II provisions
of the Americans with Disabilities Act prohibiting insurmountable barriers
in access to health care facilities for the disabled. Surely the current
virtual barriers in access to mental health care facilities for the mentally
ill are as real as the steps and curbs to health care facilities which are
prohibited as barriers for the wheelchair bound.
Outpatient commitment for medication alone is no quick fix for lowering the barriers
in access to comprehensive treatment that prevent chronically psychotic patients
from receiving decent health care. The New York Times Magazine (5/23/99)
details the double tragedy of the death of hope for a young man with untreated
psychosis and the consequent all too preventable death of a young woman seeking
hope in New York City. The managed health care pressures which deny or curtail
any attempts at needed long term hospitalization for the mentally ill have
created barriers to access which are virtually insurmountable for the seriously
mentally ill and have resulted in the public system being overwhelmed. There
is a much needed recognition of how such managed health care pressures control
the practice of medicine and mental health care. What is needed is not an
outpatient commitment medication quick fix but the political and judicial
commitment to lower the managed care driven barriers to decent health care
for this relatively helpless and easily marginalized by stigmatization patient
population of chronically mentally ill.
