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.