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.