'It's Just a Sin:' With Nowhere to Go, America's Mentally Ill Often End Up on the Streets

Tens of thousands of people live on the streets of our most beloved cities. It's unsanitary and unsafe. One psychiatrist who closely examined Skid Row, the notorious section of Los Angeles that has widely become known the worst and most profound depiction of America's homeless crisis, says many people who wound up there as well as in nearby hospitals and jails are mentally ill and simply had nowhere else to go.

Psychiatrist Kenneth Paul Rosenberg documented America's mental health crisis in the award-winning movie, Bedlam recently released in book format.

Good Intentions

Dr. Rosenberg told CBN News today's homeless crisis can possibly be traced back to the last bill signed by President John F. Kennedy. In 1963, the Community Mental Health Act closed America's insane asylums. While this law meant to end the often barbaric treatment of the mentally ill, to include Kennedy's own sister Rosemary, who suffered a lobotomy at the age of 23, leaving her unable to speak the rest of her life, the move also led to unintended consequences. 

"Well the road to hell is paved with good intentions and I think that's a great example, the deinstitutionalization," he said, adding, "The result was, he created Community Mental Health Centers, but those Community Mental Health Centers were not prepared for the sickest people from the asylums. What's more, President Reagan in the 1980s canceled the funding, the federal funding, for those. President Reagan said, 'Let's give this problem back to the state and have the state asylums take care of it.' Well, the states, they didn't want it back."

In short, after the asylums closed, most people who suffer from a serious mental illness, the kind of issue that formerly led to institutionalization in asylums, were never given a viable alternative. 

Dr. Rosenberg says while people with serious mental illness were mistreated in the asylums since they closed, people with SMIs today are too often under-treated or not treated at all and end up living on the streets or made "mental illness a crime." 

"We've put them in jails and in cages and the streets, Skid Row and all kinds of dreadful places," he said, "And we've relegated them to backward and delegated their care to jails. That's just a sin if you ask me, and that's something we really have to correct."

The Sickest of the Sick

An estimated one in five Americans suffers from a mental illness, such as depression. While these conditions are troubling and warrant attention, health experts say one in 25 Americans have what's known as Serious Mental Illnesses, or SMI, that renders them utterly dysfunctional. These include schizophrenia, bipolar disorder, suicidal depression or severe Post Traumatic Stress Disorder. 

Dr. Rosenberg says an estimated 11 million Americans have a Serious Mental Illness and too many of them end up either homeless or behind bars, often passing through overcrowded hospitals.

"Los Angeles is the epicenter of this crisis. The largest mental institution in this country is the L.A. County Jail," he said, "The largest collection of people outside is Skid Row. Skid Row is kind of like a day hospital, if you will, for people with Serious Mental Illness."

Add to this equation, an estimated eight out of ten people living on the streets struggle with addiction. For the mentally ill, that's like pouring gasoline on a fire. 

"We know there are factors that can bring mental illness out of the woodwork, open a window if you will, on serious mental illness that would otherwise be closed," he said, "What are those factors? Poverty, trauma, going to jail, unfortunately, most of the mentally ill end in jail nowadays, and above all else, substance abuse," adding, "they self-medicate with drugs to feel better. They use drugs to get away from themselves. They fall into a terrible lifestyle." 

'They Don't Know What They're Doing'

Dr. Rosenberg says there's a saying within the mental health profession: "Jail is the bed that never says no."
That means people with mental illnesses that society doesn't know what to do with, take them to the nearest and easiest place.

"People with mental illness get picked up for petty crimes. They commit minor infractions. They don't know what they're doing. They'll shoplift. They'll steal but easily get caught. They'll do some drugs either through self-medication or homelessness and they end up in jail."

Dr. Rosenberg says police officers on the beat told him dealing with untreated mentally ill people occupies a good deal of their time. 

"The sheriffs and the police aren't trained to be social workers. They didn't go into law enforcement to take care of people with mental illness," he said.

For the mentally ill, a short stint in jail for a minor crime can easily escalate to serving hard time.

"They don't show up for their court appearance. They don't show up for their probation hearings. Before you know it, they have one, two, three strikes against them and they end up in prison."

Concrete Solutions

Although this perfect storm may seem hopeless, Dr. Rosenberg offers concrete solutions, starting with community treatment centers. 

"These are terrible diseases, but people can get better," he said, "They may not be curable, but they are very treatable."

He also advocates expanding the number of mental health courts. "We can mandate treatment for people who are too sick to know that they need it."

Dr. Rosenberg says the public should demand better drugs to treat mental illness, ones that are more effective and carry fewer side effects than the ones associated with today's medications such as weight gain, lethargy, sexual problems. Half of the patients with SMIs stop taking their medication during the course of their treatment.

"The medicines we're using today for serious mental illness today are 70 years old," he said, "I think that's absolutely terrible. God forbid you have breast cancer, God forbid you have colon cancer. You're going to get a treatment that's two or three years old. Not one that's 70 years old."

What You Can Do

An estimated one in five American families has someone suffering from a Serious Mental Illness.  Just as certain lifestyle factors described above can intensify mental illness, others can mitigate the symptoms.

"What makes serious mental illness better?" Dr. Rosenberg explained, "Certainly decreasing stress makes mental illness better. First of all, a healthy lifestyle like good eating, going to bed at the right time, staying away from drugs," he continued, "Also, having good spiritual practices, being engaged with your community, having good relationships, optimism, having people around you who support you. These things will help a serious mental illness. They may not cure it, but they'll help significantly."

Doctors say psychotic illness typically comes on between ages 17 and 21 and the longer the brain goes untreated the worse it becomes. So early intervention is key. Red flags include being disconnected from reality, exhibiting extremely abnormal behavior and hearing voices, particularly from animals or objects. 

"There are leaders in your community, in your church in your synagogue who can help you think this through. The clergy are very proficient in understanding how to deal with this and how to send you to the proper health care providers, people who will be consistent with your own spiritual practices."

Dr. Rosenberg also recommends contacting the National Alliance on Mental Illness through its website or by calling (800) 950-6264.