by Joseph Merlin Bowers

I first started in treatment for a serious mental illness in 1960. I was first hospitalized in a state mental hospital in 1964. Off and on I have been involved in mental health as a patient or advocate every since. In those 59 years I have seen many changes in the mental health system, society, public perception and public awareness.

Available medications and treatment programs and options have come a long way. Paradoxically, the likelihood that a family like mine of limited means dealing with mental illness will be able to access available treatment is much less. Those that do get the help they need do so with great difficulty.

It used to be too easy to get someone committed involuntarily. Now it’s too hard.

There are many fewer psychiatric beds available now than in the past. The number steadily declines. In some states like Colorado where I now live there are almost no long term care beds for civil patients.

Many state hospitals have closed. The remaining ones house many fewer patients than previously and have been largely transformed from civil institutions to forensic institutions. Civil patients unable to access needed care often wind up in the criminal justice system. This creates greater demand for forensic beds. This unfortunate situation is self-perpetuating.

The hospital psych wards that came about to replace vanishing state hospitals have mostly been closed because they were losing money and converted to profitable uses. Although parity laws have been passed they are not widely adhered to. The last time I was seriously psychotic (1986) I checked myself into a psych ward and was kept there until much better. This is a very uncommon occurrence nowadays.

It is easier for someone with a mental illness to get various types of disability and government funded incomes, but the well intended laws are poorly written. As an example: a person on SSI loses it if he accumulates as much as $2000 dollars in savings. As the end of a month draws near, people are frantically spending money on unneeded, unwanted things to avoid losing their benefit. You tell me how this makes sense or helps them better their living situation.

Stigma among mental health professionals is less widespread. When hospitalized in the ’60s no one saw any point in telling me anything such as my diagnosis, prognosis, available treatments or success rates. The psychiatrists I saw then largely asked prying, personal questions, took notes and offered no reply, comment or feedback. Bedside manner is generally much better these days. Good professional, patient communication is more common. While there are still professionals with disdainful opinions of the mentally ill, this is less commonplace.

Much of the responsibility for dealing with mental illness has shifted from the mental health system to the criminal justice system.

There is greater awareness that we are in a mental health crises.

Younger people have less stigma about mental illness. They are much more likely than older people to admit to a diagnosis and talk about it. Many though are disdainful of medications. Because smoking pot makes them temporarily feel better, they think that pot is what they need.

Civil patients are commonly turned out with little support before they are ready to reenter society. This frequently results in a preventable tragedy or a wasted life.

Many, many things that were previously considered personality traits are now included in DSMs (Diagnostic and Statistical Manuals) as diagnosable mental illnesses. I suspect this is because the industry is driven by insurance companies and people want to get paid for all the treating they do or receive. The unfortunate result is that resources are diverted from those with truly debilitating conditions.

I think there is greater awareness that much tragedy could be prevented and money saved if we did a better job of getting people into treatment before their illnesses got to stage four. People are starting to realize that substance abuse should be and is more effectively treated as a disease and not as a crime. There is almost always an underlying mental condition involved in substance abuse.

There is greater reluctance to use terms like mental illness, crazy or the like. Yes words matter but when someone like me with a mental illness objects to terms like these, I am acknowledging that there is something shameful about having a mental illness-self-stigmatization.

More people are speaking out about their illnesses. This results in less fear and ignorance-the basis of all prejudice and discrimination.

The homeless population rather than fluctuate with the economy as was the historical pattern, hit a high level decades ago and has stayed high ever since. Our jails and prisons are shamefully overcrowded. These are to a degree unintended consequences of deinstitutionalization.

This is a pretty good summery. I’m sure I’ve failed to think of a few things.