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Striking down the stigma 

A behavior health hospital in Templeton would provide needed services as California falls short in supporting the mentally ill

Mental disorders are physical diseases like diabetes, cholera, and asthma. The term mental illness refers collectively to all brain diseases. Many (not all) of the conditions called mental illness are caused by a combination of biological, psychological, and environmental factors. The biological factors link many mental disorders to certain chemicals in the brain that are either out of balance or are malfunctioning.

Psychological factors deal with childhood experiences and include psychological trauma from physical or emotional abuse, a significant loss—e.g., loss of a parent—violence, and neglect. Environmental factors are the extreme stresses that trigger mental illness. Examples of such stresses include death in the family, divorce, living in poverty, dysfunctional family situation, and low self-esteem.

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Why are homeless and incarcerated mentally ill are not institutionalized where they can get mental health treatment? Most mental health professionals trace the problem to former President Ronald Reagan. One-third of homeless people and one-half of all the people behind bars have mental illness. When Reagan was elected president, he discarded a law that had been proposed by former President Jimmy Carter. The law would have continued federal funding of community health centers. Reagan’s action practically eliminated all services for mentally ill.

In developed countries, funds are allocated based on national priorities. The United States spends more on military than the next seven countries combined (China, Russia, Saudi Arabia, France, United Kingdom, India, and Germany). The federal government spends billions of dollars on space missions to other planets. Where is mental health in the order of national priorities? The budget Act of 2015 provides an additional $80 billion, allocated equally between the military and domestic programs. It is no secret that fraud and waste in the military spending are widespread. A very recent example is a $43 million gas station in Afghanistan. The special Inspector General for Afghanistan wrote in a scathing report that a similar gas station in Pakistan cost only $306,000, i.e., Afghanistan station cost more than 140 times as much. Instead of allocating more money, doesn’t it make sense to first ensure that the money already allocated to the military is being spent prudently? Financial waste in the military and under-funding of domestic programs like mental health is a losing proposition.

A 2014 World Health Organization (WHO) report indicated that rates of most mental illnesses are much higher in the U.S. than any other country in the world. The report stated that 27 percent of the U.S. population suffers from some type of mental illness. WHO researchers consider 27 percent to be understated because many people prefer not to disclose their mental illness because of attached stigma.

Approximately 60 percent of adults and almost 50 percent of youth ages 8 to 15 with serious mental illness in the U.S. did not receive any treatment during the previous year. Suicide is a tragic outcome of mental illness. In the U.S., according to the Centers for Disease Control, suicide is the third leading cause of death for ages 15 to 24 and the fourth leading cause of death for ages 18 to 65. The total number of U.S. deaths from suicide was 38,364 in 2010. The suicide rate among Americans between 35 and 64 increased by 30 percent from 1999 to 2010. For the year 2012 the suicide rate was 12.1 per 100,000 people in the U.S. The rate for California was 10.3 per 100,000 people in 2013. San Luis Obispo County had 16.8 suicide deaths and Los Angeles County 7.7 suicide deaths per 100,000 persons in 2013.

Half of all mental illnesses cases begin by the time a youth is 14 years old and three quarters begin by age 21, according to the National Institute of Mental Health. In California, hospitalization of people age 21 or under increased by 40 percent between 2007 and 2012 because there is an acute shortage of intensive follow-up services after youth are discharged from hospitals. The capacity of group-home beds went down from 17,000 beds in 2004 to 11,000 beds in 2013 in California. California has 33,000 mentally ill in prison because the five state psychiatric hospitals can accommodate fewer than 6,000 patients. A federal judge ruled that California’s treatment of mentally ill prisoners is cruel and unusual punishment and a violation of the U.S. Constitution. There is excessive use of pepper spray, excessive use of force, and isolation. Nationally, the population of seriously mentally ill who are incarcerated is 10 times that of those in all state mental hospitals according to a report by the National Sheriffs Association and Treatment Advocacy Center.

Despite the fact that there is no logical reason to stigmatize the mentally ill, the practice is widespread. The lack of an inpatient psychiatric facility in San Luis Obispo compels those who can afford to go to psychiatric hospitals to travel as far away as Sacramento and Los Angeles. It creates financial hardship, worry for not being able to visit the family member in the psychiatric hospital daily, and increased travel time and expense for the visits. Stigma is the result of an ignorant notion that mentally ill are dangerous and a blight on the community. Hence, they are treated as pariahs. 

According to the Institute of Medicine, “the contribution of people with mental illness to overall rates of violence is small.” Although mentally ill make up 27 percent of the U.S. population, they are responsible for about 4 percent of all violent acts. According to the New York Times, mentally ill are 11 or more times likely to be victims of crime than general population.

The stigmatization of mental illness has been amply demonstrated by many (not all) residents of Templeton. The owners of a 5-acre parcel propose to build a 91-bed psychiatric hospital and a 55- to 60-bed memory care facility across from the local hospital. Many residents oppose the psychiatric hospital, but seem to have no problem with the live-in memory care facility. Those opposing the psychiatric hospital express the usual concerns: The discharged patients would not leave the area; they would live in the park; their presence would jeopardize school, residential, and transportation system safety; residents’ quality of life would suffer; etc. Incredibly they even question the need for such a facility in the county. One of the most vocal opponents is none other than a local physician. The biggest worry of the good doctor is public safety because, he claims, only a few sheriff’s deputies patrol the area. The sheriff has publicly declared that there is no reason to believe that a psychiatric facility would pose any security problems.

For enlightenment of those tortured souls in Templeton, below are some facts.

Six U.S. presidents had some type of mental illness: George Washington, Abraham Lincoln, Calvin Coolidge, Theodore Roosevelt, John Quincy Adams, and Woodrow Wilson.

Many Americans who made ground breaking contributions to the country had some type of mental illness. Some examples are: Albert Einstein, Alexander Graham Bell, Thomas Alva Edison, Frank Lloyd Wright, Walt Disney, Elvis Presley, Leonard Bernstein, J.P. Morgan, F. Scott Fitzgerald, Spencer Tracy, Cary Grant, Charles Schulz, John Nash, and Francis Coppola.

A few examples of people from other countries who had mental illness: Winston Churchill, Michelangelo, Pablo Picasso, Queen Victoria, Charlie Chaplin, Leo Tolstoy, Charles Darwin, Sigmund Freud, John Keats, Charles Dickens, Wolfgang Amadeus Mozart, Charles Dickens, and Ludwig Beethoven.

These are just a few examples. A complete list would include millions of highly accomplished mentally ill people. I challenge those in Templeton who oppose the psychiatric facility to match the talent, creativity, imagination, and monumental contributions of any one of those listed above.

Finally, both our law enforcement system and the judicial system are antiquated in the cases involving mentally ill. Due to space limitations, the issues with these systems will be discussed in a future commentary. 

Zaf Iqbal is past associate dean and professor emeritus of accounting at Cal Poly’s Orfalea College of Business. He volunteers with several nonprofit organizations, including Wilshire Hospice, Good Neighbor Program, and Child Development Resource Center of the Central Coast. He’s past president of the San Luis Obispo Democratic Club. Send comments to ziqbal@calpoly.edu.

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