Failure to treat: an American policy perspective
Katherine Warburton
July 16, 2024
Cambridge University Press
Failure to treat: an American policy perspective
Abstract
Throughout its two and a half centuries in existence, US mental health policy has repeatedly failed people living with schizophrenia. The failures are cyclical—the inhumane conditions uncovered in the first 75 years of existence were addressed with the construction of state asylums to deliver moral treatment. One hundred years later, the asylums were themselves revealed to be inhumane. Deinstitutionalization, the response to the failure of asylums starting in the 1960s, now drives outcomes such as homelessness, incarceration, and early death for people living with psychotic illnesses. In all cases, well-intentioned policy reform has failed at the level of implementation, largely due to a lack of accountability. The result has been a consistent failure to adequately treat people living with schizophrenia, which is now understood to be a highly treatable condition. As the country passes into a quarter millennium in existence, reform is once again underway. Unlike other points in history, there is good news. Other countries, such as Italy, have successfully leveraged reform to achieve greatly improved outcomes. Understanding US history and the successful implementation of policy change in other countries is imperative and teaches us that accountability in implementation is necessary to break the cycle of policy failure.
Even though I am always telling people about what I see through my stories, only when I was watching my friend pray did I make a connection. I realized that I’ve been referencing a painting featuring Phillippe Pinel unshackling a mental patient from chains in 1876, but weirdly this was the first time I asked, “isn’t this the same mythology”? We’d have to ask Freud why I repressed this parallel. Maybe because it is just too much to bear-the fact that mental health wards 250 years later are worse- so it has never really consciously occurred to me.
