The Timeshare went on sale a few days ago and I’m getting emails with excellent questions. One that I’ve heard a lot is – Why isn’t Sophie hospitalized? (Sophie is my protagonist’s wife and she’s living with multiple personality disorder.)

Mental illness is most both chronic and widespread. About 25% of Americans are living some form of mental illness and there aren’t enough resources, so care falls to the family. Even with great insurance and financial resources, adequate care often can’t be found. Therapists I spoke with told me three things that are at the root of the problem: care is expensive and there are gaps in coverage, we have a shortage of experts and there is still stigma to seeking help.

When did the problem start? Truthfully, we’ve never had great, consistent care for the seriously mentally ill, but part of the issue is the Community Mental Health Centers Act of 1963. The reasoning for this law was that the less restrictive the care, the better for the individual’s civil liberties. To be fair, the psychiatric hospitals in the 60’s were pretty scary. But there were unintended consequences to this law which emphasized outpatient care and limited inpatient treatment.

Good outpatient care works pretty well for the vast majority of people with mild to moderate mental health issues, but it’s not designed to help people with more serious problems. Mental illness is typically chronic and it ebbs and flows. People have good days and bad days. Someone with depression, for example, may do pretty well with day to day life most of the time but need some additional support on occasion and a rare spot of intensive help. Someone with bi-polar may need to be inpatient every few years when meds need to be adjusted. But we don’t have the resources to help people who need intensive help a lot of the time so at this point, those without families to care for them often wind up homeless or in jail.

Even those with families can wind up alone. Being mentally ill isn’t fun and people living with these conditions can have alienating behaviors. Financially, it can take a real toll as well. Care is expensive, but the mentally ill person may not be able to work and their caretaker may need to take a lower paying job in order to be more available. Additionally, some mental illnesses can manifest in impulsive behaviors that can be costly. Cutting the mentally ill person loose may feel like a matter of survival for families. One family I spoke with had invested so much in their son’s care that they couldn’t afford to send their other three kids to college. But they felt they had no choice. 

It’s not all bleak though. A lot of programs are coming up to try to address the gaps in care. One online resource a therapist told me about is:  People can connect with others, share resources and support each other. Families can find support there too. Faith communities and community resource centers may also provide programs. And there are representatives working to try and change the laws for better access to care for those with serious, chronic issues.

Early intervention is key as it can help prevent a downward spiral. Sometimes a little consistent care can help people regulate their moods, remember meds and maintain healthy habits.

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