Patients who are identified as difficult or suffering from border line personality or various mental diseases are usually not preferred for care and are thus demedicalized (Stergiopoulos et al., 2015). Given that these patients are termed as ‘difficult’ through their medical care and history they are straightforwardly and indirectly routed out via a number of ways. Mentally ill individuals who seek medical services do not have access to proper care and are on numerous occasions blanketed by being prescribed medication. The healthcare givers wait for the patients to attain some form of soberness or coherency and are talked out of leaving the facilities (Chen 2014). Patients with psychiatric disease combined with a history of hospital visits do not meet criteria for mental health care according to treating physicians, because they are said to visit simply for food and shelter. The overall presumption in some instances is that the patients are quite able to make decisions when they genuinely suffer from serious psychiatric illness requiring more than just a hospital visit (Krieg, 2001).
This paper will focus on how demedicalization and deinstitutionalization of the mentally ill homeless affect their lives. It will also look at demedicalization is shifted into non-medical attention since most of the mentally ill homeless do not have access to the necessary medical services. A conclusion will then be provided at the end.
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Negatives of life’s stressors for homeless adult’s limits executive functioning
The unconstructive effects of life stress can emerge from exposure to different kinds of adversity, with the inclusion of childhood physical and sexual abuse, exposure to chronic stressors such as insecure workplaces and violent neighborhoods, and premature deaths of family members (Padgett et al., 2012). Life stresses have been frequently connected with depression, premature mortality, poor health, and drug abuse. It has recently become apparent that to suffer from a serious psychological disease such as schizophrenia, one has to be victimized, separated, and troubled. For the homeless individuals who are mentally ill, the co-occurrence of alcohol and drug abuse, victimization, injuries, and health issues is all too common (Stergiopoulos et al., 2015). Homeless individuals are also more likely to hail from low income backgrounds, and thus are deprived of social and human capital which is necessary to discourage poverty following the beginning of mental disease.
Combined with mental illness, poverty has a biting impact, making individuals to rely upon disability revenue and living a minor way of life (Sulzer, 2015). Despite the burden of mental and medical morbidity in the homeless populace, only a restricted amount of research has taken a closer look at the association between homelessness and neurocognitive performance. Existing literature cites a superior rate of neurocognitive impairment amongst the homeless, with an approximated commonness as high as 80% (Padgett et al., 2012). Notably, neurocognitive impairment among the homeless can most likely affect various domains of community functioning, with the inclusion of the ability to reside autonomously and the ability to follow treatment recommendations and take part in daily activities (Stergiopoulos et al., 2015). There is proof that neurocognitive functioning is linked to functional results in this particular populace.
Some psychological experts discovered that weaker performance on measures of executive function foretold worse levels of community functioning and more unstable behavior among previously homeless persons suffering from severe psychological illness residing alone (Padgett et al., 2012). Baseline neurocognitive operation is considered a significant predictor of community functioning. Better delayed verbal memory foretells more constructive social connections, but only for those residing in group homes. Studies conducted reveal that only superior scores on upheld attention foretold subsequent operation irrespective of housing type, better communication skills, but also higher turbulence (Stergiopoulos et al., 2015). As it has so far been observed, residing in a supportive group home tends to compensate for the harmful effects on community functioning such as the ability to self care of poor executive functioning. It can also encourage the advantageous effects of verbal memory.
In the recent past, studies have revealed structural disadvantages make way for homelessness. It is quite evident that injustices and discrepancies are woven into the fabric of society, causing individuals suffering from mental disorders to have unbalanced access to political, economic, social resources, and power (Padgett et al., 2012). As a result, the society has been designed for and by those without mental disorders. With time, stigmatizing institutional practices and policies are now the order of the day by which the society functions. This means that stigma is no longer reliant on individual action. Instead, exclusion and disadvantage are often perpetrated by institutional systems. Mentally ill individuals are quite disadvantaged in terms of receiving necessary mental health care, food, shelter, and other basic necessities. In the end, a majority of them end up being homeless, since no one wants to have a mentally ill person as their tenant. Furthermore, families also tend to neglect family members who suffer from mental disorders.
Given that hosing status is seen as being under a person’s management, whereby the homeless are considered to be accountable for their lack of enough shelter, homeless persons are most likely to experience superiorly legitimized forms of discrimination, amplifying unconstructive wellbeing outcomes (Trepal, 2010). Housing may be quite unaffordable for a number of individuals suffering from mental illnesses whose earnings is restricted by the fact that they are not able to work because of their impairments. Additionally, the practices and policies of housing services may be inappropriate for mentally ill individuals. Housing that is actually affordable and tends to support services is located in communities that are physically isolated and socially disorganized (Stergiopoulos et al., 2015). This systematically channels mentally ill persons into neighborhoods that place them at higher risk of social separation, illness, victimization, and other stressful life situations. Such disparities in wealth and income mixed with other types of structural stigma have a huge influence on housing options for the mentally ill (Padgett et al., 2012).
Deinstitutionalization has negative consequences
Deinstitutionalization is a move in the care of psychologically sick individuals from long lasting psychiatric hospitalization to more autonomous living settings (Masenthin, 2016). Various factors result in this move in care. Deinstitutionalization has also meant a move in the role of the government. County and state governments have mostly financed long lasting hospital care. Notably, autonomous living must be financed privately, with some government support in the form of Supplemental Security Income (Krieg, 2001). This particular shift was instituted with the best of plans. However, there have been unexpected outcomes accumulating to many in society, due to lack of sufficient planning for alternative care with enough resources.
The discussion over deinstitutionalization is usually designed as liberty versus paternalism (Sun, 2012). According to libertarians, people are inherently free to live their lives as they desire. Deinstitutionalization has spread this to the psychologically sick, the users of care, who have become more liberal to make their own choices (Masenthin, 2016). Freedom is not the only claim used by people who push for further deinstitutionalization. Time spent in mental hospitals may actually increase a person’s inclination to be homeless (Padgett et al., 2012). On the other hand, those who are not in favor of deinstitutionalization suggest that using the criteria ‘danger to self or others’ as the only requirement for automatic treatment disregards those who are in much need of treatment but are not dangerous.
A majority of mentally ill individuals may require preventive treatment not only to preserve their mental health, but to survive. It is quite possible for someone to degrade the mentally ill by taking care of them and by neglecting to take care of them. The paternalistic perspective perceives automatic commitment as being in the best interest of a client’s psychological health (Masenthin, 2016). In some instances, treatment of deinstitutionalized patients may be seen as paternalistic where they are shifted from one location to the next without concern for their desires. However, some patient may not have logical visions about what type of housing is suitable for them. It is in a person’s nature to desire to be free of limitations even when at times it is not in their best interest (Chen, 2014). While this nature is hindered by a person’s wisdom, in the case of the mentally ill who are less rational, such hindrances may not be enough to do what is in their best interest.
Deinstitutionalization of the mentally ill has a number of negative consequences, for instance the risk of violence posed to others in the society. Some experts cite that as a group, schizophrenics are relatively more violent compared to the average individual, while manic-depressives have a lower tendency toward violence compared to those with other disorders (Masenthin, 2016). However, they usually engage in threatening behavior. This means that schizophrenics are 4 times more likely to act violently annually than the average individual. Those who are in need of care but do not receive it are prone to becoming more ill and avoiding treatment, thus making them prone to incarceration and homelessness (Chen, 2014). A majority of them are released into the streets without enough placements and follow up care, and as a result many become homeless because they eventually run out of funds.
Urban or rural status plays a key role in the effectiveness of deinstitutionalization in the community. Rural patients are less likely to be given community psychological health services and are therefore more likely to becoming involved with the criminal justice system (Scott, 2015). Reports cite that a number of those incarcerated suffer from serious psychological illness. An estimated 7.2% of inmates appear to suffer from severe mental illness in the United States alone, and about 15% globally (Masenthin, 2016). The psychologically ill are deserving of human rights. One of those rights includes treatment. Deinstitutionalization simply puts the mentally ill out into the streets with the overall populace, essentially forgetting about them and not caring for them. Given that many of those released from psychological institutions are seriously mentally ill, they are not considered suitable candidates for community centers.
Furthermore, there is not enough federal financing for the mental health centers (Chen, 2014). This means that there are not enough centers to serve the mentally ill individuals’ needs, thus making it harder to establish any all-inclusive programs. It is not surprising to learn that mental health experts tend to underestimate just how hard it is to coordinate community resources spread throughout an urban area for those with disorders (Trepal, 2010). Additionally, the courts have made it almost impossible to commit anyone against their wishes, regardless of whether or not it is for the individual’s own wellbeing and security, or for that of others. In the recent years, it has been contended whether deinstitutionalization could contribute to the increased reports of mass shootings.
According to a forensic psychologist, J. Reid Meloy, Ph.D., most mass murderers suffer psychological disorders that range from schizophrenia and chronic psychotic disturbances, to paranoid disorders (Chen, 2014). They possess the narcissistic, schizoid, and paranoid characteristics of personality disorders. The physician cites that such individuals were not initially sane people who suddenly ‘snapped.’ Instead, they are people who suffered for many years from poorly treated or untreated psychological illness. Most mass murderers plan the shootings for a number of years prior to carrying out the criminal act. Additionally, almost 50% of all mass murderers suffer from depression, ADHD, or learning disabilities (Masenthin, 2016). Failure to implement an effective system has also contributed to the negative outcomes of deinstitutionalization.
Regulations that are meant to safeguard the rights of the mentally ill have hindered treatment. For instance, families are not allowed to commit a mentally ill patient unless they have already provided evidence of being a threat to themselves or someone else (Kriet, 2001). Judges cannot also order severely psychologically ill individuals to stay in treatment. Shockingly, people are prohibited from removing guns from psychologically ill individuals who threaten themselves or others (Chen, 2014). If the system disregards such factors in the safeguarding of the mentally ill as well as the whole community, then it has failed miserably in deinstitutionalization.
Demedicalization is transformed into non-medical attention
Demedicalization refers to the shift of issues initially understood to be medical in nature, into issues understood to be nonmedical (Braslow & Luke, 2018). This movement takes place at various levels, from the conceptualization of etiology to the comprehension of whether interventions for issues are suitably nonmedical or medical. Demedicalization can, at times, be considered to be an advantageous process, especially because it contributed to ending of days when homosexuality was considered a psychological disorder, or when, in the course of the Civil Rights period, many black individuals had their discontentment with isolation diagnosed as a psychological pathology (Braslow & Luke, 2018). Contrarily, demedicalization can be quite dangerous, for instance the abdication of duty for the social outcomes of psychological illness.
Re-medicalization is not always the solution; genuine care for the psychologically ill require more than pitiful glances at panhandlers (Braslow & Luke, 2018). Programs and policies allowing individuals with mental illness to lead dignified lives should also be put in place. Although homosexuality’s demedicalization assisted in reducing long lasting medical and cultural misconceptions of sexuality, which of chronic psychological disorder meant getting rid of benefits that had enhanced individuals’ lives (Scott, 2015). People have come to accept homelessness and incarceration of the mentally ill as justifiable fates for individuals whose psychotic behavior goes against social norms. Social scientists perceive demedicalization of various behaviors to be progress, attributing the initial medicalization to cultural unawareness (Braslow & Luke, 2018). They also believe demedicalization to be an outcome of economic and political forces. People do not realize that doctors are vital to the turnaround of unsuitable demedicalization.
The criminalization of psychological illness that followed deinstitutionalization has led to a steady shift of various seriously psychologically ill individuals from mental institutions to prisons (Stergiopoulos et al., 2018). Doctors are specially prepared to identify the outcomes of demedicalization and to come up with solutions. Those who acknowledge how demedicalization has lessened medical duties to the loss of patient results are better positioned to formulate and implement interventions aimed at improving those results. Without structural transformations, these interventions will have restricted effectiveness. Doctors do their best to treat psychological disorders in clinics and emergency rooms, but addressing the issue of demedicalization in a serious manner demands both ethical and material support (Braslow & Luke, 2018). Instead of simply releasing vulnerable patients to the streets, the community can assist them find their way into the world with community health employees and rigorous case management. There is also need for medical intervention.
Recent evidence shows that the view of psychological health issues as an illness might be a contributing factor to its social stigma, causing further damage to individuals who are in need of support and community to recover (Sun, 2012). The community and the health institutions need to believe that recovery is actually quite possible; individuals can and do get better. A number of formerly mentally ill homeless individuals have gone to life rich and full lives, with support from their friends and families, and triumphing in work and education (Sulzer, 2015). However, such recovery is difficult if the only available treatment to them is pills, as this fails to address the main causes of their problems and provide the resources needed for healing.
The community, particularly the media, needs to change their attitude about psychological health. There is need to develop health systems capable of integrating physical and psychological health care, especially at the basic care level (Chen, 2014). The community also needs to widen its comprehension of recovery to mean an individual’s ability to live a better life on their own terms, rather than seeing it as lack of certain symptoms. Mental health should be treated as a human rights and social justice issue. It is clear that racism, violence, and poverty puts individuals at superior risk of developing psychological health issues, and that is why population-level interventions are needed in order to battle the root causes of this particular crisis. Treating mental health patients means fewer incidences of homelessness and a better future for such individuals.
Conclusion
As seen from the discussion above, various issues can lead psychologically ill persons to homelessness. They may find themselves wandering from one community to the next in hope that their problems and symptoms of psychological illness will be erased. For these individuals, access to treatment is usually grounded in community and social networks, some of which may be lacking in communities deemed to have superior levels of violence, homelessness, poverty, and crime. The underlying issues in the course of hospital visits for homeless persons, who are mentally ill, are treated at the surface only. That is why population-level interventions which concentrate on battling the main causes of mental illness and homelessness should be considered and implemented. The general population should also be educated on how best to accommodate and cater to the needs of mentally ill homeless individuals.
References
Braslow, Joel T, and Luke Messac. 2018. Medicalization and demedicalization – A gravely disabled homeless man with psychiatric illness.” The New England Journal of Medicine , 379 (20): 1885-1888.
Chen, Fang-pei. 2014. “Developing community support for homeless people with mental illness in transition. Community Mental Health Journal , 50: 520 - 530.
Krieg, Randall G. 2001. “An interdisciplinary look at the deinstitutionalization of the mentally ill.” The Social Science Journal , 38: 367 -380.
Masenthin, Carly. 2016. “Peace of mind: Improving conflicts between law enforcement and the mentally ill homeless while exploring sustainable community solutions for care.” Kansas Journal of Law & Public Policy , Vol. XXVII(1): 103-124.
Padgett, Debora K, Bikki Tran Smith, Benjamin F. Henwood, and Emmy Tiderington. 2012. “Life course adversity in the lives of formerly homeless persons with serious mental illness: Context and meaning.” American Journal of Orthopsychiatry , Vol. 82, No. 3: 421-430.
Scott, Russ, Dr. 2015. Liability for health services not for involuntarily detaining and treating a mentally ill person. Psychiatry, Psychology and Law , Vol. 22, No. 1: 1- 31.
Stergiopoulos, V, et al. 2015. Neurocognitive impairment in a large sample of homeless adults with mental illness. Acta Psychiatrica Scandinavica , 131: 256-268.
Sulzer, Sandra H. 2015. Does difficult patient’ status contribute to de factor demedicalization? The case of borderline personality disorder. Social Science & Medicine, 142: 82- 89.
Sun, An-Pyng. 2012. Helping homeless individuals with co-occurring disorders: The four components. Social Work , Volume 57, Number 1: 23- 34.
Trepal, Heather C. 2010. Exploring self-injury through a relational cultural lens. Journal of Counseling & Development , Volume 88: 492-497.
