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FROM MY FILES FRIDAY: Since the publication of my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, I have been fortunate enough to speak in Brazil, Iceland, Portugal, India, Poland, and Canada. Whenever I visit a foreign country, I ask how individuals with mental illness are treated. What community services are available? How do these countries handle the fine line between protecting civil rights and getting those who are seriously ill the help they might need? I posted a variation of this blog in March 2014. What experiences have you had in foreign countries? Please let me know in the comment section on my Facebook page.
Do Europeans look at mental illnesses differently from us?
I was in Warsaw, Poland, last week delivering a speech to an international group whose members appeared shocked when they heard my personal story about how my son and I were turned away from a hospital emergency room when he was psychotic. The audience continued to be surprised when I added that there were 365,000 persons in the U.S. with severe mental illnesses in U.S. jails and prisons, making jails the largest public mental facilities in America. Jaws dropped when I said a recent study found that the odds of someone getting a hospital bed vs a jail bed were three-to-one in favor of jail.
I’m always curious about how other nations balance civil rights and involuntary commitment. Poland adopted the World Health Organizations’ standards:
Involuntary admission is permitted only if both the following criteria are met: – there is evidence of mental disorder of specified severity as defined by internationally accepted standards; – there is a likelihood of self-harm or harm to others and/or of a deterioration in the patient’s condition if treatment is not given.
Given that most U.S. states use similar standards, I wondered why my European audience found my personal story and U.S. incarceration rates so surprising. Why haven’t their jails becoming dumping grounds?
One psychiatrist told me that Americans value individualism more highly than in many European countries, especially those where the collective (under Communism) trumped individualism. Consequently, we have focused more on demanding evidence of danger – imminent danger – than other nations, prompting more interactions with the police. “We focus on being humane. You focus on the law.”
One conclusion I reached is that we distrust mental hospitals more than most other nations because of our horrific past. This was true even in Poland where asylums were misused by the Nazis and Russians. In Iceland and Portugal, I found people simply were not as terrified of going to a mental hospital for help as we are. In Portugal, the mental hospitals were run by the Roman Catholic Church and were seen as places of refuge. In Iceland, people said, “Well of course you go to the mental hospital. Where else would you go?” Even in Brazil and India where hospitals were primitive and conditions often deplorable, they still were seen as places were individuals could get help.
I have yet to find a country that locks up more persons with severe mental illnesses than we do. Every foreign crowd, who hears me talk about how our jails and prisons have become our new asylums, are disappointed.
They expect more of us.
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