Behind the Muddied Glass: A Doctor’s Look at Untreated Mental Illness

By Susan Partovi

I met “Carrie” while making rounds at the Los Angeles County women’s jail with a group of mental health professionals.

A woman in her mid-50s, she had no clue what day it was.

Naked and thin, Carrie ambled over, peering through the muddied glass of her jail cell. But it was not mud on the glass. She had streaked feces on it, and all over her body.

“Ms. Carrie? Hi. I’m Doctor Partovi,” I said. She bent over, fixated on an imaginary circuit board.

“A, B, C. That goes in A, then you go in B,” she muttered.

“Ms. Carrie, do you take any medications?” I asked.

She replied, “Yes, the vitamins go in A, but what about B…?!?”

Whenever I encounter people with severe mental illnesses they break my heart. Carrie was no different. I fought back tears.

One of the group’s psychologists asked, “That bad?”

I nodded.

“She’s our number one, then,” the psychologist announced, indicating that Carrie would be sent to the jail’s psychiatric hospital as soon as a treatment bed became available.

There are now fewer psychiatric hospital beds in the United States per capita than at any time since the 1850s, but by a stroke of luck, Carrie was placed later that day. She would receive the care she needed and deserved.

Some people with severe mental illnesses like schizophrenia and bipolar disorder need to be involuntarily hospitalized and medicated. Most become remarkably more lucid after a few days and voluntarily accept prescribed medication. Their responsiveness to treatment underscores my belief that they do not belong in the correctional system.

The mental health clinicians I know strive to provide compassionate care for people like Carrie behind bars, but there is only so much one can do. Jails create a perfect storm for someone with a severe mental illness. Being locked in a cold cell with one’s hallucinations only invites further psychiatric deterioration.

However, we have created a system in which the severely ill – people like Carrie – are incarcerated, in part, because they have nowhere else to go.

At least one-third of chronically homeless adults in California now have a severe mental illness, along with more than 20 percent of inmates at the Los Angeles County Jail. Many are there for petty offenses, like stealing a bag of chips.

Society also seems to operate under the false assumption that Carrie wants to be homeless, accepts her paranoia, and decides to stand naked in the cold, smeared with feces. No. These are unwelcome symptoms of non-treatment, not rational choices.

Had I encountered Carrie in the streets, talking to her hallucinations while exposed to the elements, it would have been nearly impossible to hospitalize her involuntarily, even though a hospital stay would promote stabilization. That is shameful.

On the streets, the homeless with severe mental illness are more susceptible to drug use, other chronic illnesses, and outbreaks of medieval diseases. According to one study, they are ten times more likely to die.

Meanwhile, when they seek refuge in emergency departments and hospitals or cycle through the criminal justice system, the per person service costs to taxpayers can reach $100,000 per year – more than the cost of comprehensive care in an inpatient facility.

California, and Los Angeles County, in particular, has programs that can divert the Carries of the world into full-time care before tragedy ensues. But it does not necessarily utilize them effectively.

Laura’s Law, for example, is the state’s version of assisted outpatient treatment – a tool to engage individuals into treatment who have a history of non-adherence to medication, and who often lack insight into their illness.

When the Treatment Advocacy Center assessed the implementation of this important program, it found that its services helped decrease psychiatric hospitalizations, crisis contacts, incarcerations, and homelessness. One might presume local governments would eagerly implement it with vigor. Yet a version of Laura’s Law is available in only 20 of California’s 58 counties, most of which underutilize the tools available under the law.

To stop people like Carrie from falling through the cracks of our broken mental health system, we need to change our approach. Until we do, our collective futures will remain obscured by muddied glass.

Susan Partovi is Medical Director of Homeless Health Care Los Angeles. She has provided medical attention to the homeless in the streets and clinics of Los Angeles for fifteen years.

5 thoughts on “Behind the Muddied Glass: A Doctor’s Look at Untreated Mental Illness

  1. Medication should be monitored by a Dr. or NP on a daily basis. As long as people shake their head and turn away we will have the mentally ill with us. There seems to be good treatment for all the other illnesses that abound but there is no follow through or treatment plans for the mentally ill. As a social worker with a son who is mentally ill, I know that he would be dead today due to lack of care by our medical system if I weren’t advocating for him. When he does manage to see a Dr. she/he will prescribe 3 or 4 meds all a once so we have no idea what is working and what is just creating side affects. My son wrote a book about his illness and described what it feels like and what is in his head when he is having trouble– he wrote it for the families of the mentally ill to help them understand and help their loved one.

    1. Thank you for this information. I would like to read your sons book.
      My name is Valerie Lewis. My son is 22 and is mentally ill and on a cocktail of medication.
      I am trying to navigate this journey and be his advocate. May I have the title of your sons book so I can find it to purchase?
      Thank you?

  2. We need to hold the state and county health authorities accountable. Why don’t organizations such as NAMI proceed with these kinds of actions? Unbelievable

  3. It took a few mental health advocates nearly 6 years to convince the bureaucrats and politicians in San Diego County to implement Laura’s Law. There were lies after lies about how it takes away patients’ rights and is a step toward re-institutionalization of the seriously mentally ill. I was so incensed by this ignorance and uncaring stupidity that I played every card in my deck, citing the inhumanity and immorality of allowing psychotic individuals to die on the streets or languish in our jails and the cost savings of community treatment compared to maintaining homelessness and incarceration. In the meantime, I documented the tragic deaths and serious injuries of innocent citizens and the mentally ill themselves in our county at almost one per month in instances where those who could do something about this were helpless,, or if they could help, did little or nothing. The change finally occurred with county supervisor elections and the criminal justice system and treatment community weighed in.

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