Is deinstitutionalization better for the seriously mentally ill, or are they better off locked safely in institutions? // Melanie Boling, Harvard University.

Is deinstitutionalization better for the seriously mentally ill, or are they better off locked safely in institutions?

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In modern-day society, institutionalization could be beneficial for certain mentally ill individuals that meet specific criteria.

For example, if an individual suffers from acute psychosis that can not be treated with any form of psychopharmaceutical interventions that add to the quality of the life or cannot be treated whatsoever.

If certain mental illnesses pose an immediate danger to either the patient themself or others, these would be more specific cases in which institutionalization would be suitably warranted.

The flip side to that is the fact that in some cases, misdiagnosis does occur.

Putting a patient into an environment such as an institution could potentially exasperate the condition and cause the patient to suffer far worse than ever before.

“PTSD (posttraumatic stress disorder) is a mental health problem that some people develop after experiencing or witnessing a life-threatening event, like combat, a natural disaster, a car accident, or sexual assault.

It’s normal to have upsetting memories, feel on edge, or have trouble sleeping after this type of event. At first, it may be hard to do normal daily activities, like go to work, go to school, or spend time with people you care about. But most people start to feel better after a few weeks or months.

If it’s been longer than a few months and you’re still having symptoms, you may have PTSD. For some people, PTSD symptoms may start later on, or they may come and go over time.

If thoughts and feelings from a life-threatening event are upsetting you or causing problems in your life, you may have PTSD.” - U.S. Department of Veterans Affairs.

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Sierra Club Military Veterans Adventure Film School, 2014 (Melanie Boling, Imagery Beyond Borders, 2014).

In my professional experiences, I have observed mentally-ill combat war veterans respond positively in regards to social engagement and relatable commonalities amongst their peers who also suffered from some form of mental illness.

PTSD or Post Traumatic Stress Disorder is not synonymous with all veterans, despite the contrary being reported in the mainstream media. Some military members respond to conflict in a productive manner with little to no residual side effects after the military deployment.

However, mental illness beyond PTSD is very common in the U.S. Military. This ranges from OCD or Obsessive Compulsive Disorder to Process Addictions like Alcohol and Drug Abuse or Sexually Impulsive and Deviant Behaviors; which would all constitute a valid diagnosis in the DSM V.

Furthermore, a therapeutic environment where certain types of experiences are recreated in order to provide a dynamic that models one of the small-team environments similar to that of war; in most cases, the mentally ill veterans respond positively to the relatability and camaraderie of the overall group cohesion.

An environment fit for healing or at least a place to hold space for one another.

If certain types of alternative therapies were introduced into the regimen that institutions provide their patients, it could potentially provide an avenue for some sort of peace; even the most deranged patients could possibly benefit.

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“Schizophrenia is a serious mental health condition that is considered as a type of psychosis by medical professionals. With self-help and effective treatment, you can manage to overcome this disorder and live a meaningful life.” - Mind.help

Psychosis, such as untreated schizophrenia essentially has the individual suffering around the clock.

There is no easy fix in regards to medication. In some cases, it takes years to find the right kind of cocktail to allow a patient to be somewhat coherent and at least on the low-end of what society deems functional.

Alternatively, non-invasive therapy such as the outdoors in a small group environment could potentially be a way to take the sting out of a long-term stay at a mental institution, as long as it is safe for both the individual; the staff; and the other patients.

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Institutionalizing someone in this day and age simply because they suffer from anxiety; are a victim of a crime that they had no control over; or, even fall on the cluster b personality disorder spectrum would not benefit anyone.

There are enough resources available in the United States to not allow someone to fall through the cracks.

However, a solid professional support system and psychological interventions are imperative for the overall success of the patient maintaining a fulfilling path to healing.

That being said, despite the mentally ill’s willingness to seek help; and the social service workers being readily available to serve, knowing how the system works here in America, the obvious bump in the road or even potential failure lies solely on the system.

There is not a lot of follow-through in regards to state services or even private services paid for by insurance companies.

The system as a whole needs a major overhaul, and effective functional communication amongst all entities involved needs to be standardized.

“Restrained in the ER.” - Statnews.com

In America, we fail the mentally ill simply due to human error and overall disregard for those suffering due to the stigma that is deeply ingrained in our society regarding mental illness.

As sad as it may be, it’s a fact and failure perpetuated and repeated throughout every generation.

Now is the time to step in and change the paradigm.

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About the author:

Melanie began attending Harvard in 2020 to complete a Graduate Certificate in Human Behavior with a specialization in Neuropsychology. Boling’s research has examined extreme environments and how they can have a potential negative impact on humans operating in the extreme environment. During her time at Harvard, she has built a mental wellness tool called a psychological field kit. Implementing these tools will allow an individual to thrive in an extreme environment while mitigating negative variables such as abnormal human behavior which can play a role in team degradation.

Melanie Boling, Extreme Environments Neuroscientist, Founder of Boling Expeditionary Research Group; and Neuropsychology Graduate Student, Harvard University.