What prompted you to write “Healing the Broken Mind”?
Thirty years in the mental health field. But the capstone of that was my serving as Commissioner of Virginia’s Department of Mental Health from 1994-97. As Commissioner I saw things most people don’t see. For instance, I would make surprise visits to psychiatric facilities across the state, where I found that the care being provided was closer to custodial care [“a fancy term for babysitting,” explains Kelly]—than anything else.
While there were programmed activities—on paper, at least—I often found staff and patients alike lounging around on couches watching TV, waiting for the patients’ meds to kick in. And once their meds kicked in and they were stabilized, they would be discharged into the community. They would be given minimal follow-up care, usually a once-a-month meds check. So they would eventually spiral down and deteriorate and be readmitted to the hospital—a vicious cycle that is very costly, both for the individual on a personal level and for the state on a financial level. Seeing that over and over again lit a fire in me. I’ve been speaking and writing about mental health reform ever since.
Why is the U.S. mental health care system in such bad shape?
[In the mid-20th century] America went through an institutionalization process where we built facilities to house individuals with serious mental illness. In the 1950s, at the height of that era, we had over 500,000 people hospitalized. Then we discovered that is not the best way to treat mental illness. If you put someone in an institution and leave them there for a long time that person will become institutionalized, and it becomes difficult for them to live on the outside, even if their mental illness remediates.
So in the 1950s and ’60s a public policy decision was made to deinstitutionalize. It was the right policy, but it wasn’t implemented correctly. It requires flexible home- and community-based care, so that when patients are discharged they go home not to minimalistic care, but to creative, energetic services that are available as needed. That might include somebody coming by the house and helping out, or coming by late at night for a meds check, or helping with a problem at work. In other words, whatever it takes so that person can live successfully in their community, with a home, a job, and good relationships. That’s what is needed, and it is doable.