Lives in the Shadows: Some of the Costs and Consequences of a "Non-System" of Care




Diamond, Pamela M.
Schnee, Steven B.

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Hogg Foundation for Mental Health



This report represents an innovative approach to the clarifications of the pattern of service delivery systems and paths to treatment of persons with multiple problems such as mental illness, drug abuse, and violent behavior. They bounce in and out of community facilities both public and private, consuming an enormous amount of time and resources of the criminal justice, mental health, and public health systems. Individuals and families with multiple problems are not a new phenomenon, but the authors do break new ground in their attempt to assess the economic costs of such problems, trying to determine what agencies pay for what services and how much. Although the sample here is relatively small, the results are clear. The costs are staggering, because there presently does not exist any type of agency or system empowered to meet the needs of these individuals. Our imaginations are taxed if we even try to estimate the billions of dollars spent endeavoring to help the types of persons described in this publication. They exist in every city, large and small. The authors are to be complimented for not stopping at the amassing of figures alone, which is a difficult task in itself. They also impart to the reader a “feel” for the coping styles and strategies for survival of these persons. They communicate the effects of deinstitutionalization, homelessness, mental illness, alcohol and drug abuse, and lack of access to health facilities. The research points out areas for further study and the need to replace the current “non-system” with genuine collaborative efforts within and between human service delivery systems. The concepts of asylum and sanctuary are in need of reconsideration. The authors appropriately call on communities and state programs to reexamine their current procedures in dealing with multiple problem chronic individuals. Besides the humanistic considerations, the huge financial drains must be taken into account, especially in these times of budget cutbacks and the decrease in federal and state support to the human service areas. The Hogg Foundation has provided support for this study as it has sought to identify individuals with histories in the mental health and criminal justice system and to assess the costs to those systems and others. The findings hold promise for serving as a catalyst for communities across the United States to reexamine their current procedures and introduce changes in dealing with this “crisis.” This publication fits well one of the Hogg Foundation’s main missions—to call attention to that which must be addressed in constructive and innovative ways for the benefit of all concerned.

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