PPTFH Discusses Demedicalization of Mental Illness

By JENNIKA INGRAM | Reporter

The Palisades Branch Library community room was full of concerned citizens and experts on Monday, January 27—both locally and from nearby communities—who came to listen to a presentation organized by the Pacific Palisades Task Force on Homelessness.

Two distinguished speakers addressed “The Demedicalization of Mental Illness: Have Changing Attitudes about Mental Illness Allowed People to Languish on the Streets?”

Dr. Joel T. Braslow, a professor at UCLA in psychiatry and biobehavioral sciences, wrote an article on the topic of demedicalization as part of a greater series he penned for the New England Journal of Medicine. He came to notice by the task force after his work on the issue was published in UCLA Magazine.

“What I mean by demedicalization is that up until the 1950s, we had a much more robust view of our responsibility as psychiatrists,” Braslow explained. “Demedicalization is this gradual narrowing of what we consider our clinical responsibility of caring for people with mental illness.”

He emphasized people need to re-expand what they consider their responsibility.

The other presenter, Dr. Enrico Castillo, Braslow’s colleague and UCLA assistant clinical professor in the Department of Psychiatry and Biobehavioral Science, told the Post he was speaking as a private citizen.

Both speakers are clinicians as well as researchers.

“It’s one thing to say that you care, and it’s another thing to change the way we practice,” Castillo said. “I think that’s one thing Joel’s article so eloquently does.”

Braslow’s article on demedicalization asks fundamental questions about whether we should care as psychiatrists, as a society, as a state and as individuals, Castillo explained: “Taking that moral stance and operationalizing it in everything we do on a daily basis.”

“In preindustrial and agrarian societies, most people cared for their family members at home,” Braslow said. With the rise of industrialization and wage labor in the 18th and 19th centuries, families could no longer afford to keep them at home, there was a movement to create asylums. State hospitals were at their height in 1955.

“The vast majority of people in state hospitals had been admitted because their psychiatric illness made it impossible for them to successfully function,” Braslow shared in a UCLA statement. People could come and go in these places—the doors were not locked.

Braslow addressed the term “grave disability.”

If a person is mentally ill and unable to provide housing for themselves, then by definition they are “gravely disabled,” Braslow explained.

Since this is a legal term that can be used as a determining factor for involuntary commitment, the fact that people interpret it in different ways can impact the homeless.

“Everybody has a different viewpoint of what that level of disability is,” LAPD Officer John “Rusty” Redican said, giving an example of taking someone to the emergency room and how quickly they can be released.

Audience members suggested solutions and added input, which turned into a discussion about whether it is important to medicate people who are “gravely disabled” first and then set them up for housing, or whether to find them housing first and work within that framework. Or, if it would be better to choose a tiered-system, where participants earn housing as they progress through treatment.

One attendee who spoke at the event, Dr. Roderick Shaner, a retired medical director who worked for 20 years, urged community members who want to help to join organizations such as the National Alliance on Mental Illness, often referred to as NAMI, that work with the legislature and are versed in all the current bills.

Shaner told the Post this will give them access to letters, donations and other measures of advocacy that will make a contribution.