Thousands of people were released into society as mental hospitals closed, with the focus on community-based care, rather than institutionalization. The days of locking such people up ended when President Ronald Reagan signed the Ominbus Budget Reconciliation Act in 1987 that ended the federal government’s role in the institutionalized care of the mentally ill.īlock grants were given to the states, and the days of the “asylum” were over. She didn’t want to stay in a shelter and wasn’t willing or able to follow the rules that were required. She didn’t have a permanent address, and that made it hard for her to collect her disability income on a regular basis. She wasn’t able to work, and couldn’t afford to get an apartment on her own. She was never a danger to herself or to society, so she wasn’t kept in a mental institution. We need more facilities like the Hawaii State Hospital in Kaneohe, where almost all the patients are placed by court order after getting in trouble with the law. But part of her mental illness was so tied to hearing the voices that she would be upset when they were gone, which lead to her frequent relapses into worsening schizophrenia as soon as she stopped taking her medication regularly. When she was medicated by her psychiatrist, she would usually go to a shelter, and seem to be okay for a while. She hadn’t come to the office in the past three years before that, and did not have a current address. She was 55 the last time I saw her, living on the streets, never wanting to reveal her exact locale. I recently saw one of my former patients walking by Ala Moana Beach Park talking to herself, or to the voices she heard in her head.
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