Intended to break the cycle of institutionalization, Illinois House Bill 0449 will provide housing to individuals with mental illness and substance abuse disorders, with the requirement that they meet with a mental health professional, if signed.
Tricia Oberweis, professor of criminal justice, said the cycle of institutionalization of people with mental illness and substance abuse disorders changed about 20 years ago, when the infrastructure for caring for them was dismantled.
“In essence what we did was we took beds that were meant for a multi-stage process: detoxification, stabilization and then … rehabilitation of people, and we reduced those beds just for the detox phase,” Oberweis said. “And so what happens in treatment now is basically just that the person gets the drugs or alcohol out of their system … without really enough time to delve into whatever habilitation issue is prompting that drug use in the first place, which often is about trauma or inappropriate management of emotions.”
Oberweis said this has led to a revolving cycle of failure.
“We bring them in, they detox, we send them back out again without having addressed the problem. They simply relapse and despite their best efforts, just sort of cycle back around again. And that sense of failure after the first two or five or seven trips around through detox just increases the probability of failure continuing later,” Oberweis said. “I wouldn’t want to say that detox is worse than no treatment at all, but in some ways, detox alone seems to sort of soften the blow of future failures and could itself work against its own cause.”
Amanda Depew, a social work graduate student, said our current legislation is housing first, which means individuals are given housing, then the services they need to keep that housing, but there are no stipulations requiring them to continue treatment or follow a medication regimen. Under HB0449, they have to follow that plan.
“Recovery is one thing, like you can go to a treatment center, and if you’re lucky enough to do a 28-day program … it doesn’t take long for somebody to go in and out of a treatment center three or four times within a year … This [is], we’re going to give you the housing, and then in order to keep this housing, the incentive is the housing, you’ve got to do ‘this’ to keep the housing,” Depew said. “You have to continue going to treatment, you have to continue taking your medication, you have to continue reaching goals.”
Depew said the cycle of institutionalization is often perpetuated because if people see someone in crisis, their first reaction is to call 911. This means the individual’s first encounter is going to be with police. While Depew said she doesn’t think that should be a bad thing, she thinks there needs to be a change in how police are trained to handle these situations.
“We need people who wear that badge to do their job. But I just went through school for five years and I need two years post-grad to obtain a license that I’m going to have to pay a wazoo amount of money for, to be able to be on the other end of where the police will eventually send the person they first encounter,” Depew said. “Nothing against police, I know they’re educated as well, but we’re educated in different things. My training is with people, and people in crisis. That’s not their training.”
Oberweis said the bill is intended to break this cycle because there’s a strong correlation between drug addiction and homelessness that works both ways.
“We think about people who are drug addicts sort of running out of money and then running out of people and then becoming homeless because of their addiction. Interestingly though, it works the other way around too, where people become homeless for a variety of reasons — often it’s mental health issues, maybe tied even to military service — and the event of becoming homeless puts them at greater risk for drug use or drug abuse, and subsequently for addiction,” Oberweis said. “So to break that connection between homelessness and substance abuse, whichever comes first, seems to me a great way to help establish healthy, normalized living patterns.”
Sociology Professor Gerry O’Brien said the correlation between mental illness and institutionalization is a chicken-and-the-egg phenomenon because individuals may self-medicate due to symptoms of mental illness.
“Sometimes that might come from individuals having been prescribed psychotropic medication in the first place, and they could have side effects, there could be problems with the psychotropic meds. Oftentimes some of those folks might start to self-medicate,” O’Brien said. “It could work the other way. Individuals who have substance abuse issues could develop some type of mental health symptomatology.”
Corey Stevens, assistant professor of sociology, said there’s a huge cost issue with how we currently institutionalize people with mental illness and substance abuse disorders, but it’s also a human rights issue.
“There’s a literal economic cost and there’s this real moral cost. And the prison industrial complex, at least in the United States, is huge. It’s bigger than in Soviet Russia and the Russian gulags,” Stevens said. “There are more people incarcerated in the United States, and a huge proportion of these people are just people who are chronically poor and chronically mentally ill.”
Oberweis said the bill’s requirement that participants must engage with a mental health professional is absolutely necessary, as empirical analysis suggests even those who don’t want help can get it. She said the most important predictor of success is actually time in treatment.
“When patients make it to that first benchmark threshold, which is 90 days, they become substantially more likely to maintain their sobriety, to maintain their recovery … After we reach that first 90 days, continuing on, the best predictor of future success is length in treatment,” Oberweis said. ”So if we have carrots and sticks where we can get people to stay in treatment, things like drug court where the stick is big and heavy, things like loss of housing, those are great incentives to keep people moving forward.”
Depew said it needs to be more than just a mental health provider, because that’s such a broad term. She said the treatment needs to be interdisciplinary, meaning that in addition to talk therapy, some participants may need to be regulated through medication, or may have other physical needs.
“Depending on how long they’ve had the addiction or whatever that addiction is, they could have organ damage. If they’re going to get better, they’re going to need to see much more than just a mental health provider … One of my clients who’s been under the influence for years and is just barely recovering and brain cells are going to come back, they’re not going to be able to follow what that special diet’s going to be or when they need to take that medication,” Depew said.
Opponents of the bill have criticized its lack of deadlines. Depew said it is ludicrous to put a date on recovery.
“Recovery waxes and wanes. It’s not one-and-done. I will always have to do something to maintain my sobriety … At any point in time, someone who’s got 27 years sobriety in, something could happen and lose a day … Are we going to throw away the 27 years of hard work that they’ve put into that? No, we’re going to hopefully be right there to help pick them back up and put another 27 years in, as opposed to snub our nose at them … In my opinion, it’s ridiculous to put any type of timing [on recovery],” Depew said. “But I would say if someone’s not putting in the work, that’s what needs to be measured … if I’m not putting any work into it then maybe yes, maybe there needs to be a time frame on that, because you’re taking up a resource that someone else could truly, truly need to be using.”
Stevens also said deadlines are not a good formula for recovery.
“With mental illness, there’s this huge issue of trying new medications, trying new therapies, and some work for some people and some don’t. I think it’s a lot like any chronic illness,” Stevens said.
Oberweis said having a healthy response to mistakes is a part of how professionals know things are working.
“This sort of deadline, clock-ticking approach just reflects a misunderstanding about what recovery is like as a process,” Oberweis said.
If signed into law, the bill will be evaluated for success in five years. O’Brien said the measures that will be evaluated are reduced costs for institutionalization and health care.
“These are individuals who don’t have private health insurance, they’re covered by Medicaid or just by the hospitals doing indigent care and passing those costs on. So the assumption is that hopefully these housing-first programs will pay for themselves, largely from reduced emergency care,” O’Brien said.
Depew said recovery isn’t perfection, and we shouldn’t expect perfection out of people.
“People go into remission from cancer just the same way as people can go into remission from addiction, but there’s all kinds of cancer recovery centers. There’s all kinds of addiction recovery centers as well, but we don’t look down on people when their cancer comes back,” Depew said. “But we look down on people when they relapse. But why?”