Since deinstitutionalization in the latter half of the twentieth century, portions of America’s mentally ill population have struggled with issues such as incarceration, homelessness and affordable housing, and lack of health insurance among other issues. In Nashville, where affordable housing is one of the most pressing issues for the low-income segment of the mentally ill population, and the general population, it may be easy to isolate homelessness as the largest issue. But studies show that poverty moderates the relationship between serious mental illness and social problems, while other works highlight overall stigmas towards the mentally ill as the root issue.
Regardless of its root cause, mental illness and society is a complex relationship that has plagued America since the colonial days. In recent years, however, the situation has gotten more complicated with deinstitutionalization and the lack of proactive government policies and nonprofit resources to address unforeseen consequences.
The conversation is particularly relevant to Nashville because of the city’s new mayor. Liberals across the city cheered as she came out ahead of David Fox in the polls, but the moment was bittersweet. Fox was the only candidate to bring mental illness back into the conversation of local politics since the 1970s and 1980s. At that time, city and state officials across the country at that time were forced to deal with the aftermath of the end of the institutionalization era. States were pleased to shut down involuntary institutionalization. For Tennessee, the long-term care these hospitals were offering was costly. Shifting the responsibility to the community took a financial burden off of them. Nationally, the number of institutionalized people in the United States dropped to approximately 100,000 in 1985, but with many unintended consequences. Local and state politicans quickly had to determine what to do with these individuals, and unfortunately, the jail cells, street corners, and shelters became the new home of the mentally ill.
And while the situation in Nashville is not as drastic as it once was, mental illness is still relevant to the city. Fox understood this current burden, constantly reminding voters about the TennCare changes the affect the lives of the city’s mentally ill population. The most recent TennCare changes have made access to health care has become a privileged many living with mental illness cannot afford. As of last June, for instance, a single, male adult cannot qualify for TennCare unless he receives social security (SSI), but SSI is not always the best path. At Park Center, a local rehabilitation center for the mentally ill and disabled, they do not encourage their members to request government supplements. “They have always encouraged me to work,” one member shared, “and [they] have showed me I could do more than collect a pay check.”
Luckily for Nashville, non-profits and grassroots organizations, like Park Center, have stepped in to help the situation. In 1986, the National Alliance on Mental Illness came to Nashville as family members of mentally ill persons rallied together resources and support to bring the four existing mental illness support groups together and promote expansion. Since then, NAMI TN, and along with similar organizations like Mental Health Association of Middle Tennessee, has actively advocated both federal and state legislatures on behalf of mental illness research funding, insurance parity, ending incarceration of the mentally ill, and affordable housing – the main four problems around mental illness both nationally and in Nashville. Other organizations, such as Centerstone and Park Center, also popped up in the 1980s and 1990s to provide case management and day programing for those with mental illnesses who could not afford expensive treatment centers.
But there is only so much non-profits can do. There is still a problem with It would be nice to think that Mayor Barry will pick up this social issue and make waves during her time in City Hall, but the subject is so taboo that it is a wonder Mr. Fox brought it to the table at all. Instead, conversations like public v. charter schools and public transportation will remain central to all political conversations in Nashville. These issues, however, will not be solved in the Mayor’s tenure, not because she is incapable, but because they’re so heavily tied to issues of race, ethnicity, and class – issues Nashvillians have yet to reconcile with.
The mentally ill population by no means effects the every day life of Nashville’s citizens like education and transportation, but it is a neutral issue that the Mayor can work on with or without public support. This does not have to be the center piece of her tenure in office, but it should be something that is worked on diligently until there is more stabile support and more resources available in Nashville. Mayor Barry could start by addressing the incarcerated mentally ill population. Or, she could launch a Nashville mobile treatment team that partners with nonprofits to bring mental health screenings to homeless individuals and government subsidized housing residents. She could even install permanent on-site support in low-income housing areas. It does not matter which policy she chooses, but she must do something.
image by paul nicholson