The Risk of Freedom

We're worried that one of our patients may be dead. Over a month ago, he simply wandered away from his day program and was never seen again.
Sometimes patients leave our programs suddenly, but we're confident they'll manage just fine. They may take a bus to another city, decide to live on the streets for a while, or move to California to be near an imagined celebrity lover.
But this patient wasn't like that. He barely managed a life that kept him within the confines of his apartment and the local convenience store. Members of our staff would periodically take him to a larger supermarket for more sensible grocery shopping. He'd take care of the doughnut shopping on his own, though. He'd bathe when we bribed him. Sometimes he'd take his medications.
Although our patient was likeable, he never appeared relaxed or comfortable around others. Yet he always smiled when we came to visit. We would sit for a while and have wide-ranging conversations with him. He especially enjoyed talking about sports. His eyes would brighten as he recited the current standings or described highlights from recent games.
At first glance he looked like a regular guy. But after a few minutes with him, it would be clear to anyone that he was not entirely regular. He had odd speech mannerisms. Bizarre beliefs would sometimes emerge.
Decades ago, someone with this sort of chronic psychotic illness would be confined to a psychiatric institution for years if not for life. State psychiatric hospitals housed thousands of patients. That changed with the development of antipsychotic medications in the 1950s and the deinstitutionalization of many of these patients in the 1960s.
The Community Mental Health Act of 1963 established a nationwide network of community mental health centers to care for the tens of thousands of discharged psychiatric patients and the others newly diagnosed.
Reintegrating these patients into local communities was an admirable goal for both therapeutic and social reasons. Inevitably, some patients fell through cracks in the system and became homeless. Resources are not equally available in all communities. State hospital beds were cut drastically and entire hospitals closed. As a result, some areas are experiencing a shortage of beds for patients who require hospitalization.
Vast numbers of people with chronic psychiatric illnesses lead satisfying and productive lives in our communities, living with family members, in supervised settings, or on their own. With this freedom now enjoyed by so many, however, come some risks. For a few, the results can be tragic.
When we first noticed our patient was missing, we sprung into action. For weeks, we checked regularly with the local Missing Persons office, hospitals in the region, and the city morgue. We're still hoping that one day he'll miraculously wander back into our office. Or we may get a call from a distant police department or emergency room telling us he's on the next bus home.