Part I of a four-part series looking at the sorry state of treating the mentally ill — beyond warehousing people in institutions or prisons — and the tentative efforts to improve the situation. Also see Part II, Part III and Part IV.

When David Eldridge was finishing his senior year of high school, one of his teachers said to his mom, Ann: "He is bright, but his mind is disorganized."

Looking back, Ann Eldridge wishes she had paid closer attention. She was a psychiatric nurse at the time; still she didn't see the warning signs. Now, 32 years later, she watches her son struggle with severe schizophrenia and wonders if things would be different if they had been able to diagnose him sooner.

Even with all of today's medical advances, recognizing, diagnosing and treating the severely mentally ill in this country takes an average of 10 years, experts say. Almost without exception, they are 10 years of heartache and frustration for the mentally ill and their families. Add to that lack of funding for adequate care and treatment of the mentally ill, nearly a quarter of whom end up in the criminal justice system, and you have a recipe for disaster.

"Since 1990, I don't know of a single state that's doing a better job now than before," said Dr. E. Fuller Torrey, likely the nation's foremost expert on severe mental illness and a tireless advocate for improved services. Twenty years ago, he said, several states were leading the nation in the services they provided, notably New Hampshire and Wisconsin.

Now, Torrey is more discouraged than ever. The latest of his 11 books on severe mental illness, The Insanity Offense, details what he calls a disgraceful lack of care nationwide for the mentally ill. The book, published in June, claims society as a whole is endangered by this lack of care.

"Certainly there are some nice programs, for example in Ohio, because it has excellent leadership committed to doing something for the seriously mentally ill," said Torrey, who directs the Stanley Medical Research Institute, the largest privately funded center for research on mental illness. Torrey also founded the national nonprofit Treatment Advocacy Center, which fights for changes in mental health laws to improve services to the mentally ill.

No Traction for Reform
According to a 2003 national report by the president's New Freedom Commission on Mental Health, mental illnesses rank first among illnesses that cause disability in the United States, Canada and Western Europe. In any given year, between 5 and 7 percent of adults suffer from a severe mental illness. Additionally, one of the preventable consequences of untreated mental illness is suicide, which causes more deaths each year than homicide or war, according to the World Health Organization.

The annual estimated cost of treating mental illness in the United States is $79 billion, of which $63 billion is due to lost productivity. Indirectly, mental illness costs $12 billion in lost productivity due to premature deaths and $4 billion in productivity losses for those in jails and prisons and for the time of family members who care for their mentally ill loved ones.

Nearly everyone involved in the mental health system in this country agrees it's broken. Few agree on how to fix it. The issues are myriad and complex. Diagnosis is difficult, and even with a relatively accurate assessment, finding the right combination of drugs and psychotherapy for each individual is a matter of trial and error over a long period of time. Many of those who suffer from mental illness refuse to accept they are ill, so getting them to agree to treatment is iffy, at best. Many live on the streets, unable to cope with or stay in "normal" housing.