A Call to Advocacy
Part One of a Three Part Series
On December 15, 2016, A Palm Beach Florida newspaper, The Sun Sentinel, printed a feature story titled, Dying for help: Families struggle with severely mentally ill relatives, then become victims of their violence. Florida’s health care system is too stressed to prevent the tragedies, authored by By Megan O’Matz, Sally Kestin and John Maines. While the article pointed out that mentally ill people are no more likely to be violent than the general population, it also documented several personal and family tragedies in Florida resulting from the current sad state of affairs in mental health care.
Unfortunately, the problems identified by the article are not confined to the Sunshine State, but are representative of a national crisis characterized by:
- Lack of availability and access to local crisis services.
- Discrimination in health insurance
- A scarcity of inpatient beds.
- A shortage of psychiatrists available to work in a timely manner with seriously mentally ill clients.
- A lack of community based crisis prevention services, psycho-social rehabilitation programs, and residential options.
- Homeless mentally ill persons.
- The criminalization of mental illness.
When a mentally ill person is in crisis the availability of appropriate care often means the difference between life and death. All too often, depressed persons with suicidal thoughts, and persons with active psychotic symptoms, have been forced, sometimes with tragic results, to wait days, and even weeks, for an appointment with a mental health professional. Desperate patients seeking help from hospital emergency rooms have sometimes been held there for hours, even days, waiting for a psychiatric bed to become available.
It is not unusual for a person with mental illness to be turned away, or prematurely discharged from care. This is often due to insurance discrimination issues, including, but not limited to, healthcare insurance policies that do not cover mental health care at the same levels as other health needs, out-of-network insurance plan provisions that require substantial co-payments, providers that will not accept patients who are covered by Medicaid, and providers who discriminate against persons without insurance.
Nationwide, the number of available psychiatric beds is shrinking. Since the mid-1950s, bed availability has been reduced by 95%. The nation is also facing a shortage of psychiatrists, especially in rural areas. Compared with previous decades, fewer medical students are opting to specialize in psychiatry. The deficit in psychiatrists incentivizes those who are in the field to “cherry pick” their patients, which often means that seriously mentally ill persons are excluded, or put on long waiting lists, only to be seen once or twice a year.
The current mental health crisis is especially tragic because mental health policy makers know how to do better. Research based models of care have demonstrated that a comprehensive array of programs, including crisis prevention services, assertive outreach case management, psycho-social rehabilitation programs, and residential options, produce remarkable positive outcomes. Such effective community programing reduces the symptoms of psychiatric disorders, the need for inpatient hospitalization, improves life-skills, and provides the supports necessary to help sustain persons with serious mental illnesses in successful stable community living. But, in most communities today, there are huge gaps in such services. As a result of this failure in care, approximately 250,000 mentally ill persons are currently homeless.
Arguably, the greatest national shame of the current mental health care system is the criminalization of mental illnesses. Because inpatient beds and good effective community treatment can be virtually non-existent, mentally ill persons often end up in the criminal justice system, sentenced mostly for minor offenses. Ten times more mentally ill people are now in jails and prisons than in state psychiatric hospitals.
In Part II: Lessons of History – How the Crisis in Mental Health Care Came to Be
I hope to lay the groundwork for an advocacy agenda to improve mental health care in this nation. I believe a clear understanding of the public policy mistakes that created the current crisis is essential for the success of any efforts to improve future care for persons with mental illness.