Shift of Mental Health Care to Jails

Once again the author finds himself balefully writing about the continuing appalling trends in mental health inpatient care nationally. However, I am moved to do only when I see a very good reference that I feel the reader interested in this vital topic, should be alerted to.

A recent article in the news blog, Vindy.com of November 24th, 2015 showed that it does not take a nationally prestigious paper or news sources to put out a superb summary and analysis of a subject pertinent to this topic. In an article entitled, “Mental health care in Ohio shifts from hospitals to jails,” written by Peter H. Milliken [milliken@vindy.com] in Youngstown Ohio, the issues were as clearly spelled out as I have ever seen.

That author started that “”in the past five decades, state-run psychiatric hospitals have been phased out with funds shifted into each community cereate outpatient care and support services for those afflicted with any of a number of mental illnesses.” He adds tellingly: “As in all complicated cases, the result has been a complicated stream of causes and effects,” and I would add ‘unintended effects’ that have marked ill conceived mental health reform efforts nationwide over the last 15-20 years. The three basic mistakes were 1) way too rapid closing of albeit aging state mental health hospitals and beds, 2) grossly inadequate replacement of those inpatient beds, the thinking being in the minds of frankly ignorant and misinformed ideology on the part of state level mental health planners and legislators, that the beds were not needed and should be “liberated” [my term] bourne out of the “de-institutionalization” misguided ideology arising in the 1950’s and 1960’s, and 3) the totally insufficient of funds to cover the community based needs as a result of the closure of inpatient, BOTH public and private.

The author gives an example of a state hospital closing 19 years before, the Woodside Hospital, and its surrounding county gradually absorbing what sounds like an inordinate number of extreme mental patients who had no place else to go. He states tellingly, “We’re in a crisis for state hospitals,…we have days when there are no hospital beds for our clients,” quoting Duane Piccririlli, executive director of Mahoning County, whose jail had to pick up the slack.

The article goes on to describe what happened in stark broad overview terms. The state of Ohio previously had 19 state hospitals but now has only six. Patient shifting as it is sometimes, called has occurred in  a massive way from non-existent state hospital beds to jail beds. And it costs the state more in most studies to house such patients in jails than even so called “expensive” or “labor intensive care,” and the care if far poorer and more and more marked by preventable tragedies.

 

 

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Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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