NH Governor Issues Urgent Call for More State Hospital Beds

As what I feel and predict will go from a quiet common state governmental call to action to hard pressed and at times, downright stingy state legislators, Gov. Sununu of New Hampshire has gone quite public in his urgent call for the establishment of inpatient acute state hospital psychiatric beds. This might seem like not so big a deal but I expect that this will become more and more frequent as the acuity of the public deficit in the capabilities to the now overflowing needs in many states overwhelmed by the numbers of chronically mentally ill.

In an article published of all places in the New Hampshire newspaper, The Portland Press Herald,  April 21,2017 entitled “New Hampshire Gov. Chris Sununu calls for more beds at psychiatric hospital,” the Governor publicly declared again but more emphatically the need for major figures in the state government agencies, especially the Dept. of Health and Human Services to mount a rapid effort with short-term corrections, which I guess  means “more beds please,” and a long-term realistic plan to address the mental health crises for treatment service delivery in the state. I think that this is noteworthy because it represents a growing trend that has finally burst into the open. However reluctant many governors have been in confronting this issue, I think that more will come out of their legislative closets and start trumpeting the needs for such actions. It has already started in such states as Texas and especially Washington state where Gov. Jay Inslee has been focusing on acute state public mental health issues as much or than any other state chief executive except the Governor and the Virginia’s two year old oversight committee on mental health issues with some of the most comprehensive and innovative programs in the country except perhaps my own state of North Carolina which has worked on these issues very quietly (in spite of HB2 ‘bathroom law’ distraction.

Continue reading “NH Governor Issues Urgent Call for More State Hospital Beds”

Advertisements

Does It require a killling to get a state hospital admission still…?

In yet another unbelievable horrible tragedy, a chronically mentally ill man in Washington state was finally admitted after a few months of court orders by a judge, a fine of the state mental health department to the tune of $2,000per  day and ceaseless and desperate advocacy for inpatient psychiatric treatment for their relative.

I must confess that in the above first paragraph, I did a little dishonest thing, an intentional literary device. I implied that it only after all those pushing and shoving well placed and well-intentioned efforts, did this man get the help he needed. No, those efforts were the unsuccessful prelude…

This middle aged man murdered his elderly father and THEN he was admitted to the state hospital. The article, “David Altman finally gets a bed at Western State Hospital,” makes for a very sad read. As I read it for the first time, the old colloquial phrase, “a train wreck in slow motion,” came to mind.

This tragedy is even worse in a way than the Gus Deeds tragedy in Virginia over two years ago. In that ‘case,’ Gus Deeds was a mentally ill psychotic young man in his early 20’s. His mental illness was known to the family and well managed as the father, a Virginia state legislator, is a Ph.D. clinical psychologist. He also saw the warning signs of spiraling psychosis and immediate need for acute inpatient psychiatric admission. Under the then peculiar obstacles in Va’s state hospital admissions procedures a bed could not be found for Gus and he was released from an emergency after four days. Within 1 or 2 days as I recall, he had tried to stab his father to death and then ended up suiciding.

Clinicians around the country  years ago began warning of these kinds of tragedies in the 1990’s. I remember joining the shrill and desperate warnings in those days at various levels of my own participation in state and then in my younger days, the national organizations as we advocated for our patients. I recall realizing along with many others that our estimates and assumptions about the weight of our influence in the ‘halls of power,’ were vastly self-deluding. ‘We’ were not only not listened to, but I recall as those in power and frankly zealots in the new wave of the then growing world of mental health restructuring, viewed us as psychiatric Luddites, old fogies who were no longer ‘with the program’ so to speak. Mental health professionals were viewed as stumping to preserve their own positions of power or whatever and our warnings were not only resented but also labeled as being rather like Chicken Little shrieking “the sky is falling!” As we continued our dissent and disturbingly factual predictions of what kinds of tragedies that reductions in training programs, inpatient, and outpatient resources would produce, we began to be denigrated, ignored and accused of holding up progress. Well, truly not to gloat utilizing families’ incredibly sad tragedies to do so, I must state the obvious, “We are not Kansas anymore,” and the predictions a generation of mental health professionals repeated over and over that fell on deaf ears, have to come to occur and confirm not how smart us mental health nags and gadflies were, but that those actions were to have dire and tragic consequences and for the last decade or more we have seen them materialize in front of us.

But on an optimistic note, we have turned the corner I firmly believe. The growing number of bills in legislatures at the national and state levels are now openly addressing and discussing the issue of the failures of mental health reform. Pieces of legislation are looking at many of the correct entre’ points for cultivating solutions: increasing training funds for all types of mental health professionals, financial incentives to go into the traditionally underpaid careers with loan forgiveness programs and other responsible incentives, starting up new training programs, restoring services, and spending monies by states and the nation even (gasp) talking of ‘enhancing revenue streams,’ (read new modes, methods of taxes, horror of horrors) to make any and all of these corrective measures possible.

Corrective legislation will have to be written to facilitate the immediate and easier mobilization of emergency psychiatric admission and legal mandated involuntary psychiatric hospitalizations to help to stem these kinds of horrific tragedies and save lives. And the balance of the rights of the person so involved will have to be redrawn in a different conceptual framework so that it is not virtually impossible to hospitalize someone who is psychotic and dangerous as it still is in some venues.

 

 

Mental Health Reform Legislation Coming?

After several years, much needed mental health reform legislation at the Federal level may finally be coming our way.

I must state at the outset, the gnawing sentiment that at least some of the suddenly growing and politically fashionable reason for pols to jump on this now aged, creaky bandwagon stems from the recent years of increasingly frequent mass shooting we have experienced in this country. And the growing heart-rending and hard to shout down with caustic political rhetoric often based on hysterical fears of somehow losing “our” guns rabid pushback that seems to instantly spring from the same blusterers of certain quarters because, surprise, surprise, these atrocities are committed with guns instead of Nerf toys.

Continue reading “Mental Health Reform Legislation Coming?”

Mississippi budget cuts to close psychiatric beds

In a very recent article, “Mississippi budget cuts to close psychiatric beds,” published in the Clarion-Ledger newspaper on may 10, 2016, it is reported that Mississippi will close a number of treatment units and beds in the state’s public mental health and substance abuse facilities.

The article details that this has come about as a result of the state’s legislature deciding to cut funding by some 4.4% or $8.3M imposed by the current governor Phil Bryant’s yardstick, something called”performance- based budgeting process.”

The article goes on to detail a number of state-funded services that will be cut or reduced in size.  Such targeted/designated services include inpatient mental health services and residential and community-based substance abuse treatment programs. The reader may follow the link above to read exactly what services will be trimmed or shut down altogether.

This is a rare opportunity for the concerned mental health/substance abuse services policy wonk, observer of both the national and regional scenes in such matters, to monitor what happens in the coming  few years in this locale, the state of Mississippi.

Further, it affords almost an experimental laboratory, to watch the consequences unfold. One will be able to see if this has a positive influence on the overall “mental health of the state,” or negative consequences. To reveal this writer’s own bias from having watched many other states do the same since the early 1990’s,  it will test the hypothesis that this action likely will repeat the past history of such efforts , namely to cause predictable negative results.

These results in other states have included: 1) increase in the mentally ill populations in local jails; 2) increased waiting lists in ERs around the state of acutely disturbed public psychiatric patients in crisis who need inpatient hospital services; 3) perhaps an increase in public incidents involving the chronically mentally ill of both a minor nuisance variety or major ones of tragic proportions; 4) increase in deaths of the mentally ill through suicide; 5) increase in the deaths of mentally ill persons through extreme public law enforcement actions due to the more disturbed and the communities not having a timely access to treatment; 6) more grieving families and tales in the local media as time goes on of possibly preventable tragedies; 7) increased strain on private treatment facilities ranging from private hospital based psychiatric units to hospital ERs, to the university medical school based psychiatric services.

The reader is invited to watch Mississippi as this made for observation stage in the ongoing struggle with provisioning public mental health services plays out in the media and locales of Mississippi to see how this turns out. I know this observer will watching with keen interest and growing concern and foreboding.

 

 

Colorado Has Same State Wide Problem

A very recent article, Colorado Still Lacks Inpatient Psychiatric Care by Ms. Elizabeth Drew published May 10, 2016 documents the same kinds of problems with psychiatric acute inpatient treatment resources that many other states have faced around the USA for the last 15 to 20 years.

Ms. Drew highlights the backdrop that started the mental health reform effort in Colorado so suddenly and starkly. Colorado suffered the misfortune to have the two double tragedies of mass shootings, the Columbine High School tragedy a number of years ago and the more recent Aurora CO theater shootings of 2012 committed by the then clearly psychotic James Holmes, whose trial riveted the nation. The James Holmes shooting caused a huge outcry from the public in that state for major and thoroughgoing changes in mental health services’ delivery.

Colorado has closed two state hospitals due to aging facilities being shut down and not being replaced. Colorado ranks now well below the current statistical average of 14 or so (13.9 in the previous blog posting’s article) per 100,000 beds for public inpatient psychiatric care in the state. Like many other states, its public mental health system has suffered greatly in the past two decades with inadequate funding and lack of growth of services commensurate with its higher than national average population growth. And like many other states, tragedies have begun to ramp up in severity, frequency and publicity as the “chickens have come home to roost.”

This article describes the very ambitious and quite rapid changes in point of fact, that Colorado put into place just last year, only about three years or so after the Aurora theater shooting. A massive state-wide system of acute outpatient crisis centers and much more rapid access to mental health contact, screenings and referrals to treatment resources was put in place. This clearly had a positive effect. Admirably, Colorado has begun a serious open effort to evaluate only one year into the operation of its new system. The results have been mixed and no matter what criticisms or kudos one may choose to endorse. Colorado, in my opinion as a long-time observer of mental health reform efforts nationwide, had commendable courage to permit and undertake this open review process. This review effort, documented in Ms. Drew’s article appears to show two results if I may condense and categorize them: 1) positive results in the delivery of acute mostly outpatient services, and 2) the common bugaboo of the yet unaddressed shortage of acute inpatient hospital beds seen now almost everywhere. Ms. Drew succinctly summarizes the reasons for this as relating to loss and closure of state hospital psychiatric beds and facilities, and,  inadequate funding at the state and federal levels of the riddle of the expense of inpatient psychiatric hospital based treatment. [In a coming post I will try my psychiatric hand at explaining why inpatient psychiatric treatment is always expensive].

In  coming posts,  I will try my psychiatric hand at enumerating other issues common to all states beyond hospital beds that make the current mental health delivery crisis so severe. These issues will include the shortage of mental health professionals especially psychiatrists and the history of some more discrete and largely unknown to the public, mental health training fund losses that have caused our current severe practitioner shortages.

 

A Good Idea from a Texas Mental Health Leader

Texas, like many states, has been struggling for the better part of the last two decades with its public mental health system’s needs. Like almost all other states in the United States, it has seen its share of declining state funding for state-wide mental health services. Ageing state hospitals for the acutely mentally ill, chronically mentally ill and developmentally disabled have been closed or downsized. Short-falls have gradually appeared in the provision of outpatient services recommended and hoped for, to supplement or replace those reduced state hospital beds.

Texas for a number of years has begun to experience the enormous increase in jail populations of the mentally ill, mirroring many other states, especially New York with its travails at Rikers Island, perhaps the country’s most famous metropolitan jail facility, serving New York City. Rikers Island has lamentably been in the tragedy borne headlines in the last few years with repeated suicides of mentally ill inmates, and lawsuits by families and repeated efforts at reform and improvement, recently occurring again by necessity under the mayoralty of Bill DeBlasio.

Harris County Jail, of Houston Texas, has become known as one of the largest “psychiatric” facilities in the country. Several years ago I recall that the Harris County Jail had to increase its psychiatrist staff roster from three psychiatrists to fifteen and add a number of psychiatric physician extenders and other staff to serve the needs of this swelling psychiatric segment of the inmate population. What happened in Harris County, encompassing metropolitan Houston, was not unique to the country’s correctional systems at all, but became known readily nationwide as one of the first such settings recognized for this tell-tale barometer of the deficiencies in any area’s public mental health service system. Harris County, on a personal note, is known quite well to me, as that extended area was where my father came from and is where I have my only sibling living all our adult lives.

A very recent article online written by Stephen M. Glazier, one of the nation’s leading mental health care executives and head of UTHealth Harris County Psychiatric Center of Houston, outlined one of the best-written definitions of the concept of psychiatric “continuum of care,” that I have ever read. His article appearing at TribTalk.org, “Bridging the Mental Health Treatment Gap,” on May 9, 2016,  provided insight into Texas’ progressive efforts in just the last 1-2 years on improving the state’s mental health reform and care delivery efforts which have not received the recognition they deserve.

Mr. Glazier pointed out the common issue seen in many states who have had to face the need to close or replace aging state hospitals, and the multifaceted dilemmas of what to replace them with. He eloquently wrote of the concept of providing what he termed the middle range of less intensive residential and non-hospital based psychiatric services in the overall continuum from hospital to home or ultimate living placement for the mentally ill person. He delineated some key concepts and facts: 1) that Texas’ state psychiatric bed ratio has declined since 2001 from 13.4 beds per 100,000 persons to 10.9; and that, 2) even if Texas had ‘kept up’ with the growing mental health needs, the rapid growth population growth in the state of Texas, which has always been in the top five states in the US, the state’s level of services would still have fallen behind previous levels of beds per 100,000 population.

His idea is not a new one, that increased and nuanced provision of these middle ground “residential,” transitional psychiatric services, would to at least some degree, not only replace some state hospital beds, but reduce the spill-over, or “trans-institutionalizations,” (the new buzzword) that we are seeing as ever more rapidly increasing numbers of the seriously mentally ill, shift from non-existent state psychiatric hospital beds to jails, hospital ERs, and the streets and shelters, all never intended to serve this population. But Mr. Glazier’s description of what is needed in filling in the gaps in the continuum of care of the mentally ill is well worth reading.

 

Corporate Psychiatry, and Greed Back Again?

This will be a full post but a ‘sidebar’ type as mentioned a few posts ago. This concerns one of the other states suddenly having a different type of problem in mental health reform service delivery. This involves what can happen when there is an attempt to privatize andsplit off the tasks of mental health care delivery by the mantra popular in certain political and business circles.

The enthralling idea behind privatization for traditionally “government services,” such as municipal water supply, trash collection, mass transit, public health care and mass pandemic protection, to cite an extreme example, is that governments cannot do the work as well, efficiently or cheaply as can the “private sector.” The political machines of the past century such as Tammany Hall and its decades of corruption and cronyism, the Daley political machine of Chicago where everything that got done, “got done,” often as a result of greasing the palm of your local alderman.

The ideological faith and belief that capitalistic, corporate business could always do a better job took strong hold of the political imagination of many in this country by the middle of this past century, emerging fully in the Reagan years largely in the form of “de-regulation,” and unfettering the business world from choking restraints of governmental rules, over-regulation that stifled innovation, efficiency and the free market and its potential productivity. Much of this was indeed true in certain sectors and up to a point. But the non-psychologically minded politicians who could not live in the world of ambiguity and human nature, would behave as if humannature and all its foibles and inherent sense of self interest would sacrifice for the betterment of the greater good of the Almighty Economy. A huge ideiological boo-boo in this paradigm shiftwas committed under this belief system, that began perhaps with President Reagan’s breaking the air controllers’ strike in the earliest years of his first term. But human nature asserted itself and those years came to be known as the “Age of Greed” years before our Wall Street crooks in nice looking suits broke the economy with hedge funds that were worthless, the housing mortgage bubble, insider trading and greed on a scale never seen or achieved in history.

So now we are witnessing states who have either given up

Continue reading “Corporate Psychiatry, and Greed Back Again?”