Typical Example of a mental health system crisis

The first newspaper series I recall reading about a state’s then system wide mental health crisis was in the 1990’s in the venerable Detroit Free Press. It is no longer available online unfortunately; it fell victim I guess, to the declining fortunes of that paper a number of years ago when it nearly went out of existence and went to publishing only three weekdays during the week. The series came after the governorship of John Engler who had to cope with the decline of the economic fortunes of that state in the 1990’s when the Big Three automakers fell on hard times and the state of Michigan suffered tremendously as much as any “Rust Belt” state at that time of disappearing manufacturing jobs. Governor Engler was one of the first governors who took a severe economic axe to human services, as well as many other state funded services, in order to keep the state going. Michigan was dear to my heart as I had attended college and medical school there and I had close friends there. One friend kept me in the loop by sending me paper cut-outs of articles from the Free Press documenting the devastating effect upon mental health services. Institutions, both academic and public state hospitals were closed that I had worked in. I found it all very hard to believe and it stimulated then my interest in “mental health reform,” that later hit my home state beginning only a few years later.  As an historical, geek aside, this was early in the days of newspapers going online and during the series on that state’s mental healthcare revolution; later the series was online but now no longer available. But this series was almost prescient as it foretold the crises other states were likely to face and how the severe but likely economically inescapable wrecking ball approach to funding in mental healthcare delivery, would affect patients, soceity, hospitals, law enforcement, jails, courts and practitioners.

A more current and still available online newspaper series on this same topic, is from the Milwaukee Journal-Sentinel, a wonderful paper. It is entitled: “Chronic Crisis: A System That Doesn’t Heal.” This series appeared in 2013 but if the reader follows the above link, you will find articles referenced also in the same newspaper that go back to 2006. I highly recommend this first lead article and its successors also found linked at the above site for further reading. It has the all too familiar stories of human tragedies, patients not helped for various systemic reasons, who died, their grieving families, analyses of the circumstances and cases, etc. If one has read any of these genre of series that are now appearing in the media now for the last several years, one has seen too many of these accounts already.

This series however, has a few features that make it exemplary and worth reading if you are interested in this social issue. It has presented a fascinating portrait of how local circumstances and even local legislation and lawsuits, one referenced in particular, that have either hamstrung systems, approaches and practitioners, or local differences in approaches to emergency services that surprised me and were new and issues I had not conceived of. I am like everyone else, still primarily local and parochial in my views and unconsciously, assuming that laws regarding, for example, involuntary commitments for mental patients urgently-emergently needing mandated care, worked the same. This series disabused me of my naive stance in a hurry.

As a “spoiler” to the reader, I will highlight the one issues that surprised me the most of all. In Wisconsin, only police can initiate an involuntary mental health petition process. In my state, any adult can initiate a psychiatric “petition.” To quote the article referenced above: 1) “Wisconsin is one of only five states that require police officers to detain a patient in an emergency;” 2) “It is a system built in reaction to state laws drafted by public defenders in the mid-1970’s that stressed the need to ‘avoid commitment at all costs’–laws that put the focus on the right to refuse treatment, not how best to provide it.'”

To afford the reader some helpful contrast, in my home and practice state, any adult who has first hand knowledge of the imminent danger to self or others on the part of the petitioned person, can initiate a mental health petition. This means that family who witness a valid and deserving need for emergency treatment, such as a credible suicide threat or act by their family member, can initiate a petition and quickly mobilize an evaluation and possible treatment. In such states’ statutory process, there is still a very strong check and balance system reviewing the evaluation, commitment and certification of treatment process that is mandated, open and transparent, and, provides for appointment of responsible and skilled counsel for every petitioned individual. A court proceeding for review of all these steps is mandated routinely. So petitioned persons are not “railroaded” as one could infer or fear. Just the opposite in fact and practice.

In future installments, I will go on to review other articles and sources of the now 15-20 years of mental health reform efforts. One will come to appreciate that even with the local variations that is unique in Wisconsin as so well documented by the Milwaukee Journal-Sentinel, many of the issues are the same from state to state.

 

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Introduction to Mental Health Reform in North Carolina

Mental Health Reform began in North Carolina partially out of economic necessity. Other states had had to do so in the Midwest during the decade of the 1990’s for similar reasons, the decline of manufacturing in the so-called “Rust Belt,” but one example used mental health reform undeniably as a nearly vindictive budget slashing measure, singling out more than any other major expenditure category of a state budget for drastic cuts.

North Carolina’s impetus was truly largely driven by a perfect storm [no pun intended but it is one unfortunately nonetheless as the reader will quickly see below] confluence of unexpected and massive budgetary hits to the NC state coffers. In 1999-2000 along with a number of other segments of the economy, the “Dot Com” bubble burst nationally. This affected NC severely as North Carolina had long been building an information economic powerhouse through especially the Triangle area’s [Durham, Chapel Hill and Raleigh which are all within 8 or 15 miles of each depending on which leg of the triangle connecting the three cities you measure] universities, Duke, UNC-Chapel Hill, and North Carolina State University, respectively. NC State at the time and still is the most technically driven of the three and is now beginning to rival Rensselaer, MIT, Georgia Tech and Cal Poly in terms of research, award winning faculty, technical centers and spin off high tech companies. In fact, NC State had already established a new technical campus, the Centennial Campus adjacent to NC State’s campus and on the way to Research Triangle Park toward Durham. That campus has continued to massively grow in the years since the dot com recovery, for instance now housing the headquarters of Red Hat, the world’s leading commercial Linux distribution. This illustrates how much of an economic vortex the RTP {Research Triangle Park) is, generating hundreds of millions of dollars into the state economy. When the Dot Com bubble burst in those days when idiotic Internet companies were starting up, having no real product but promising getting groceries delivered to your house (now perhaps closer to reality), being overvalued in the stock market by unimaginably inflated multiples, the RTP of North Carolina suffered greatly, more so than Silicon Valley which was older, more established, larger and deeper. Jobs by the thousands were lost which were very high paying. High tech personnel left the state, state income tax revenues took a substantial hit. All this was a preview on a mini-scale of what was to come in the 2008 mortgage housing and financial derivatives scandal and bubble/Great Recession, partially still with us.

Continue reading “Introduction to Mental Health Reform in North Carolina”