What the New 21st Cure Mental Health Law Brings with It Locally

From the Christian Science Monitor newspaper, comes a good article, New reforms to alleviate pressure on local mental health system that lays out what the newly passed this week 21st Cures Act can bring with it at a local area and gives a hint of the tremendous expectations that will arise around this bill.

In the article, the author outlines some of the major features of the bill, but more importantly, shows how its provisions, especially in the legal arena may be expected to both furnish and require the provision of nonexistent services for the mentally ill in the justice system.

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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.

 

 

Criminal Discharges When There Is No Outpatient Infrastructure

This subject and set of events is dated, and I offer my apologies to the reader. But this offering will serve to remind what can go wrong when in the course of the mental health reform process, things can go very wrong when the health care sector succumbs to criminal insufficiencies in their immediate continuum of care system, gives in ethically to a dishonest set of circumstances, does not fight back and falls back upon devising equally criminal ways of coping and inventiveness instead of advocating at any cost for their powerless patients who are dependent upon them for everything and anything they need to start over and begin the recovery process outside life in the  hospital.

Over two years ago the Los Angles Times reported on a story that I thought I would never see again in my practicing lifetime, that of “dumping patients.” I practiced in Arizonaover 15 years ago and saw the now extinct Charter hospitals do this when a patient’s health insurances would be exhausted after a month or long stay in the free-standing hospital and then be “discharged to the street” literally and abruptly. I was witness to this process as our hosptal system having a rather compassionate approach to psychiatric care would willingly accept these unfortunate and truly traumatized persons when their desperate families brought to our admission doorsteps, those of the Camelback hospitals, once a group of psychiatric hospitals in the Phoenix and Scottsdale areas, started in the 1940’s and in the days of affordable psychiatric healthcare, a nationally recognized system for its superb quality of care. These dumped persons from  the for-profit hospitals, still suffering acute symptoms such as severe unremitting depressions, suicidal impulses or pressing urges and thoughts, would be admitted no questions asked–at a loss to the hospital and to us attendings who took them on as inpatients, not expecting to be paid at all, and saw this as part of our responsibilities and part of universe of care we should offer out of our senses of service and ethics. I saw no practitioner at the Camelback system of hospitals ever turn down such a patient or take on their care resentfully.

The process of discharge in modern inpatients psychiatric care literally begins with a day or two of admission, not so that we can hurry up the process, but so that we can get a head start in lining up the needed outpatient resources, financial support, sometimes a place to live for a homeless person, sometimes family resources for a homeless minor, but always for a “best fit” between the patient and the all important team of team of therapist and psychiatrist. Often during the patient’s inpatient “do-over,” we would have the prospective therapist and future psychiatric come to visit the patient in person to have a get-acquainted session to make sure there was a good personality fit and rapport among them all, thereby giving often these persons brutalized by the “for profit” systems genuine hope that after discharge, whenver all arrived at a consensus decision made together, there would be the help ready in place to support them, giving them genuine hope instead of another trauma.

The article I came across recently in my constantly Google searchbot curating system for developments and trends inthe massive nationwide effort at changing our mental health care delivery system for all for the better was in the Los Angeles Times, entitled “S.F. sues to recoup costs for patients ‘dumped’ by Nevada hospital,” published ‘way back” in September 10, 2013. Its dated historical time of occurrence does not make it any less timely and happens to follow up on my previous post, which documented the emerging and alleged corruption of a privatized (read also for profit but sanctioned by the state who handled over inpatient psychiatric care to a national money making hospital system, to deliver service and make profit like the experiment with privatization of state prison systems who crowed about saving money to state legislatures, and of course pocketing the difference.) Well that did not go so well in a number of instances and the practice is still be re-examined in states who went in this direction.

The LA Times article though documented simply horrendous new heights of patient care callousness in patients at hospitals in Nevada, at discharge, from the Rawson-Neal Psychiatric Hospital in Las Vegas, often by bus with no resources, not provision at all for any outpatient care or personnel to San Francisco. The investigation by the newspaper the Sacremento Bee, started small but uncovered a scam/scandal of monstrous proportions and scale. It was found that about FIFTEEN HUNDRED patients had been shipped off to cities and towns in California over the previous five years. The investigation at that time was headed up by San Francisco City Attorney Dennis Herrera.

Those days were a unique confluence of corporate greed, and the growing appearance in the 1980’s of the seeds of the crisis we now face: the national shortage of adequate outpatient resources to replace which that hospital, especially the state public psychiatric hospitals could furnish even if at times, it bordered on “institutionalization.”

The solution is obvious and in everyone’s sight and radar. Outpatient resources and its infrastructure must be constructed nationwide, and governors and the no more taxes ideology of the present day and last 0 years must confront the reality that this costs money. Period. Good luck all you politicians trapped by your ideologies that do not square with reality. You need a paradigm shift in the biggest way and it will painful for your as you have to rethink your dearly held assumptions and shibboleths.

 

 

More States Paying the Price of Cuts

One of the sadly recurring, and enduring themes of so-called “mental health reform” in this country,  is the inevitability of a number of problems as state hospital beds are foolishly cut in this country and staff positions are cut as well.

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