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.

 

 

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Plastic Surgeon Describes Michigan Mental Health Delivery Issues: Mirrors Nationwide Problems

I would like to give creidt to Dr. Vikram Reddy MD MHSA, a plastic surgeon, NOT a psychiatrist who has lately been advocating in print for renewed reforms in the state of Michigan which is now over 20 years after the slash and burn cuts in that state’s public mental health care surgeon. You may find his timely and very thoughtful article in The Bridge Magazine or the trusty, still surviing Detroit Free Press.

You may ask why and how would a plastic surgeon of all physicians become so concerned about little ol’ mental health issues? Many reasons: 1) first and foremost he is a dedicated and committed physcician whose first priority is patient care, and primarily ensuring delivery of quality care; 2) he is “medical director of quality and clinical integration at his home hospital in Clinton Township, part of the Henry Ford Macomb Hospital system of great Detroit. His timely article, entitled, “Mental health care in has room for improvement, but will it?” says it all.

Dr. Reddy described a well thought clinical-analytic-management effort by his staff and himself to identify the problem patients of any kind who account in any hospital, especially in the ER departments, for utilizing, or in a more sarcastical-critical way of characterization, “using up,” the largest portion of such services for less than bona fide indiacation for the services they seek. And many of these services are costly procedures, and huge sinkholes of constantly recurring costs that do solve anything and ultimately do not “satisfy” or clnicmally meet the needs of the patients. Drug seeking pains who  claim pain, requires expensive workups by multiple specialistis, imaging studies, and then frustrating nonproductive earnest time spent with them thrying to divert them to more appropriate, and ultimately cost reducing services that appropriate address the problems of drug addiction. Also psychiatrist patients, for whom, like most every other state, there are not enough psychiatri residential or true 24 hour acute inpatient psychiatric beds and services manage and correct the issues that bring them repeatedly into ERs in crisis to get often the only timely help available to them. Dr. Reddy correctly alludes to, but does not specify, one of the historial causes of these typical nationwide problems, that has resulted in shorgages of outpatient services for psychiatric clients. I would inject the fact Republican Governor John Engle through the 1990’s’ reduced the statewide publc mental delivery system to a fraction of its former size. He, for instance, closed all but five of the major psychiatric state funded hospitals in the state. And like just about everywhere else, nowhere near a sliver of replacement community based services were responsibly created by the state. In fact this state was one of the first to start the Wild West, open the doors and let the private large and small business, not clinically oriented, agents of public psychiatric services take over. One would think that had this model worked which was exported by the same cadre of planners in Michgian to other states, notably the very next, North Carolina in 1999-2000 with very similar results except that NC did not close abruptly the four state hospitals, but instead “revamped” the community service universe by eliminating the county by county based mental health care delivery system, which while flawed through inadquate funing and other factors peculiar tot the geography and absurdity of having ONE HUNDRED often rural little bitty counties, and letting the privateeers decied what they would cherry pick and put in place. Buth states as well ass many others now face the second half of the equation of mental health care devliery, providing adequate and large, comprehensive multi-disciplinary relapse prevention of illness, whether it is substance abuse based, psychiatric or that of the developmentally disabled. North Carolina’s now causative “exacerbator,” was reducing almost by two thirds the public psychiatric beds in the whole state instead of closing hospitals, in order to save money.

Dr. Reddy has initiated a pilot project to identify frequent flyer costly mostly non=medically appropirate patients in the ER systems, and to responsibly divert, refer and get them to the services they need but often avoid, to stamp out maintenance of opioid additions through naive physician prescripbing and I suspect drug diversion but finds the outer system that needs in poorly organized and not up to the task.

He notes positively that the succeeding Democratic Governr Jennifer Granholm had to attempt to correct her predecessor’s Cossack approach, and I recall  her having to bravel condemn her political future by having to wring out of the state legislature and ailing economy, $500M to begin reorganize and stabilize the system. Dr. Reddy also refers to the more sensible long term positive approach of the current Governor Rick Snyder’s now comprehensive Mental Health Commision report and impetus of 2014 to begin to further “rehabilitate” the crippled Michigan system.

The reader who is intersted in the current nationahwie crisis of mental health care and its hobbled systems, both private and public would well advised to follow closely the developments in Michigan as the politicians, citizens, patients and their families, and their adovates and the providers, labor now to effect positive appropriate and responsible changes, that WILL cost money no matter what, and see if they are successful and can be a good example of a state’s corrective efforts for the rest of the states faciling simiilar issues.