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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Maldistribution and Shortage of Psychiatrists and Child Psychiatrists

This is a reprise of a recent post on my other site “Pen and Psychiatrist.” I apologize to the the reader if you have already read this topic at the other site which deals in more cultural and social issues. But after I posted that entry not too long ago, I realized it more properly belonged on this site, since it deals with one aspect of the mental health reform puzzle in this country.

In my previous life some two decades ago as a young Turk clinical teaching and supervising faculty of psychiatric and child psychiatric residents and fellows in training at Duke Medical Center, I became interested in “manpower” (the vernacular then) or more properly speaking practitioner distribution and training issues of psychiatrists. This was in the so called Golden Age of mental health practice, even though the service delivery system in all disciplines, had serious issues, I and many many others could see the troublesome issue of maldistribution of mental health care professionals that was emerging three decades ago and worsening  year by year. Basically what was evolving was a situation in which desirable places to live, urban areas with urban amenities such as the symphonies, ballet and performing arts companies, university centers, and above all many colleagues around for support and lively continuing education meetings of regional psychology, social work and psychiatry societies, kept graduates of advanced training programs in the regions in which they trained. So over time, it evolved that areas like Boston/Cambridge MA, Raleigh-Durham-Chapel Hill NC (the Triangle Area), Ann Arbor MI, Dartmouth, New York City especially Manhattan, Stony Brooke, Long Island, Houston, Los Angeles, San Francisco, Seattle, Eugene OR, San Diego, Davis CA, Charleston SC, Atlanta GA, Birmingham AL, Albuquerque, Tucson AZ, and many other urban areas became the landing places where psychiatrists trained and often stayed to practice, in the university medical center cities. A good friend and colleague, now passed on Bruce Neeley MD of Duke and Emery, used to give lectures to residents nearing the penultimate stages of their training careers and were a year away from the decision of where to settle to practice. By then the 1980’s the trend had become set in concrete, only a minority of graduating psychiatrists left the training centers and set up practice in under-served areas.

Bruce Neeley and I separately in turn would give almost off the records seminars to the ‘senior residents,’ telling them in so many words, almost like the famous newspaper editor of the 1800’s, “Go West Young Psychiatrist,” In North Carolina we first meant go literally to western North Carolina which I knew very well because of my wife’s origin from Cherokee NC. But we also meant “get out of the urban centers, there are too many of us here already.”

WNC then and sadly still is vastly under-served by psychiatry with a chronic shortage that is almost criminal. I can count on the fingers of one hand the number of child psychiatrists in practice west of Asheville and that is a lot of territory. I used to tell senior residents to “Get out of the RTP [Research Triangle Park, another term used to denote the entire Raleigh-Durham-Chapel Hill area since each of those cities incredibly are only 8 to 15 miles from each other!

Continue reading “Maldistribution and Shortage of Psychiatrists and Child Psychiatrists”