Mental Health Care Reform by user Headoc
This week was a busy one...
Certain revelations about the delivery system I found to be most concerning and troubling to consider giving thought to. I want sometimes to be able to just say that I don't care anymore and discover a way to turn a profit and forget about the ethical and sociological dilemmas that face the future of public mental health care delivery. No matter how frustrated I become with the realities I'm faced with I expect to always maintain a certain social consciousness and not sell out. At a dinner meeting last night I was chatting with a colleague who made an insightful comment that rang so true; "our patients don't vote" meaning that they don't really matter to the politicians. I then listened to a story of a professional who organized a voting rally specifically for the mentally ill and took a bus load to vote at a recent election. For this act he almost lost his job.
Often I get tired of mentioning mental health care reform because very few people care about it unless they work in the field. I become angry when I think of what happens to a vulnerable group of citizens, especially knowing that the general public is not aware of the whole truth. For several years there has been knowledge of this reform which translates basically to "we don't want to spend this much money from the budget to pay for these services." The essence of the plan has been to phase out virtually all Mental Health Centers from the role of providing substantial services and refer the clients out to a make believe private sector for services. The four state inpatient facilities are to be closed and replaced by a single facility. The transformation from theory to reality seems to have occurred. Lately, I have learned that the local county Mental Health Center will no longer accept new patients. Also I've learned that other than myself no local providers are accepting Medicare or Medicaid patients. This is a problem of great magnitude because it leaves a large part of the population without access to care, not to mention the uninsured.
I quit my consultant job at a metropolitan pretrial detention center a couple of years ago partly because of not being able to tolerate some of what I was witnessing. On several occasions there would be a severely mentally ill inmate I was asked to see after several days or weeks of laying on the jail room floor without treatment. This person may have been experiencing severe hallucinations and paranoia from receiving no treatment. Usually they would be refusing oral medications and it wasn't legal to give intramuscular forced medications which is exactly what was needed. The jail cleared themselves by being able to document the person was seen by a psychiatrist within the 14 day limit as required by law, but in essence nothing was really done for the individual. Sometimes they could be transferred to the state prison mental health unit for safekeeping but this was not a guarantee. Usually the person had been charged with a misdemeanor and fell into the category of public nuisance more so than dangerous criminal. Due to pressure to close the local state hospital this type of person was now a part of the criminal justice system instead of the public health system. Now they can never vote nor will they ever be eligible for Medicaid. As the mental health centers close down there is report of a rise in the number of jails and prisons being constructed. Is this what we as a society really want?
Sometimes I feel like I may care a little too much since there is little or nothing I have been able to contribute to help the situation directly. I feel I am a good clinician but that does nothing in the way of policy making and legislation. Often I wonder if the cause is worth fighting for. At times the forces within the public sector seem undefeatable. I see a disability system that defines people as either totally disabled or totally healthy when in most cases they are neither extreme. Those applicants who might be rehabilitatable or partially disabled seem to be encouraged to appear as ill as possible as they file one appeal after another for sometimes up to more than 2 years. The Social Services Department is so overloaded with cases that often it seems to function as a triage and cases not labeled as life threatening are placed on the back burner. Two parents of small children positive for cocaine in their urine is not even grounds for investigation. Now I see public mental health care on the brink of extinction and it seems that very few are concerned about what this could mean for our society. Maybe I'm the one that doesn't get it. I really don't think so. I don't think the Virginia Tech tragedy served as the wake up call it should have been. Individual emotional and spiritual illness when neglected eventually morphs into social sickness.
In my opinion, the cocaine and opioid epidemic will eventually reach a point of no return. Everyone is affected by the illness of addiction by just being part of the addicts' social or family network. Based on my experiences, I have no problem with locking up sociopathic drug addicts because majority of them seem to become incorrigible menaces to society and without a desire for recovery that is sincere there is very little hope for a good outcome. I do not feel this way about those with primary mental illnesses or even alcohol dependence that is not complicated with polysubstance abuse. I don't think these people should be thought of much different from the person who has cancer or cardiovascular disease since effective treatments are available. At this point it is not at all apparent in my state that those with a severe mental illness will be looked out for as the reform meets its cryptic future goals. I do like the idea of those who have similar views to my own organizing a bus load of mentally ill voters from your district and making sure they cast a vote in the next election. This could begin to build needed political clout. You'll probably lose your job, but you are going to lose it anyway eventually if you are employed in the public sector. This idea seems to be the only viable solution to avoiding a future disaster.