Nation's Crumbling Mental Health System

by John M. Curtis
(310) 204-8700

Copyright December 25, 2011
All Rights Reserved.                                         

                Budget crises across the country have left an already shaky mental health system in shambles, driving otherwise adjusted individuals into homelessness.  As the nation—and the Supreme Court—debates the survival of President Barack Obama’s health care plan, emergency rooms around the country are inundated with psychiatric emergencies.  Without Obama’s plan to cover some 30 million currently uninsured citizens, hospitals can’t get reimbursed for emergency medical services, whether psychiatric or otherwise.  “He had been homeless for about two weeks.  He hadn’t showered or eaten a lot.  He asked if we had a meal tray,” said Dr. William Sullivan, an emergency room doctor a University of Illinois Medical Center in Chicago.  Formerly head of the Illinois College of Emergency Physicians, Sullivan sees growing numbers of psychiatric cases flooding hospital emergency rooms.

            Strained budgets continue to tax and already broken mental health system, driving otherwise treatable problems into disabilities and homelessness.  Early intervention is crucial when treating most illnesses, certainly mental illness, where life-or-death emergencies routinely occur.  “These people without psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and the are becoming severely depressed,” said Dr. Felicia Smith, director of acute psychiatric services at Massachusetts General Hospital in Boston.  Smith points to the inexorable cascade from unemployment, homelessness and ultimately to life-threatening forms of mental illness like depression and suicidal behavior.  Once an otherwise adjusted individual breaks, there’s no assurance, with the best of care, of returning to normal functioning.

           State legislators around the country need to prioritize budgets to provide some modicum of mental health services before an otherwise adjusted population find themselves deteriorating into mental disabilities.  Prevalence of bipolar disorder—a condition characterized by alternating mania and depression—fill emergency rooms with self-destructive, violent and suicidal cases.  Before the Supreme Court rules on Obamacare, state legislatures must allocate resources to cover mental health services for today’s uninsured population.  High levels of unemployment eventually takes its toll, driving adjusted individuals into mental illness and maladaptive behavior, including street crime and violence.  “We’ve seen actually more very serious suicide attempts in that population that we had in the past as well,” said Smith, concerned about what’s become a national emergency.

            While the Republican Party campaigns to end Obamacare, hospitals around the country are driven more into insolvency complying with federal law requiring all patients presenting at emergency rooms—regardless of legal status—to receive services.  Hospitals or urgent care centers have no vehicle for reimbursement.  Psychiatric emergencies have risen 20% in recent years, accounting for the corresponding drop in psychiatric services around the country.  “We’ve seen actually more very serious suicide attempts in that population that we had in the past as well,” said Mass. General’s Dr. Smith.  Most emergency room docs and nursing personnel are ill-equipped to mange suicidal and violent patients, requiring specialized psychiatric strategies and treatments to protect public safety.  With the economy down, more normally adjusted individuals are driven into homelessness and mental illness.

            National Assn. of State Mental Health Program Directors estimates that $3.4 billion has been lost in the last three years in mental health funding.  Without urgent restoration of mental health funding, ER doctors could see marked increases to an already broken emergency care system.  Not only can hospitals not get reimbursed for psychiatric services, they can’t accommodate the degree of dangerousness now presenting for standard medical care.  “It’s been horrible,” said Linda Rosenberg, president of the National Council for Community Behavioral Healthcare,  “Those who need it the most—the unemployed, those with tremendous family stress—have no insurance.”  Whatever the price of Obamacare, it’s far less than the ongoing hemorrhage to state and private hospitals unable to get funding.

            When the Supreme Court decides Obamacare next June, they’d better have an alternative\ plan for financing the current train wreck that leaves hospitals broke and the public welfare in danger.  With California cutting $587 million in state mental health services, hospital emergency rooms can expect more psychiatric patients flooding into an already overtaxed system.  “Now you are adding in patients who are unsafe to leave but yet have nowhere to go,,” said Dr. Bret Nicks, an ER doc at Winston-Salem’s Wake Forest Baptist Medical Center, spokesman for the American College of Emergency Room Physicians.  Whatever today’s whopping budget deficits, the government can’t turn its back on the nation’s uninsured mentally ill.  Even if the economy recovers, something must be done to manage the nation’s mentally ill.  Sabotaging Obamacare offers no fix and only adds to the problem.

John M. Curtis writes politically neutral commentary analyzing spin in national and global news.  He's editor of OnlineColumnist.com.and author of Dodging the Bullet and Operation Charisma.

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