ER woes transcend deinstitutionalization

Thanks to Meredith Cohn and Andrea K. McDaniels for compelling coverage of pressing behavioral health needs in Maryland’s emergency departments (“Some patients crowd ERs: Hospitals struggle to handle mental health, substance abuse cases,” April 22).

Yes, hospitals are experiencing the consequences of a decades-long practice of “deinstitutionalization” – the closure of state psychiatric facilities without sufficient investment in community-based services. But this phenomenon provides only a partial explanation. Over the past 40 years, the United States has also invested less in subsidized housing for extremely low-income people, while housing in the private market has soared beyond the reach of those with low incomes. As a result, we’ve seen an unnerving increase in people, including those with untreated addiction and behavioral health challenges, living transiently or suffering on the streets, under bridges, in the vestibules of businesses and in emergency rooms.

Housing is the very foundation for health, yet it remains out of reach for too many. Increasing access to communitybased treatment will help, but it will fall short unless housing and residential support services are integrated parts of our treatment system.

In Baltimore, Health Care for the Homeless has collaborated with local, state, and federal partners to house – and support in maintaining their housing – more than 300 people with complex behavioral and medical health challenges; 90 percent remain housed long-term. Similar community collaborations all over the country keep people out of emergency rooms by placing them directly in housing and giving them the services they need to stay there. The results are consistent: supportive and affordable housing improves health, increases success in treatment, lowers public costs and reduces emergency room visits.

To solve our most pressing health care challenges, we must summon the political will to reinvest in affordable housing and the supports our most vulnerable neighbors require to pursue health and remain housed.