The gap in men­tal-health care

The Washington Post Sunday - - LOCAL OPINIONS - The writer is ex­ec­u­tive di­rec­tor of the Na­tional Al­liance on Men­tal Ill­ness of Vir­ginia.

Two re­cent in­ci­dents, each hor­ri­fy­ing, should give Vir­gini­ans pause about how much progress has been made in re­cent years re­gard­ing our men­tal-health sys­tem.

Twenty-four-year-old Jamy­cheal Mitchell, who had a history of men­tal ill­ness, died in a Vir­ginia jail while wait­ing three months for a hos­pi­tal bed to open up.

Natasha McKenna, a 37-year-old mother from Alexandria with a history of men­tal ill­ness, died in a Fair­fax County jail af­ter be­ing shocked mul­ti­ple times with a Taser. Her death was ruled ac­ci­den­tal.

So many ques­tions. So much heart­break. So much out­rage.

In­stead of get­ting the psy­chi­atric care they ur­gently needed, these peo­ple were need­lessly caught up in the crim­i­nal jus­tice sys­tem.

Last year, Vir­ginia’s lo­cal and re­gional jail sys­tems re­ported 6,787 in­car­cer­ated peo­ple with men­tal ill­ness — 1 in 4 of Vir­ginia’s in­mates — mak­ing jails among the com­mon­wealth’s largest providers of men­tal-health ser­vices.

Vir­ginia has fewer than 1,500 state psy­chi­atric beds. That sounds like a lot of hos­pi­tal beds, so what’s the prob­lem?

At any time, hun­dreds of dis­charge-ready pa­tients are oc­cu­py­ing those beds be­cause of a lack of com­mu­nity ser­vices, such as med­i­ca­tion treat­ment, ther­apy groups, case man­agers and hous­ing.

Given the cir­cum­stances, it’s not un­rea­son­able to ex­pect that jail staff be trained in han­dling in­mates with men­tal ill­ness. But we need to ask why there are nearly 7,000 in­mates with men­tal ill­ness in jail. For what other healthcare con­cern do peo­ple wind up in jail in­stead of in a doc­tor’s of­fice?

The prob­lem goes back decades. Start­ing in the 1970s, in­pa­tient psy­chi­atric hos­pi­tals were down­sized un­der a laud­able phi­los­o­phy that aban­doned the out­dated mode of in­sti­tu­tion­al­iz­ing peo­ple in fa­vor of more hu­mane and com­pas­sion­ate com­mu­nity-based care. Treat­ments were be­com­ing more so­phis­ti­cated, and newer med­i­ca­tions did not have the hor­ri­ble side ef­fects of their ear­lier forms. Money was sup­posed to fol­low the pa­tients into the com­mu­nity af­ter the mas­sive down­siz­ing of state hos­pi­tals, but that prom­ise was not kept. In­stead, down­siz­ing was seen as away to shift costs to state and lo­cal gov­ern­ments and ul­ti­mately skimp on men­tal-health care. We are still see­ing the fall­out from this faulty ap­proach, and jails are pick­ing up the slack.

Lack of hos­pi­tal-based care is only part of this com­plex prob­lem, though. Safe, af­ford­able hous­ing for peo­ple with men­tal ill­ness is ur­gently needed. Ser­vices such as coun­sel­ing are in short sup­ply; it is not un­com­mon for peo­ple to wait four or six weeks for an ap­point­ment. Mo­bile cri­sis teams have been de­funded and dis­banded. The men­tal­health work­force is fac­ing short­ages, es­pe­cially in ru­ral com­mu­ni­ties. Fam­i­lies strug­gle with a con­fus­ing sys­tem.

And those with men­tal ill­ness — such as Mitchell and McKenna— fall through the deep cracks. What can we do? Vir­ginia law­mak­ers should call for in­ves­ti­ga­tions into the deaths of Mitchell and McKenna, for ac­count­abil­ity and for learn­ing.

The Gen­eral Assem­bly should in­ject a mas­sive amount of fund­ing into per­ma­nent sup­port­ive hous­ing, which helps end the costly cy­cle of home­less­ness, in­car­cer­a­tion and hos­pi­tal­iza­tion. Per­ma­nent sup­port­ive hous­ing also is sig­nif­i­cantly less ex­pen­sive than in­car­cer­a­tion and hos­pi­tal­iza­tion, mul­ti­ple stud­ies have shown. In the past, it has re­duced emer­gency room costs by 62 per­cent.

Vir­ginia also should ex­pand the use of jail di­ver­sion strate­gies, in­clud­ing im­ple­ment­ing men­tal-health courts in all dis­tricts and en­sur­ing that at least 25 per­cent of po­lice per­son­nel are trained in de-es­ca­lat­ing men­tal-health crises.

And Vir­ginia’s law­mak­ers should quit bick­er­ing and ex­pand Med­i­caid, which would in­clude more than 34,000 adults with men­tal ill­ness not now cov­ered, en­abling them to get reg­u­lar men­tal-health care and med­i­ca­tions, stay healthy and avoid cri­sis. That would save taxpayers money.

The public must hold lead­ers ac­count­able for the prob­lems and pit­falls of our men­tal-health sys­tem. Law­mak­ers jug­gle many com­pet­ing pri­or­i­ties, and the squeaky wheel of­ten gets the grease. While the fam­i­lies of Mitchell and McKenna try to pick up the pieces and go on with their lives, the rest of us need to pro­vide a voice for the voice­less and en­sure that there are never again need­less deaths like theirs.

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