The insanity of how we do mental health care in L.A.
On May 16, the Los Angeles County Board of Supervisors voted to create a unit at the Twin Towers Correctional Facility to treat inmates with severe mental illness. The new Jail Inpatient Unit, also called the Acute Intervention Module, will have beds for inmates who are a danger to themselves or others.
According to the motion passed by the board, submitted by Supervisors Kathryn Barger and Janice Hahn, “the number of inmates in need of acute, emergency mental health services is on the rise. On average, 40 or more acutely mentally ill inmates are booked on a daily basis.”
Forty or more. Daily. Remember that number.
These are the inmates whose mental illness is too severe to be treated in an outpatient setting, the supervisors explained in their motion. Other mentally ill inmates “live in a jail housing unit and receive regular mental health treatment but do not require 24-hour care.”
How many? According to the supervisors' motion, “approximately 6,800 inmates housed in County correctional facilities participate in jail mental health programs with varying levels of care and treatment.”
That makes the Twin Towers Correctional Facility in Los Angeles “the largest de facto mental health institution in the United States.”
This is appalling. California could be building and staffing large hospitals and residential facilities for the treatment of mental illness. Instead, it clings to the antiquated belief that “institutions” are always bad and it's somehow better to let seriously ill people fend for themselves in the community and to fund “services” for those who wish to take advantage of them.
We still have institutions. Once a mentally ill individual harms someone else, that lost soul can be tossed into the criminal justice system and locked up in a cell.
Is it preferable to treat the mentally ill in a jail instead of a large psychiatric hospital?
Some people think so. Apparently Gov. Gavin Newsom is one of them, and politics may be the reason.
The closure of large psychiatric hospitals decades ago was a consequence of the 1965 Medicare and Medicaid Act, signed by President Lyndon Johnson. The law denied federal reimbursement for care in “Institutions of Mental Disease” that had more than 16 beds. As a result, indigent adults through age 64 who were on Medicaid could not be treated in large residential facilities, because if they were, the counties would get no federal money for their care.
At the time, it was fashionable to believe that new prescription drugs for mental illness were so promising that no one would need to be institutionalized, and community clinics were the modern way.
It has been clear for quite a long time that this model didn't work for everybody. Where are the people today who would have been receiving treatment in a large hospital in that earlier era? Many are in jails and prisons, or on the streets, or grimly cycling between them.
In November 2019, the Kaiser Family Foundation issued a report titled “State Options for Medicaid Coverage of Inpatient Behavioral Health Services.” In the very first sentence, the report states, “Since Medicaid's inception, federal law has generally prohibited states from using Medicaid funds for services provided to nonelderly adults in `institutions for mental disease' (IMDs).” Then it goes on to explain that “in recent years, the federal government has provided new mechanisms for states to finance IMD services for nonelderly adults through Medicaid in certain situations.”
“In recent years” means during the Trump administration. States can now get a waiver from the IMD exclusion and receive federal funds to pay for mental health services in large institutions. The limitation of “16 beds” would be removed.
Why hasn't Gov. Newsom asked for a waiver from the IMD exclusion for mental health services? Is it because this was a Trump administration initiative?
California doesn't have enough mental health beds to properly care for people who are suffering from gravely disabling mental illness, people dying from substance use disorder, and people who are a threat to themselves and others.
On average, “40 or more acutely mentally ill inmates” are booked in L.A. County every day. The new Jail Inpatient Unit at the Twin Towers facility will have 16 beds.
This is insanity.