Investigative report on collapse of US mental health care system

Karen Kelley is one of about 10 million people who suffer from mental illness. The cost is staggering, and could never account for the emotional toll, since that could never be fully calculated. [USA Today]

Karen Kelley is one of about 10 million people who suffer from mental illness. The cost is staggering, and could never account for the emotional toll, since that could never be fully calculated. [USA Today]

"More than half a million Americans with serious mental illness are falling through the cracks of a system in tatters," reports Liz Szabo and colleagues in an important USA TODAY special report. Absolute must-read.

The mentally ill who have nowhere to go and find little sympathy from those around them often land hard in emergency rooms, county jails and city streets. The lucky ones find homes with family. The unlucky ones show up in the morgue.

"We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin," says Rep. Tim Murphy, R-Pa., a child psychologist leading an effort to remodel the mental health system. "How is that compassionate?"

States looking to save money have pared away both the community mental health services designed to keep people healthy, as well as the hospital care needed to help them heal after a crisis.

"At least 590,000 mentally ill patients end up in jail, on street or in the morgue each year. Only 108,000 get hospital bed at any given time. Are there solutions to help the mentally ill?," tweets Szabo today. "Yes. We just don't fund them."

Read: The cost of not caring: Nowhere to go. [Liz Szabo, USA TODAY]


Notable Replies

  1. This article specifically focuses on the state budgetary problems associated with mental illness while ignoring completely that it was Ronald Reagan who made it a state budgetary problem to begin with:

    The Omnibus Act was passed by the efforts of the Reagan administration as an effort to reduce domestic spending. The Act rescinded a large amount of the legislation just passed, and the legislation that was not rescinded was almost entirely revamped. It effectively ended federal funding of community treatment for the mentally ill, shifting the burden entirely to individual state governments.[7]

    So yes, this problem really picked up speed about 30 years ago

  2. Does America want to be this kind of a dog-eat-dog society? This situation really sickens me.

    Agreed, it's a damn shame the article didn't mention the root of this evil, but then again, it's USA Today, not Democracy Now, etc.

    Aside from that issue, it's terrific to see a mainstream media outlet like USA Today actually put all of our collective noses in it and show us where we are today. And, we've had plenty of time to reverse the damage that sick fuck Reagan initiated, but as a nation we haven't and it's a travesty. A sick, foul travesty that should be a wretched embarrassment for all Americans.

    As a nation we should get together and...

    What was I saying?

  3. My insurer, Anthem/Wellpoint, made a unilateral change to how they adjudicate visits to mental health professionals. In the past, visits were always treated like a visit to your GP, as a co-pay. You pay your $20 and see your counselor.

    The change Anthem made was to start treating mental health services as an out-of-pocket expense applied to your deductible. In one fell swoop, seeing a counselor went from a $20/week cost, to a $75-125/week cost. This has made it financially impossible for us to get any regular treatment.

    Thing is, they didn't tell customers or the healthcare providers about the change. They just started denying the claims from the providers, who in-turn started sending multi-hundred-dollar bills to unsuspecting patients.

    When we called Anthem to ask about the change, their excuse was that they had discovered that they had been doing the mental health claims wrong for 30 years and were simply correcting the system to the correct way. Uh huh.

  4. "Falling through the cracks" implies a generally strong foundation in need of a few fixes. Perhaps a more apt metaphor might be "falling off the tightrope into the abyss."

  5. Unfortunately, the situation is much worse than this article depicts. Many of the problems we see today began when we stopped treating patients on an inpatient basis long-term. The government requires that people be able to "participate in the life of their community." This is what happens when the community does not want the mentally ill and there is no refuge for them. I agree that patients should not be tucked away and forgotten, but they shouldn't be thrown onto the streets and expected to bootstrap their way to mental health.

    I am a clinician working in an inpatient facility. We are focused on crisis stabilization, and we are good at what we do; I see a tremendous improvement in most of my patients. But the fact remains that there are very few placement options for them; institutionalization has not been replaced with independent living, but with 'personal care homes', which are often unlicensed and sometimes provide deplorable conditions for patients. For the price of a patient's disability check, they usually get no better than a few meals a day (Vienna sausages, baked beans, or a sandwich) and boarding in a home that is falling in on itself or is housing more residents than it can reasonably hold. There is very little supervision, and little to no therapeutic care. Unless the chronically mentally ill live in an environment that supports medication compliance, quality of life and hospital admission rates will continue to worsen. Even when people are ready for help (which is a hard place to come to for many), the resourcefulness and tenacity you need to acquire services is mind-boggling.

    We have to have other options besides standard outpatient counseling/psych care, intensive outpatient programs, and acute inpatient facilities. Assertive Community Treatment and other efforts are improving outcomes in locales across the country, but we need systemic reform to mental healthcare and healthcare parity. If people worked on the inside like I do, they'd know how much money we're wasting with poor policy and how burdened existing inpatient facilities are with the result of poor outpatient programming.

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