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Economic Times

Feds Award $26.2 Million for Mental Health Care

by John M. Grohol, Psy.D. 7/28/2023

Feds Award $26.2 Million for Mental Health Care All too often, I find myself writing about how mental health care fails in the U.S. It’s an easy story to write — during hard economic times, health care (especially for the poor and indigent) often takes a big hit from the government.

So it’s always refreshing to write a different story. Especially one where the feds step up and fund not just a good idea, but a great one.

The hero in this instance is the U.S. Department of Health and Human Services (HHS) and the funding mechanism is the Affordable Care Act’s Prevention and Public Health Fund. Forty-three agencies share in the $26.2 million booty (most receiving about $500,000). The goal of the funding? To help better integrate primary care into the mental health services they offer.

Yes, you heard me right — helping poor people who have a mental disorder get proper health care, sometimes in the same facility where they get their mental health treatment.

7/28/2023 2 comments

Locking up Kids with Mental Illness

by John M. Grohol, Psy.D. 12/22/2022

By John M. Grohol, Psy.D.

Locking up Kids with Mental Illness A few weeks ago, we wrote about the opening of a mental health court in Philadelphia to help deal with a problem that’s overwhelming the U.S. justice system — poor mental health care in prisons, affecting up to 30 percent of those incarcerated.

Some of the problems our prisons face can be traced back to a pretty straightforward issue — our prisons are overcrowded. For instance, the prisons have been so overcrowded in California, the California prison system has been under a federal court’s oversight for years. And that court has become so frustrated by California’s lack of interest in the humane treatment of their prisoners, they recently ordered the number of prisoners cut by 27 percent within two years. The case that resulted in the court order began as the result of class action lawsuits addressing — surprise, surprise! — inadequate medical and mental health care in the prison system.

Which brings us to the sorry state of affairs in the juvenile prison system.

According to a recent New York Times article, about two-thirds of the nation’s approximately 93,000 juvenile inmates have at least one mental illness, citing surveys of youth prisons.

You’d think with such high rates of diagnosable mental health concerns in these children, you’d be offering them the highest mental health care possible, right? I mean, if anyone can be helped by such care early on, it’s likely to be children who are under the state’s care.

Sadly, that’s not the case. Just as with adults, we warehouse the children in facilities that not only do little to provide for their mental health needs, but continue to cut back in tough economic times:

At least 32 states cut their community mental health programs by an average of 5 percent this year and plan to double those budget reductions by 2010, according to a recent survey of state mental health offices.

Juvenile prisons have been the caretaker of last resort for troubled children since the 1980s, but mental health experts say the system is in crisis, facing a soaring number of inmates reliant on multiple — and powerful — psychotropic drugs and a shortage of therapists.

The children and teens in the juvenile justice system are just that — children and teens. According to surveys, more than half have histories of exposure to violence, neglect, abuse and trauma. It is estimated that up to 75 percent of young offenders have a substance abuse disorder. Other research has shown that as many as 20 percent of this group also suffer from a serious mental disorder, like clinical depression or bipolar disorder.

There are no easy answers to these problems, especially in tough economic times. States have no money, so they cut back on these “luxury” items, like adequate medical and mental health care to those under its charge. And few people care about the criminal justice system in the U.S. (since most of us have never been to prison or have any direct experience with it). Yet you can tell a lot about a society by the way they treat not only their indigent, but also their criminals. Even more so when those criminals are our own children and teens.

Out of sight, out of mind.

Read the full article: Mentally Ill Offenders Strain Juvenile System

12/22/2022 4 comments

Hospitals Full Up? State Suggests We Cut Beds

by John M. Grohol, Psy.D. 12/8/2022

By John M. Grohol, Psy.D.

Tough economic times affect everyone. Even, apparently, the ability to look at data in a rational and logical manner.

When your data tell you that your psychiatric hospital bed capacity is hovering around 97 percent, many people would consider that a sign that perhaps more psychiatric hospital beds are needed.

But in Massachusetts, apparently the reverse is true — at least, that is, when you start looking at ways to cut the budget. The Boston Globe has the story:

A state commission has proposed speeding up the closure of Westborough State Hospital and a slate of other measures that would cut about 120 psychiatric beds at a time when the mental health system is already under significant strain.

The proposal is in response to a $13 million budget deficit at the state Department of Mental Health and would reduce its 788 adult continuing-care psychiatric beds – those that provide inpatient mental health services and are operating at 97 percent capacity. Yet a commission member said the impact would be partially offset by 200 people being discharged from hospitals into community programs.

Not only will speeding up the closure of a psychiatric hospital already slated to close save money, but it will actually improve care to patients needing psychiatric hospitalization. How so? Well, according to the state’s logic, we’ll just discharge those “extra” patients into outpatient or community care settings sooner. Like, right now.

But wouldn’t you already have done so if there were people who could be better served in a less restrictive environment? The state appears to be saying, “We admit, we’re not presently providing the best possible, least restrictive psychiatric care for patients today.”

Or, more cynically, they’re saying that only as a matter of convenience to save some money.

The state has already cut 100 social workers from a system that could ill-afford such human services cuts. Now this state commission has recommended further cuts to services in the hopes that the community services will somehow magically make up for the lack of psychiatric hospital beds.

What happens when a community has fewer psychiatric beds than the population needs? Patients partake of emergency medicine services in ERs. Are ERs well-equipped to address a patient’s mental health needs? Most are not. And guess how much an ER bed costs? Significantly more than a psychiatric hospital bed does. A perfect example of not seeing the forest for the trees.

The commission also suggested that funding for the additional community treatment services could be paid for this year by Obama’s economic stimulus package. That’s great for this year, but what happens next year, when nobody’s looking and the hospital beds have already been cut? The state will cut back the community services, since there won’t be any federal stimulus money to partake of every year for years to come. And once again, the most vulnerable people in Massachusetts will be forsaken by their government.

I’m all for cutting back unnecessary psychiatric hospital services, especially for less-restrictive and more open-ended outpatient services. I already believe this should be the norm — that a psychiatric hospitalization is usually an avenue of last resort. And it would make absolute sense if these hospitals were running at 40 or 50 percent of their capacity.

But when your hospitals are running at 97 percent capacity and you have only a short-sighted plan on how to make up for the cut of 15 percent of that capacity, I don’t feel like it’s necessarily been well-thought through with an eye for “What’s best for patients?,” not, “What’s best for meeting this budget deficit?”

What a strange world we live in where politics — not science or scientific data — dictates the best treatments and care for an individual in need.

Read the full article: State commission proposes speeding closure of Westborough State Hospital

12/8/2022 2 comments