Sunday, January 23, 2011
On Mental Health Issues -- Follow Up
I was going to end this series on Mental Health Issues with the "do the right thing" post labeled "Final", but I see that today's paper is full of "5150" stories and editorials on the crying need for adequate mental health care locally and beyond.
There are a lot of statistics involved and quite a lot of law that I had not considered more than tangentially. I know -- empirically -- that the over all mental health care issue is dire and getting worse for many, many patients. But as the situation worsens and the calls for improvement escalate, Americans aren't yet at the point of recognizing the need for complete overhaul and reform. It's getting closer, but we're not there yet.
I will try to have a more complete post covering the topics in today's paper later today.
The 5150 story is just insane -- as a friend described it this afternoon as we discussed the mental health (lack of care) situation in this area. There has been a 40% drop in 5150 incident reports since 2008. The patient described in the first few paragraphs was cowering under a therapist's desk, refusing aid and threatening to kill herself when the therapist decided to call the police hoping they would take the patient to the hospital for a 5150 commitment -- the involuntary commitment of a suicidal or dangerous person.
The therapist said she was told by the police officer who responded that the patient had to be standing there with a knife to her throat to be "5150'd" -- and left.
Commitments have dropped from over 2,000 in 2008 to less than 1,400 in 2010, while the seriously mentally ill population has remained essentially stable at roughly 74,000, including 27,000 children. Calls to the police for help have stayed pretty much the same during that time period, too.
The reason for the decline in involuntary commitments is budget cuts that have closed almost all the public mental health care outpatient clinics and inpatient facilities in the county. Now, the only open facilities to handle mentally ill patients are the overcrowded ERs at general hospitals, and because it may take a long time to find an open bed, police are simply refusing to take patients for treatment. Of course, if they cause trouble enough, they'll be taken to jail or killed on the spot.
The myth is that even with the lack of facilities for care and treatment of the mentally ill, "the most serious cases" are still being committed, and private community organizations are "stepping in" to fill the gaps left by the closures of the public clinics. This is simply not so.
There are numerous cases detailed of severely mentally ill individuals in the county who could not get care because there is none available.
That's the reality in this county and this country.
Carla Jacobs and Dr. E. Fuller Torrey opine on the necessity of the county to deal with its dangerously mentally ill or face the consequences. In their opinion piece, they detail what happened when Ronald Reagan signed the Lanterman-Petris-Short Act in 1969, effectively ordering the deinstitutionalization of the severely mentally ill, and changing the standard for involuntary inpatient commitment from a court finding of "need for treatment" to "danger to oneself or others." Now no one can intervene legally unless a patient is predictably imminently "dangerous." Knowing just where that line might be is almost impossible.
According to Jacobs and Torrey, the problem is that 40-50% of the severely mentally ill have a syndrome that prevents them from recognizing their own condition, which means, ultimately, that they get no treatment. At all.
Nationwide the statistics are staggering: in 2007 DoJ reported that 56% of state prisoners and 64% of local jail inmates were suffering from mental illness. Why do we let this situation continue and worsen year after year?
"Freedom?" For whom?
Because of chronic overcrowding in California's state prisons, many low level prisoners will have to be transferred to local jails, and then released. Many of them will be mentally ill, and there will be no treatment access for them.
This is not a sane policy.
There are laws in California and Arizona which make access to mental health care much more available than it usually is, but these laws are not implemented in either California or Arizona. Consequently, despite the need, there still is no adequate access to treatment and what little access there is is being even further restricted.
We need reform of the entire system. Now.