Mentally Ill Flood ER as States Cut Services

CHICAGO/NEW YORK (Reuters) - On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Ditto, from a fellow shrink - doing my MD gig since 1984 and the shrink sub-gig since 1988, Boarded in ‘93.

Having spent sizable portions of my career working at both state hospitals and at public mental health clinics, I could go on and on confirming and elaborating upon your points, but instead, I’ll just offer up a few skewed insights that have fascinated me over the years:

1. The do-gooder involvement of federal and state governments have done nothing to lessen the suffering for most patients with serious mental illnesses, and have often enabled a worsening. The emptying of the state hospitals, and the stultifying politicization of what remains of them is but one example. Despite what should have been game-changing advances in pharmacological treatments for mental illness, and vast armies of people devoted to helping them live outside an institution, the experiment has failed dramatically. Liberally politicized professional organizations, courts and patient advocate groups, playing out compassionate fantasies based on statist ideologies, have insured the mess we have now.

2. The general erosion and breakdown of the traditional, cohesive family and societal institutions, ushered in by the Marxist changes initiated in the 60s, have been devastating to those with enough remaining ego strengths to prosper in a more orderly society. The bulk of the patients I have seen over the years would probably never have needed my services before those changes.

3. The drug epidemic, facilitated by the failed “War on Drugs” and the failed “War on Poverty,” with all their attendant corrupting influences, has caused unimaginable damage to the most vulnerable.

When I was awarded a Mead Johnson Fellowship in Public Sector Psychiatry towards the end of my residency, they sent me to the APA convention in Chicago to hob nob with others like me and with the movers and shakers in that field. My interest in the field was based on a perceived need to turn back the failed de-instituionalization movement, revamp the old private or state hospital system into a truly therapeutic force that would end the suffering and the maltreatment of the severely mentally ill now living on the streets and in the jails and prisons. How naive.

I was treated there like a leper or a naive little kid for challenging the outpatient system that had provided such lucre, prestige and power to these people. I recall my final moment of involvement in that charade, in the penthouse of some uber-plush hotel along the waterfront, quite dressed up, waiters and waitresses coming around constantly to the little cliques of movers and shakers, and the promising young fellows like me, handing us as much champagne, caviar, goose liver pate and other delicacies as we wanted. I was standing - drink and caviar in hand - with a little group of luminaries, listening to them discuss the latest legislative proposals they were backing, when I raised my glass, made an overly gleeful and loud toast to “all those homeless mentally ill,” downed the entire glass of champagne, and left, never to return. I’ve never regretted closing that door behind me.

It is a tremendous crisis in our county. Mental health can only deal with the severe and persistently mentally ill. They are preety much able to handle crisis calls and that is about it. We did have a noted community based program that was defunded. It was operated through our 10 family resource centers. There were countless cases of people who were gently assisted from homelessness and drug abuse to independence and functionality by para professionals.

What happens with a 5150 -danger to self or others, is that the cops bring them in to the hospital ER. They have to sit with them as there are no quiet safe rooms anymore. We don’t have a detox facility to place them in either. The crisis mental health workers can’t do an assessment until the “clients” come down from whatever drug they are on. The hospital won’t accept them, so a cop is taken off the street to sit with them until they are sober and can be assessed. Then they are likely sent to an in-patient facility at tax payers’ expense.

The loss of treatment dollars makes money spent on extremely expensive hospitalization even more certain. The state wants to “realign” all responsibility for mental health patients back to the county. Our county wants to give it back to the state. It just is not working.

I think the best all-round solution is for states to build low cost managed care barracks for the non-dangerous mentally ill.

As a good example of such a program whose primary goal is to save the taxpayers money, Seattle set up a hotel for 75 confirmed alcoholics.

http://seattletimes.nwsource.com/html/localnews/2002684566_eastlake15m.html

The bottom line is that it saved the taxpayers a huge amount of money, it got the alcoholics out of the gutter and off the street, and drastically reduced police and emergency room costs as well.

The largest group of people who are mentally ill all share the same problem: chronic and incapacitating depression. These are the people who would benefit most from such a barracks.

Oddly enough, the mentally ill who are depressed are rather low maintenance compared to many, and are generally satisfied with minimal needs, such as a bed, shower, food and water, and clean clothing. But it is very hard for them to earn a living or perform extended tasks. Some respond very well to antidepressant treatment, but others do not.

Yet concentrating them would save a lot of money, with a more institutional economy of scale.

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.