Later On

A blog written for those whose interests more or less match mine.

Jails and Emergency Rooms Are Our De Facto Mental Health Clinics

with 2 comments

I think it would be more efficient and save money overall if the mentally ill could go or be taken to a local mental health clinic and get expert treatment by a staff trained in and knowledgeable about mental health illnesses and treatments, thus taking a burdensome and inappropriate responsibility from the police and ERs.

But I don’t think that will happen because, much as with the poor, the controlling powers (Congressional majorities, business interests) simply do not care about people in that category, and so no government money is released to provide the resources. Instead, the problem is to a great degree simply ignored. Somehow we avert our gaze.

But services for this group very much are aligned with promoting the general welfare.

Lauren Kirchner writes in Pacific Standard:

The last time Virginia state senator Creigh Deeds made national headlines, the occasion was a shocking family tragedy. In November, Deeds’ son Gus, who had been on and off medication for bipolar disorder and crippling paranoia, repeatedly stabbed Deeds, before ending his own life. Now, a recovered but visibly scarred Deeds is back in the news, publicly urging his colleagues in Richmond to help him reform the state’s mental health laws.

On the night before his son attacked him, Deeds told Scott Pelley in a 60 Minutes interview, the family had taken Gus to an emergency room and tried to place him in a psychiatric facility, because they worried that he might hurt himself or someone else. Under Virginia state law, Gus could only be hospitalized against his will for six hours, or until an available bed in a psychiatric facility could be located. But no bed was free, and so Gus went home. Deeds is now working to get Virginia to extend the length of those emergency stays, and to build a state-wide computer database that would make finding open psychiatric beds easier.

Deeds’ story was just one part of the 60 Minutes segment, called “Nowhere to Go: Mentally Ill Youth in Crisis.” Scott Pelley interviewed a number of parents who have had to repeatedly bring their children and teens to the hospital for short-term stays and unsatisfying, piecemeal mental healthcare, for things like bipolar disorder, schizophrenia, and major depression disorder. Long-term psychiatric care is just so much harder to come by. Pelley explains that their experiences today illustrate the result of a half-century-long systemic deinstitutionalization of mental health care in America:

In the decades after the 1960s most large mental institutions were closed. It was thought that patients would get better treatment back in their communities. But adequate local facilities were never built. The number of beds available to psychiatric patients in America dropped from more than half a million to fewer than 100,000. That leaves many kids in crisis today with one option: the emergency room.

But what if those people suffering from mental illness aren’t minors, and they don’t have parents or support systems to bring them in to emergency rooms? If those people are adults, and they’re out in the world, disturbing people with antisocial behavior, then chances are that at some point, they’re going to have a brush with the law.

In a recent NPR report from the nation’s largest jail, Cook County in Illinois, Laura Sullivan described the spare, padded cells that many of the inmates are housed in. At least a third of the 10,000 inmates in Cook County are mentally ill, and the jail’s staff sounded absolutely overwhelmed.

Staff members called the situation they’re facing “staggering” and the policies that caused it “ridiculously stupid.” Sullivan reported that in the past three years, budget shortfalls caused Chicago to cut funding to six of the area’s 12 mental health clinics, and three nearby state hospitals. Those clinics and hospitals had provided mentally ill patients in the community with counseling and medication; without them, many of those patients tend to end up in jail.

Cook County is doing what it can to process the flow, and provide medicine and help to the people who need it—and this help, in turn, attracts more people who need it. Sullivan interviewed one inmate/patient who told her that after his local mental health clinic closed, he started relying on the jail to get regular access to the medication he has been taking for decades to manage his illness. In fact, he regularly commits small crimes just to get sent to jail, where he’ll then stay, until he goes before a judge to receive his sentence. This situation is not only incredibly ineffective in serving the community’s needs, it’s also incredibly expensive, as Sullivan describes: . . .

Continue reading.

Written by LeisureGuy

5 February 2014 at 11:31 am

2 Responses

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  1. Please forward this message on to the people you know! I think that most people don’t know that people with mental health issues are tragically underserved. I’m a social worker (I run a few websites as my “side hustle”), and last year I worked in a mental health clinic. What I found there was depressing at best, and horrifying at worst.

    Pelly’s interview mostly got it right, in that most long-term mental health facilities were closed in the 1960s. The fear was—and it wasn’t an unreasonable—that people with mental health disorders were basically being locked away for years, and that being locked up indefinitely violated the constitutional rights of the patients. So, mental health facilities became limited in the amount of time they could keep mentally unwell patients.

    That was not necessarily a bad thing (especially as some patients had “lesser” mental health conditions, such as OCD). Unfortunately, what happened was that services became limited, but state and county governments—having saved a ton of money by closing those facilities down—never developed the proper resources to help community members who struggled with mental illness.

    What broke my heart most was one patient I talked to, who had been denied services again and again. She suffered from bipolar disorder with psychotic aspects, and she told me, “The only way you can count on getting help is going to the ER and saying, again and again, ‘I’m going to kill myself.’ That’s the only way to get their attention and get the help you need.”

    Sorry for the long comment—I feel very strongly about the subject of this post! I’m actually scrolling through your topics and I see a few other things I feel very strong about (namely, the environment and caffeine), so I hope you don’t mind if I make a few more comments!



    5 February 2014 at 2:03 pm

  2. I’m delighted by your comment. US behavior in the area of mental health is unconscionable, and I don’t understand how either party—but particularly Democrats—can simply neglect the problem. It isn’t as though Congress were busy with other things: they basically are doing nothing, while we have repeated daily tragedies across the country.


    5 February 2014 at 3:11 pm

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