Fragile, handle with care

Renata Alder, a New York Times film critic and award-winning novelist, made a concise observation of society’s need to respond to the needs of the mentally ill. She said, “Nothing defines the quality of life in a community more clearly than people who regard themselves, or whom the consensus chooses to regard, as mentally unwell.”

The tragic shootings in Skagit County that claimed six lives once again reminds us of the fragility of our state’s Mental Health system. It’s not the first time we’ve received this kind of reminder. Eleven years ago, the stabbing death of a retired Seattle firefighter by a mentally ill man who had been released from jail prompted changes in the law. But all too often it takes a tragic crime before we discuss the needs of the mentally ill.

The Heritage Foundation reports, “An estimated 5.6 million Americans suffer from severe mental illness. It strikes without regard to age, gender, race, education, socioeconomic status, culture, or ideology. In many cases it brings suffering not only to the individual but also to family and friends. Depression, which causes many of the 30,000 suicides in America each year, especially targets the elderly…” They also conclude that the “economic costs of mental illness are staggering. America spends over $69 billion yearly on direct treatment costs.”

So what are the major challenges facing the State of Washington’s Mental Health system? A state-commissioned study of residential and hospital bed capacity and need that was completed several years ago found an additional 680 residential and inpatient beds are needed statewide. But no action was taken on that study. Instead, state and local hospital beds have continued to be closed, and even more closures are planned next year.

The 1999 Legislature initiated the “Community Integration Assistance Program” to improve the process of identifying mentally ill offenders released from the Department of Corrections. These individuals, who pose a threat to public safety, were to be provided with treatment and services for up to five years. The funding provided by the state for each person served is $700 per month for Medicaid-eligible participants and $900 per month for those not on Medicaid. The reimbursement rate has not increased since the program began in 2000 despite an enormous increase in housing and other costs. In many cases, especially in King County, the cost of housing alone exceeds the reimbursement received from the state that is meant to cover all costs

Housing is absolutely critical for people with mental illness if the mentally ill are to benefit from treatment and move toward independence, employment, and recovery. It is integral for them to have the best opportunity, yet housing is hard to find for anyone with low income, and even harder for those who have a serious mental illness. The homeless, mentally ill, are much more likely to commit crimes and end up in jail. It is imperative that the housing dollars authorized by the recently adopted sales tax for mentally ill services should not be diverted for other uses.

We need training for our police about how to work with people with mental illness, and more resources for police to refer people to programs that help avert crises and violent acts; to divert people from jail and into treatment.

Legislation on gun ownership for people who have been involuntarily committed needs to better align between the state and county – currently there are different standards – with state legislation allowing ownership if you have been committed for 14 days or less and federal legislation not allowing ownership if you have been committed for any length of time.

There is insufficient state funding to provide services for people who are mentally ill, but not covered by Medicaid, either because they are too disorganized to get through the process, or because their illness is new (such as the first break psychosis of young people), or because of their immigration status. When people can’t get the treatment they so desperately need, they are much more of a risk to themselves and others.

Involuntary commitment is an extremely controversial issue. Most people with mental illness are not dangerous and their civil rights must be protected. Yet many people believe that it should be easier to commit people who have mental illness. As a result, commitment laws have been amended numerous times since 1998, all with the intent of making it easier to commit people who might be a danger.

Last year, the state Mental Health Division brought in national consultants to lead a task force of mental health professionals, law enforcement, consumers, advocates, prosecuting and defense attorneys, and state officials to review the involuntary commitment law. The conclusion of the task force is that changing laws is not the answer; what is needed are more accessible, consumer-focused, comprehensive services.

Even if the state were to respond to all of the issues listed above, there is no way to ensure that nothing like what happened 11 years ago in King County, or last week in Skagit County, will ever happen again. What we can and should do is provide services and safe housing for persons with mental illness that will minimize the risks for them and for society, while also giving them the resources needed to help them in the recovery process.

The Heritage Foundation report concludes, “Current mental health policy tends to support the status quo system regardless of the effectiveness of services.” This must not continue. America has the compassion, resources, and available treatments to care effectively for its citizens who suffer from severe mental illness.”

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3 responses to “Fragile, handle with care

  1. Thank you for this. As someone whose family is currently struggling with the mental health system in the state of WA is great to hear that we’re not the only ones that think it needs to be improved.

  2. I used to work in the mental health system, and I have ample experience with relatives and friends on both sides of the 72-hour hold. Since this is a comment, I’ll *try* to be brief.

    Here are some issues that warrant our immediate attention:

    1. Mental health parity. If medical insurance didn’t cover enough treatment for physical ailments to keep people from becoming permanently disabled, there would be an uproar. Unfortunately, most employer-sponsored mental health coverage is woefully inadequate.

    2. The extraordinary overwork of case managers in the community mental health system. If you think that a case manager can know — and be somehow legally answerable for — the current mental status of >100 people on any given day, you are “crazier” than any of their clients.

    3. The residential mental health system is a shambles. People are all but forgotten when they are parked at a group home for the mentally ill. Their care is varied, at best, despite the good intentions of many — but not all — of the facilities. Almost without exception workers are drastically underpaid and undertrained, and the safety of the facilities is often questionable.

    4. It is virtually a given that someone applying for social security disability for the first time — no matter how sick — will be turned down. For people who are without case management, or adequate case management, this is a nigh insurmountable obstacle. Without SSDI, basic needs like housing and medical benefits are much harder to access. The assumption by the administration seems to be that people are lying.

    5. Stigma. When we think of people with mental illnesses as dangerous, as problems to be handled, we deny them (and ourselves) humanity. The vast majority of people with mental illnesses — even serious, incapacitating mental illnesses — are not dangerous. Ostracizing and otherizing people has never led to their increased benefit, health, and well-being. And it makes nobody safer.

  3. Mental illness remains the last medical condition that carry’s such a stigma that people aren’t willing to stand up and demand treatment for this vulnerable population even though it will impact 1 in 5 people at some point in their life. Although it hits the headlines when someone who is mentally ill commits a crime in fact most people who are mentally ill are more likely to be the victim of a crime then average and are not violent.

    When there is violence is often self-directed and guns are the leading method used. Sadly in this country suicide is the second leading cause of death for people 15 to 24 and twice as many police officers die from suicide as being killed on the job.

    The cost of untreated depression and other serious neuro-biological disorders like schizophrenia pales in comparison to the consequences in terms of lost lives, productivity and unnecessary incarceration.

    In almost all cases it is a treatable medical condition and although in some cases it is chronic (just like diabetes or heart disease).

    Treatment works. In fact, the treatment success rates for some common mental health illnesses are approximately: 80% for bipolar disorder; 70% for major depression, obsessive-compulsive and panic disorders; and 60% for schizophrenia.

    Each mental health consumer who becomes employed saves taxpayers approximately $1,000 per month in taxes paid, lowered assistance costs and lowered mental health service costs.

    If the moral arguments “save you do it unto the least of these mine brethern you do it unto me” dont’ sway people there are clear cut economic arguments to be made for providing mental health services for people who live with mental illness. It is far cheaper to provide mental health services (including housing) then it is to incarcerate people. The county is moving in the right direction by training crisis teams of police officers to intervene but we need places to take them for treatment as well. Even people who want care are often unable to obtain it and people with severe mental health problems frequently lose their jobs and insurance coverage.

    Years ago when I was a developer and worked on a construction project for a local University (Bastyr) I hired people who were living with chronic mental illness to clean up the woodwork and refinish dorm and classrooms and the biggest challenge I had was in making sure they didn’t work too many hours as they would lose their medical coverage.

    Ron one of the signs of a leader is when he stands up for those people without power and government is at its best when you give a voice to those who are too ill to speak up on their own.

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