Cracks in the Dam of Mental Health Care

Yesterday I heard a law enforcement officer say the following, “I worked on the police force back in the 1990’s when they cut all the mental health funding and left chronically mentally ill people out on the streets. It was a dark moment for our state, and it’s hasn’t gotten any better.” He was talking about one of the best understood “gaps” in services for treating mental illness: there aren’t enough hospital bed days to get people stable. Some illnesses benefit from months, even years living under 24 hour supervised care, and now the standard is down to 3-5 days, and only to stabilize a safety crisis (like suicidal thinking or extreme paranoia that could make a person act against a perceived threat).

There aren’t enough hospital beds available, and that is true whether the patient in need is penniless (and in need of state funded treatment) or independently wealthy and able to pay all expenses up front in cash. For either person, hospital care for a mental health crisis is generally limited to a few short days. Longer program exist, but are harder to access and always have limited availability.

Even when care is available, people with mental illness may not understand that they need care. Sometimes their diseases rob them of that understanding, and they believe delusions represent reality. When patients lack understanding of their illnesses, families cannot force unwanted psychiatric treatment except in an emergency. 

Mental health care has now become a constant struggle to repair cracks in an aging dam. Few truly get what they need. People live with treatable diseases because they don’t know where or how to get help. Some spend more time with law enforcement officers than with mental health providers, and although law enforcement officers would prefer to take psychiatric patients to treatment, they don’t have many options. 

Cracks in the dam of available mental health care services:
•    During the wait for a first appointment
•    When the symptoms are new
•    When diagnostic clarification is needed
•    After a move to a new community
•    In cases where a long-term psychiatrist retires or dies
•    In a crisis that doesn’t require a hospital
•    Alternative to hospital
•    Alternative to jail
•    After hospital
•    After jail
•    When addiction is also a problem
•    Nursing home behavior problems
•    During hospital stays for general medical illness
•    When funding runs out
•    Hospital bed days
•    Long term mental health care

The results of these cracks: Rising healthcare and criminal justice costs due to caring for people with advanced illness, homelessness, broken families, increasing severity of disease, broken lives. 

Posted on December 12, 2016 .