On November 1st, the Star Tribune posted an article bearing grim news for local mental health patients. It stated that St. Joseph’s Medical Center in Brainerd, MN has stopped accepting patients with severe psychiatric problems who are court-ordered to receive treatment, citing concerns that they were overburdening the facility. According to the article:
“The Duluth-based health care system said St. Joseph’s Medical Center in Brainerd in September stopped admitting “involuntary” patients held under a court order, known as civil commitment. Instead, the hospital’s 16-bed psychiatric unit now admits only patients who voluntarily accept treatment — who tend to have less-acute mental health problems than those who are civilly committed.”
Stories like this are popping up all over the country. Thousands of people in desperate need of care are being turned away because hospitals have neither the beds nor the funds to treat them. The idea behind this mode of thinking looks something like this:
“Patients who were civilly committed were staying an average of 40 days at St. Joseph’s mental health unit, nearly eight times longer than patients who voluntarily sought treatment, officials said. By accepting only voluntary patients, the hospital will be able to treat an additional 200 or more patients a year, including more patients from the Brainerd Lakes area, hospital executives said.”
This is great for people with less acute symptoms, but a potential death sentence for people who are dealing with an immediate mental health crisis. And the numbers are rising. According to the Treatment Advocacy Center, from 2005 to 2014, the total number of hospital stays for mental health/substance use conditions rose 12.2% in the United States. The majority of hospitalizations were for mood disorders, which rose by 23.2% in the 10-year period, from 690,900 stays in 2005 to 851,100 in 2014.
So where do people with severe mental illness end up, if not in the hospital? More often than not, prison. In another study done by the Treatment Advocacy Center, In 2014, there were 744,600 inmates in county and city jails in the United States. Inmates with severe psychiatric disease in US jails numbered approximately 149,000 that year. In 2014, there were 1,561,500 inmates in state prisons. Inmates with severe psychiatric disease numbered approximately 234,200 that year. The number has grown since then.
And mentally ill inmates tend to serve longer sentences, due to difficulty understanding and following prison rules. In New York’s notorious Rikers Island, the average stay for all inmates is 42 days; for mentally ill inmates, it is 215 days.
But some health officials are trying to make a difference. The National Association of State Mental Health Program Directors director Brian Hepburn has stated that the United States is overdue in treating mental illness the same way it treats other health conditions. The NASMHP recently released a joint report with the Treatment Advocacy Center with ten recommendations to policymakers regarding treatment, including:
• Prioritize and fund the development of a comprehensive continuum of mental health care
• Fund and foster evidence-based programs to divert adults and youths with serious mental illnesses or emotional disorders from justice settings to the treatment system.
• Identify those policies and practices that operate as disincentives to providing acute inpatient and other beds or that act as obstacles to psychiatric patients’ accessing existing beds and require hospitals benefiting from taxpayer dollar investments to directly provide or ensure timely access to inpatient psychiatric beds.
With additional issues at hand, like the threat of dismantling the Affordable Care Act, which includes expansion of Medicaid and Medicare, and the allowance for pre-existing conditions, patients are at further risk for slipping through the cracks. Funding for mental health research and hospital maintenance is also being cut. It begs the question: Will America ever fully address the needs of the mentally ill? With the number of mental health patients continuing to skyrocket, time is running out.