Some States Wake Up To Severity Of MH Crisis

Problems of access to quality psychiatric care are accelerating for those with serious mental illness, according to recent newspaper accounts, but some states are using the crisis as an impetus for a broad look at their mental health system.

Reporter Jennifer Liberto in the St. Petersburg Times (December 7, 2003) told of the plight of indigent persons who are deemed a threat to themselves or others under terms of Florida’s Baker Act.

After a suicide attempt, one woman was kept as a boarder at a general hospital, because no psychiatric hospital would take her. If so-called Baker Act patients are first taken to a general hospital for medical treatment, psychiatric hospitals that do not receive state funding are not required to admit them from that hospital. An increasing number of private hospitals in the state have elected not to receive the funding because it does not cover their costs.

The result is that patients are sent to psychiatric hospitals or units at some distance from their homes or are held in general hospitals, which do not have staff to treat them.

Meg Kissinger in the Milwaukee Journal Sentinel (December 7, 2003) reported that Milwaukee County had cut the number of beds for patients with acute mental illness by more than half over the past 10 years, “with the notion that private hospitals would care for such patients.”

In the last two months, however, one private hospital eliminated its psychiatric ward, and another stopped taking referrals of psychiatric patients who were being detained by the county on an emergency basis. Spokespersons for both institutions said that reimbursement by the government did not cover the costs of care.

James Hill, interim director of behavioral health for Milwaukee County, said that Medicaid covers only a portion of the costs of care for a psychiatric patient in a hospital.

Medicaid law prohibits federal reimbursement for inpatient psychiatric care for patients between the ages of 21 and 64, resulting in further costs for local governments.

APA member Jon Gudeman, M.D., was quoted in the Milwaukee Journal article as saying, “We have a crisis all right. The pendulum has swung too far. We now have too few beds to effectively treat the sickest of our patients.”

He is the former medical director of the Milwaukee County Mental Health Complex and is now director of the Center for Psychotherapy at Columbia-St. Mary’s, Columbia Campus.

A front-page series titled “Michigan’s Mentally Ill: Crisis in Care” in the Detroit News last July led to joint hearings of the Senate’s Committee on Health Policy and Subcommittee on Community Health of the Appropriations Committee about problems in the state’s mental health system (Psychiatric News, November 7, 2003).

On December 15 Gov. Jennifer M. Granholm (D) appointed a mental health commission that is “designed to recommend sweeping changes in both the delivery of service and effectiveness of Michigan’s mental health network.”

The 33-member commission includes three members of the Michigan Psychiatric Society (MPS): Thomas Carli, M.D., a clinical associate professor of psychiatry at the University of Michigan; Michele Reid, M.D., immediate past president of MPS and medical director of the Detroit-Wayne County Community Mental Health Agency; and Rajiv Tandon, M.D., a professor of psychiatry at the University of Michigan.

The Flinn Foundation of Detroit has contributed $220,000 to support the commission’s work.

Ten states have convened temporary mental health commissions, and three have established permanent standing bodies to analyze the way states deliver mental health services, according to the press release announcing the Michigan commission.

In Nebraska, also on December 15, Gov. Mike Johanns (R) and Sen. Jim Jensen (R) released a plan developed by the state’s two academic health science centers—the University of Nebraska Medical Center and Creighton University—that calls for the creation of the Nebraska Center of Excellence in Behavioral Health.

The center would recruit more students into behavioral health, increase access to services through tele-health and tele-education, and provide statewide training programs for clinicians.

The recent plan is part of a larger effort by Johanns to restructure the state’s mental health system. He advocates closing two of the state’s three public psychiatric hospitals in 2005 and has said that “not one regional center bed” will be eliminated before a substitute bed is established in a community-based setting, according to the January 4 Omaha World Herald.

The World Herald reported that a “pre-session survey of Nebraska lawmakers found that a significant number of lawmakers need reassurances that the state still will provide adequate care for people with mental illness.”

Thirty lawmakers identified the mental health restructuring plan as one of the top five issues for the 2004 legislative session. ▪