The gap in mental health

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Yesterday I downloaded a police scanner app for my phone. The nurse in me likes to listen to the fire/EMS channels. So there I was, sitting on our porch swing on a fine summer evening, listening to the goings-on about town. And what I heard was absolutely depressing.

Most people probably have a fairly straightforward conception of what people in law enforcement and EMS do. Firefighters respond to fires, car accidents, and the like. Paramedics respond to the various accidents, traumas, and heart attacks around town. And the police respond to burglars, vandalism, drug activity, and other violent situations.

Wrooooooooong.

You know what the majority of the dispatch calls for both the police and the fire/EMS services were? Suicide threats or attempts.

Let that sink in for a minute.

First of all, this is a gross misuse of these two services. Your tax dollars at work, ladies and gentlemen. Instead of out addressing crime, our police force is dealing with people threatening to take their own lives. Same thing with firefighters and paramedics, amazingly. You’d actually be pretty shocked at how misused fire/EMS services are in general. It’s a huge issue in healthcare in general, not just mental health, because low income people and families have a propensity to use 911 as primary care and a shuttle service instead of going to their local clinic or urgent care. But I digress.

The biggest issue with this is that these people aren’t mental health professionals. At best, these people get cursory training on how to deal with mentally unstable people. They’re a band-aid for a much, much larger issue. And that issue is the unaddressed mental health problem in this country.

I say unaddressed because everyone knows that it exists. It’s just that nobody wants to apparently do anything about it. I don’t know why, considering the rise in violent crime in this country. You’d think that after a few mass shootings by mentally unstable people, everyone would be interested in mental health again. But sadly you’d be wrong.

The current problem with mental health in this country can be linked to deinstitutionalization. A big fancy word, but basically it means that we closed down all the mental health parts of public hospitals and other mental institutions. The act to deinstitutionalize mental health patients started in 1955 and picked up steam in the 1960’s with the civil rights movement. And, like most acts, it started out with the best intentions. Mental health doesn’t exactly have the greatest track record when it comes to having treated people like human beings. Conditions in a lot of these institutions were abysmal, and it was believed that by taking these people out of institutions and placing them into community facilities, they would get better care and more humane treatment.

Obviously that didn’t happen.

So where did everything go wrong? Well, that little tidbit of history I just gave you is from a 2007 report by the Kaiser Commission on Medicaid and the Uninsured. So what does their report say happened? Well, a lot of these deinstitutionalized patients were absorbed by nursing homes–also not exactly equipped for such an influx. Here’s a short list of mistakes in mental health reform from the 60’s to the 80’s according to the commission:

1. While the original plan was to move these patients to nursing homes, single room occupancy buildings, and board and care homes, these places were ill-equipped to handle the shear number of people released into the system. Reagan defunded a lot of public and standardized housing in the 80’s, which made a lot of these people homeless.

2. Essential services were never realized.

3. The federal and state governments did a poor job of communicating terms of community care policy, and therefore a lot of people fell through the cracks.

4. Mental health systems used measures of success like bed-days, instead of quality of care. So instead of saying, “This person got better,” they were essentially qualifying a successful treatment as, “Hey, this person only stayed for three days!” Not the greatest metric for mental health.

5. Money. As usual, everything comes down to the almighty dollar. Multiple funding streams were never coordinated, federal funding never materialized, and state funding was misappropriated.

6. NIMBY. I thought that this one was the most interesting point that the commission made. The “not in my backyard” attitude of our society killed a lot of community mental health services. The stigmas around mental health can be extremely detrimental to treatment and rehabilitation.

I would encourage everyone to read the report themselves, as it makes a fascinating read and gives great information about a crisis facing our healthcare system and our nation.

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