The mentally ill are better off in jail

by Tom Campbell, Executive Producer and Moderator, NC SPIN, September 18, 2014.

If anyone you love is mentally ill God help you, because the odds of getting adequate help elsewhere are about as good as winning the lottery. I speak from experience. My brother is bi-polar.

Even with better diagnostic tools, improved treatment techniques and advanced medications we aren’t much better off than in the 1800’s, when we locked the mentally ill in attics and families were too embarrassed to talk about relatives with such illnesses. Dorothea Dix convinced North Carolina legislators to open a hospital for the mentally ill and lives were dramatically changed for the better.

Now what we’ve got is a train wreck. North Carolina “reformed” our mental health system in 2001, shifting care responsibility from state to local communities. This ill-advised and poorly executed strategy resulted in the dramatic loss of psychiatric hospital beds. The acute shortage of psychiatrists, coupled with the unwillingness or inability of most hospitals to provide facilities, left the mentally ill with few options.

The emergency room has become the most common resort for episodic occurrences. Patients wait, sometimes for days in hallways, for scarce psychiatric beds to come available. If none open up patients are discharged in a few days; insurance companies aren’t willing to pay unless a doctor certifies the patient is a threat to himself or others. Recently I witnessed a screaming and cursing woman disrupting the entire emergency department while awaiting a bed.

They are discharged to families unable to adequately care for them but who have typically spent years trying and are frequently out of money and patience. Sometimes these patients are committed to nursing or assisted living facilities that have neither the expertise or close supervision needed to prevent them from being a danger to others. More often, these troubled souls end up homeless, penniless and land in jail. It is a sad commentary that our jails are better than most treatment they receive.

There are those who say mental healthcare shouldn’t be a responsibility or expense for government but few other entities can or will provide the unique housing, specialized care from doctors and nurses and sometimes powerful medications that necessitate close supervision.

Just to be clear, citizens are currently paying the costs for mental illness. When these mental patients visit emergency rooms, as they usually do several times a year, this care is the most expensive in the hospital. They are frequently indigent or receive Medicaid or Medicare. We pay for the jails that house those who have nowhere else to go and social workers trying to help them. The biggest expense comes when these undertreated patients sometimes commit violent acts that result in the loss of life, property or both.

It is time we stopped turning our heads. It is time we admit mental health reform is a dismal failure. It is time we faced this issue that is ours to resolve. Let’s agree mental healthcare is a service nobody else is going to provide so government must do so. We must build more facilities with more psychiatric beds. And yes, this will require more funding. If you don’t agree, show us your workable option.

History will seldom remember most of the issues we argue about or how much we spend on most services, but it will forever remember how we treated our brothers and sisters unable to help themselves.