I went to a funeral of a friend today. He was 53 years old and died of pneumonia. He also suffered from a chronic, severe mental illness. His death was an avoidable tragedy in more than one way.
He was certainly a poster child for the federal study released two years ago that announced that individuals with severe and persistent mental illnesses tend to die 25 years earlier than those without the illnesses.
That fact is one of the most significant tragedies associated with my friend's death because it is indictment of the nation's and Maryland's health system. Integration of behavioral and somatic health happens rarely in our country and that is a signficant problem and that is why so many people with severe mental illnesses die so young.
I actually have colleagues who express caution in rushing to integrate the care, fearing that mental health care will get short shrift in an integrated system. Mental health care has gotten short shrift in a fragmented system! Come on! People are dying.
My friend actually got better mental health care than most in this country. He lived in a group residence with 24 hour support. He had a good medical daycare program to go to five days a week. He had case management support and access to clinical care.
Would that he had regular access to primary care instead of having to go to the emergency room repeatedly when his COPD became problematic.
My colleagues need to get over their paranoia and push for a system of integrated care for individuals like my friend. Twenty-five years is a crime!
Tuesday, October 27, 2009
Thursday, October 22, 2009
Evidenced Based Practice
This anonymous quote was posted on the OpenMinds site today and is indicative of the lack of vision, practicality and insight of the Maryland Mental Hygiene Administration:
"In our clinic, we are carrying out an EBP—family psychoeducation—and the reviewers who have deemed our practice to have high fidelity to the model focus entirely on process rather than on outcomes. We have been using a unique approach to co-occurring disorders that (in our fairly primitive field research) indicates between 40% and 50% one-year sobriety and stability rates for all who start the program. However, it will not meet the Maryland standard for an EBP, since it appears to be going to a model for which I can find no longitudinal outcome data whatsoever."
This is pretty typical of the MD MHA, which doesn't seem to have the capacity to devine what is in the best interest of Marylanders but must rely on EBP's that haven't been proven here. Millions of dollars have been wasted because of the lack of analytic capacity in the Administration.
Housing development has suffered, critical daily supports have been lost, cost-shifting to jails, emergency rooms and homeless shelters has been rampant because of exceedingly poor policy decisions.
Granted, a laudable, decades late, decision to close Upper Shore Hospital has been made and a decision to close 80 beds at Spring Grove Hospital Center has also come to fruition, but with such tardiness that no one will be able to judge the impact on the quality of lives of people with severe psychiatric disabilities in the state.
Clearly, MHA needs an opthalmic correction for its vision.
"In our clinic, we are carrying out an EBP—family psychoeducation—and the reviewers who have deemed our practice to have high fidelity to the model focus entirely on process rather than on outcomes. We have been using a unique approach to co-occurring disorders that (in our fairly primitive field research) indicates between 40% and 50% one-year sobriety and stability rates for all who start the program. However, it will not meet the Maryland standard for an EBP, since it appears to be going to a model for which I can find no longitudinal outcome data whatsoever."
This is pretty typical of the MD MHA, which doesn't seem to have the capacity to devine what is in the best interest of Marylanders but must rely on EBP's that haven't been proven here. Millions of dollars have been wasted because of the lack of analytic capacity in the Administration.
Housing development has suffered, critical daily supports have been lost, cost-shifting to jails, emergency rooms and homeless shelters has been rampant because of exceedingly poor policy decisions.
Granted, a laudable, decades late, decision to close Upper Shore Hospital has been made and a decision to close 80 beds at Spring Grove Hospital Center has also come to fruition, but with such tardiness that no one will be able to judge the impact on the quality of lives of people with severe psychiatric disabilities in the state.
Clearly, MHA needs an opthalmic correction for its vision.
Tuesday, September 22, 2009
Housing Affordability
According to 2008 US Census data more than 40 million Americans spent 30% or more of their household income on housing costs, 600,000 more than in 2007. This is despite the fact that housing prices dropped by 20%.
Renters were hit hardest by the changing financial climate. The number of renters swelled by 900,000 in 2008 and supply struggled to meet demand. The market clearing price for rental property escalated.
Obviously, the poor and disabled are hurt worst during a period like this and more and more of the poor and disabled are getting pushed out of the housing market.
Despite that fact, the Maryland Mental Hygiene Administration is about to enter the ninth year of a freeze on the development of affordable housing for people with psychiatric disabilities in the state. It is true, a few million dollars was allocated this year to develop housing in Baltimore City but this is a drop in the bucket compared what is needed statewide.
In contrast, a model program in Florida, yes Florida, Boley Centers in Pinellas County has developed hundreds of new beds for people with psychiatric disabilities since the turn of the century and the state mental health authority in Tennessee, yes Tennessee, has developed thousands of beds in the same period.
Come on, Maryland, get your policy act together!
Renters were hit hardest by the changing financial climate. The number of renters swelled by 900,000 in 2008 and supply struggled to meet demand. The market clearing price for rental property escalated.
Obviously, the poor and disabled are hurt worst during a period like this and more and more of the poor and disabled are getting pushed out of the housing market.
Despite that fact, the Maryland Mental Hygiene Administration is about to enter the ninth year of a freeze on the development of affordable housing for people with psychiatric disabilities in the state. It is true, a few million dollars was allocated this year to develop housing in Baltimore City but this is a drop in the bucket compared what is needed statewide.
In contrast, a model program in Florida, yes Florida, Boley Centers in Pinellas County has developed hundreds of new beds for people with psychiatric disabilities since the turn of the century and the state mental health authority in Tennessee, yes Tennessee, has developed thousands of beds in the same period.
Come on, Maryland, get your policy act together!
Thursday, July 2, 2009
34th USPRA Conference
I just returned from the 34th USPRA conference in Norfolk, VA. Despite the devastation wrought by the economy on the mental health field, over 900 folks from as far away as Australia showed up to learn from thought leaders and peers in the field.
The agenda was overflowing with creative workshops and institutes related to recovery, employment, peer support and other scrumptious topics for practitioners.
Of course, Maryland was not represented, either by presenters or attendees. That's to be expected given the dearth of creativity in the Maryland system.
Next year -- June 13-17 in Boise, Idaho (it's a long story). Put it on your calendar and view it as an investment, not an expense.
The agenda was overflowing with creative workshops and institutes related to recovery, employment, peer support and other scrumptious topics for practitioners.
Of course, Maryland was not represented, either by presenters or attendees. That's to be expected given the dearth of creativity in the Maryland system.
Next year -- June 13-17 in Boise, Idaho (it's a long story). Put it on your calendar and view it as an investment, not an expense.
Wednesday, June 24, 2009
Growing Number of Mentally Ill Inmates
In "The Gazette of Politics and Business" June 12,2009 there is a front page article entitled "Growing numbers of mentally ill inmates struggle with inadequate treatment". A therapist at the Montgomery County Correctional Facility talked about her facility being a "revolving door. When inmates are released back into the the community, there often is not a strong support system of family or public programs to help them, and they revert to their prior behavior."
One can only point to the lack of vision and failed policies of the Maryland Mental Hygiene Administration over the last two decades. The Administration has held in check a moratorium on the development of affordable housing for individuals with psychiatric disabilities since its inception in 2001. The Administration then wonders why jails, emergency rooms and homeless shelters, and, most unfortunately, morgues have been flooded with individuals with severe psychiatric disabilities since then. Couple that with a de-emphasis on psychosocial programming that had demonstrated results in helping people stabilize and improve in their community settings and you have the makings of the perfect storm for increasing, inappropriate incarcerations as highlighted in The Gazette article.
The Administration instead focuses on the concept of "Recovery" which they clearly don't understand, Evidence Based Practices in lieu of practical solutions which have historically been proven to work and the platitudes of their "Transformation Grant" process, which has resulted in little but hot air. Until the Administration focuses on a real-world solution to the support of people with psychiatric disabilities and begins to develop a cogent vision of how the system works, the problems at the Montgomery County Correctional Facility will continue to escalate.
I'm not optimistic.
One can only point to the lack of vision and failed policies of the Maryland Mental Hygiene Administration over the last two decades. The Administration has held in check a moratorium on the development of affordable housing for individuals with psychiatric disabilities since its inception in 2001. The Administration then wonders why jails, emergency rooms and homeless shelters, and, most unfortunately, morgues have been flooded with individuals with severe psychiatric disabilities since then. Couple that with a de-emphasis on psychosocial programming that had demonstrated results in helping people stabilize and improve in their community settings and you have the makings of the perfect storm for increasing, inappropriate incarcerations as highlighted in The Gazette article.
The Administration instead focuses on the concept of "Recovery" which they clearly don't understand, Evidence Based Practices in lieu of practical solutions which have historically been proven to work and the platitudes of their "Transformation Grant" process, which has resulted in little but hot air. Until the Administration focuses on a real-world solution to the support of people with psychiatric disabilities and begins to develop a cogent vision of how the system works, the problems at the Montgomery County Correctional Facility will continue to escalate.
I'm not optimistic.
Thursday, June 11, 2009
Primary Care Integration
Not much stellar came out of Washington during the past years in regards to mental health. The New Freedom Commission Report and SAMHSA's 16 State Study were probably the most worthwhile products of those eight years. The New Freedom Commission Report didn't have teeth and was followed up with few funds. The "Transformation Grants" that followed the New Freedom report have generally been viewed as a waste of money by those not bought by the grants.
The 16 State Study was excellent but essentially told us what we already knew. It was a wake up call in many respects.
It would seem that it even woke up SAMHSA, for there has been significant movement related to one of the issues highlighted in the study. The study's research revealed that individuals with severe and persistent mental illness die 25 years earlier than the population without the disabilities. There is a whole panapoly of reasons for this but one of them has been the silos that have built for behavioral health care and physical health care in our health care delivery systems.
A few months ago, SAMHSA let an RFP to fund 11 primary care integration sites with the purpose of promoting primary care services for the target population in community mental health centers. The funding level was not piddling, either, at 1/2 million dollars a pop. The request was written well with a significant number of points allowed for the research and outcomes management component of the projects.
There are pockets of excellence in the US related to primary care integration and a growing interest in doing something about the problem. I believe there is some real promise for successful, replicable projects to come out of this funding.
Good job, SAMHSA!
The 16 State Study was excellent but essentially told us what we already knew. It was a wake up call in many respects.
It would seem that it even woke up SAMHSA, for there has been significant movement related to one of the issues highlighted in the study. The study's research revealed that individuals with severe and persistent mental illness die 25 years earlier than the population without the disabilities. There is a whole panapoly of reasons for this but one of them has been the silos that have built for behavioral health care and physical health care in our health care delivery systems.
A few months ago, SAMHSA let an RFP to fund 11 primary care integration sites with the purpose of promoting primary care services for the target population in community mental health centers. The funding level was not piddling, either, at 1/2 million dollars a pop. The request was written well with a significant number of points allowed for the research and outcomes management component of the projects.
There are pockets of excellence in the US related to primary care integration and a growing interest in doing something about the problem. I believe there is some real promise for successful, replicable projects to come out of this funding.
Good job, SAMHSA!
Wednesday, June 10, 2009
State mental health budget shortfalls
I just came across an article produced by the NASMHPD Research Institute that was published in December of last year related to a survey they conducted of state mental health authorities last year. NRI queried the states about whether there mental health systems were experiencing shortfalls. 32 of the 42 responding states said they were.
To deal with the shortfall, 42% of the states are closing state hospital beds, wards or entire hospitals.
Wouldn't it be nice if my state, Maryland, would learn something from this? Maryland continues to be one of the highest per capita spenders on state hospital beds in the nation. When you couple this with the state's eight year moratorium on the development of affordable housing for people with psychiatric disabilities, you have a system in peril.
It is time for a change!
To deal with the shortfall, 42% of the states are closing state hospital beds, wards or entire hospitals.
Wouldn't it be nice if my state, Maryland, would learn something from this? Maryland continues to be one of the highest per capita spenders on state hospital beds in the nation. When you couple this with the state's eight year moratorium on the development of affordable housing for people with psychiatric disabilities, you have a system in peril.
It is time for a change!
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