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.

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!

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!