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!

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.