by crbutler on Sat Dec 22, 2012 6:51 pm
The basic issues are money and bed space as far as dealing with the mentally ill.
In the state system so far it is a matter of "if you build it, we will fill it"
All the state MH beds have a waiting list at most times of the year. The state is the ward of last resort, where you send folks that don't fit in the regular MH system. We have tried to go to a smaller, more localized state MH system, and unfortunately, it really doesn't work as designed. Because of wait lists, there is tremendous pressure to discharge a patient as soon as possible.
The private system is based on bed turnover. They have something called DRG limits which cap how much insurance pays for treatment. If it takes too long, they end up losing money on the care they offer. This is all part of the fed's medicaid/medicare financial savings system, which is likely to be worse with the new health care act.
In essence, the hospitals medicate until the person is not a hazard to themself or others then tell them to follow up with an outpatient clinic to fine tune the treatment. This works well if you have a cooperative patient and an involved family. If they are not cooperative or their social system is not great, then it usually falls apart.
Talk to some of them sometime. The medications are usually expensive, the side effects are pretty significant, and you usually add on a bunch of medications to control side effects, with their own side effects. Add on to this the fact that we have no way of making sure that the person takes his medication in the first place and its a mess. Heck, in the institutions we have big issues getting folks to take their medicines.
Now the old institutions were not particularly pleasant places. How could they be when you are putting large numbers of generally unhappy (and usually not in their right minded) folks in a single place? However, economies of scale being what they are, it was a cheaper alternative and the folks were forced to stay there. They got rid of this system in the late 90's (after decades of trying to mainstream treatment, with varying levels of success) when the feds offered to pay more money for small maximum 16 bed hospitals, and now they cut most of that funding.
Its now cheaper to put someone in jail than in a MH program, and there are a lot more places in jail than in the MH programs as well. The mentally ill, while not necessarily dangerous, do tend to do things like "self medicate" with various illicit drugs, violate other people's rights, do things under the influence of illicit substances, and so on, and thus end up on Law Enforcement's radar. If you get on LE's radar enough, you usually end up in jail/prison.
And people wonder why the jails are full of the mentally ill? There is no place for them to go. Jail or the streets. And on the streets they get on LE's radar, and its a vicious cycle.
Oh, and MN is one of the "Mecca's" for MI treatment. We spend a lot more money than most states. If we have problems here, imagine what it is like in the South or in one of the chronically broke states like CA or IL.
So, if we want to do something to insure that the mentally ill are helped, and kept away from firearms, its going to require money. Probably lots of money. And it will likely increase the stigma of mental illness, which will cause its own set of issues.
Somehow, I don't see a solution that is as easy for our politicians as banning a few guns and saying we did something, its now not our fault. That is our real enemy here.
