A man-made disaster
A
MENTAL HEALTH SYSTEM DROWNING FROM NEGLECT
More than half a million Americans with serious mental illness
are falling through the cracks of a system in tatters, a USA TODAY special
report shows.
The mentally ill who have nowhere to go and find little
sympathy from those around them often land hard in emergency rooms, county
jails and city streets. The lucky ones find homes with family. The unlucky
ones show up in the morgue.
"We have replaced the hospital bed with the jail cell, the
homeless shelter and the coffin," says Rep. Tim Murphy, R-Pa., a child
psychologist leading an effort to remodel the mental health system. "How
is that compassionate?"
States looking to save money have pared away both the community
mental health services designed to keep people healthy, as well as the
hospital care needed to help them heal after a crisis.
“We have replaced the hospital
bed with the jail cell, the homeless shelter and the coffin”
REP. TIM MURPHY, R-PA.
States have been reducing hospital beds for decades, because of
insurance pressures as well as a desire to provide more care outside
institutions. Tight budgets during the recession forced some of the most
devastating cuts in recent memory, says Robert Glover, executive director of
the National Association of State Mental Health Program Directors. States cut
$5 billion in mental health services from 2009 to 2012. In the same period,
the country eliminated at least 4,500 public psychiatric hospital beds —
nearly 10% of the total supply, he says.
The result is that, all too often, people with mental illness
get no care at all.
Nearly 40% of adults with "severe" mental illness —
such as schizophrenia or bipolar disorder — received no treatment in the
previous year, according to the 2012 National Survey on Drug Use and Health.
Among adults with any mental illness, 60% were untreated.
Rep. Tim Murphy (R-PA) chairs a Congressional hearing on
the shortage of beds for in-patient psychiatric care on March 26, 2014.
(Photo: H. Darr Beiser, USA TODAY)
Although mass shootings focus the public's attention on mental
illness, patients and families coping with it suffer private tragedies every
day, says Ron Manderscheid,executive director of the National Association of
County Behavioral Health and Developmental Disability Directors.
In a series of stories in the coming months, USA TODAY will
explore the human and financial costs that the country pays for not caring
more about the 10 million Americans with serious mental illness
Karen Kelley knows those costs well, resorting to desperate
measures to find care.
Kelley, 55, has battled depression for 15 years. Two years ago,
she says, the disease threatened to pull her under.
"I was in a very dark place and could not see the way
out," says Kelley, a mother of three adult children who lives in
Burlington, Vt. "I just felt like I was letting everybody down around me,
and I was never going to get better. It's like being in a tunnel that's
encased in with black, and you can't see the way you came in or the way out,
and you're all alone."
Kelley felt hopeless, as if the world would be a better place
without her. Her psychiatrist tried to have Kelley admitted to a hospital but
was told there were no available psychiatric beds. Not in the city. Not in the
entire state.
“I was in a very dark place and
could not see the way out”
KAREN KELLEY
A year earlier, Tropical Storm Irene had barreled through New
England, inundating Vermont's only psychiatric hospital with 8 feet ofwater,
scattering its mentally ill patients across the state. The flood closed the
aged hospital for good, and Vermont has yet to open a new state psychiatric
facility.
Kelley has attempted suicide several times. Her husband and
daughter, afraid that she would hurt herself again, took turns staying with
her most of the time.
Kelley says she didn't really want to die, but she realized
there was only one way to get into a hospital.
Karen Kelley finishes up making cornbread to go along with
some corn chowder at her Burlington home.
(Photo: Ryan Mercer for USA TODAY)
She swallowed an entire bottle of pills, walked into the next
room and told her husband, "Now they will have to admit me."
Patients and their advocates say the country's mental health
system has been drowning for a long time, not from floodwaters but from
neglect.
Suicide claims the lives of 38,000 Americans a year — more than
car accidents, prostate cancer or homicides, according to the Centers for
Disease Control and Prevention. About 90% of suicides are related to mental
illness, says Thomas Insel, director of the National Institute of Mental
Health.
People with mental illness die early for a variety of reasons,
Insel says. Some are victimized by violence. Others are too sick to take care
of their health. On average, people with serious mental illness die up to 23
years sooner than other Americans, giving them a life expectancy on par with
people in Bangladesh, Insel says.
Many with untreated mental illness are too sick to work. Insel
notes that 44% of those receiving federal disability payments have a serious
mental illness.
“The way we pay for mental
health today is the most expensive way possible”
THOMAS INSEL, DIRECTOR OF THE NATIONAL
INSTITUTE OF MENTAL HEALTH
Mental illness costs Americans under 70 more years of healthy
life than any other illness, Insel says. That's because mental illness, unlike
cancer or heart disease, is not a disease of aging. It often develops when
people are in the prime of life, arising during adolescence or young
adulthood. Left untreated, mental illness can rob people of decades of health.
Although some may believe mental illness doesn't affect them,
Insel notes that it costs the country at least $444 billion a year. Only about
one-third of that total goes to medical care, Insel says. The bulk of the cost
to society stems from disability payments and lost productivity. That total
doesn't include caregivers' lost earnings or the tax dollars spent to build
prisons.
These losses are especially tragic, Insel says, because of
growing evidence that early intervention can prevent mentally ill people from
deteriorating, halting what once seemed like an inevitable decline.
"The way we pay for mental health today is the most
expensive way possible," Insel says. "We don't provide support
early, so we end up paying for lifelong support."
