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.


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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."


http://www.usatoday.com/longform/news/nation/2014/05/12/mental-health-system-crisis/7746535/