Sunday, June 7, 2009
Geno's World: Video: How to make homemade ice cream in a plastic bag. This has nothing to do with the topic, but I thought it interesting, and doable. Now back from your break, we have important work to do!
The laws either need to be changed, or else a complete reworking and expansion of our public mental health system needs to be accomplished as part of health care reform. That will probably mean going back to federal funding of mental health community centers as we did in the 1960s and 1970s. The block grant system isn't working. This is not a small problem. It is a big problem. One that has been ignored for far too long. Looks like we need to go back to the future to fix our problems.
In the midst of my health care reform blog, I'm taking a mental health break to address the broken mental health system. In the 1981 Omnibus Budget Reconciliation Act (OBRA), federal funding for community mental health centers and other mental health and substance abuse services was eliminated. It was replaced by a block grant to the states that cut funding by 21% and made mental health facilities dependent on private funding to make ends meet. Thus the mental health safety net began to collapse. Looking at the STATISTICS, the number of psychiatric beds decreased by more than half, from 524,878 in 1970 to 211,199 in 2002, the corresponding bed rates per 100,000 civilian population dropped from 264 to 73, and beds in State mental hospitals (the ones that will treat you if you are uninsured) accounted for most of this precipitous drop, with their number representing only 27 percent of all psychiatric beds in 2002, compared with almost 80 percent in 1970.
And it is a huge problem. Nearly every day I have a patient declaring they are suicidal and need legally required treatment and evaluation by a psychiatrist. But they are waiting longer and longer to find a psychiatric bed at a psych hospital. It is not uncommon for patients to wait 16 hours in the emergency department, though the other day, I had a patient wait 41 hours. This sucks up a needed ER bed, nursing staff, doctor attention.
And when I brought this to the attention of the hospital administrator their response was, "Oh, we've had patients wait longer than that." I tried to impress him with the fact that more patients were LWBS (left without being seen) as a result of the longer wait times from the psych patients (there were 2 there that night, in an ER that has 9 beds) occupying 2 beds for a combined 56 hours. He was unmoved, though my exasperation did garner the response "I'll look into it."
The public funding cuts and closure of mental hospitals is compounded by a large uninsured population that is growing by the day. If you are insured and suicidal, you can find a bed. If you are uninsured, you wait, and wait, and wait. They are not the only ones who suffer. The patients not seen in the waiting room suffer as well. But the law says suicidal patients insured or not, must be seen by a psychiatrist before discharge from the ER. The law does not seem to account for the lack of mental health coverage though.