Mental Health Care in America: We can do better

The television in the waiting room at the Marion County in-patient mental health facility was behind bars, with Fifty Shades of Grey flickering on the screen, while patients waited to be admitted. A person admitted here faces a bill of more than twenty thousand dollars for a week of treatment, but they were lucky to have found a bed this week, which underscores why Indiana rates so poorly when it comes to mental health. Many of the patients come from surrounding counties, sometimes a couple of hours away, where almost no in-patient options exist. Most rural counties have a shortage of therapists and clinics cannot keep up with the demand for services.  

In too many rural counties, quick response teams join law enforcement on calls to overdoses. The team arrives with Narcan and a social worker, when one is on call. If they’re lucky, the victim detoxes in the hospital, watched over by a sheriff’s deputy - there’s no lockdown or protective unit in the local hospital. In fact, there’s no OB unit either. When the clinics in the county close at 4:30 pm, the county jail becomes the next bed for someone endangering themselves (or others) under the influence or having a mental health crisis. Deputies as young as 19 or 20 oversee the inmates in a jail system that can only offer substandard medical options compared to a hospital. With the arrest, inmates rack up a reputation, financial problems, and a criminal record that snowballs as they try to find housing, land jobs, and get treatment. 

They don’t belong in jail

Mental and behavioral health treatment would be a game-changer. Over half of incarcerated Americans with mental illness do not receive treatment in prison or local jails, so diversion and treatment are critical for them, and for the community. Every person diverted from prison will avoid one more obstacle to recovery and healthy living. Unfortunately, Ryan Needham, sheriff in my home county, doesn't see the statehouse funneling money to meet that need. Actionable change begins when states prioritize mental health, and communities avoid the fallout of a gaping break in the system. Rachel Christensen, program director of the Residential Crisis Stabilization Unit in Maryland, sees her statehouse’s efforts paying off. Her clients get treatment rather than jail time.

We can do better

Christensen began her nearly two-decade career serving people with mental illness, substance use disorders, legal issues, and cognitive disabilities in Frederick, Maryland. She began with a small three-county program that is now part of a statewide mental health system that serves 6,000 people at any given time. Her program treats and houses people being released from the state psychiatric hospital. 

“They have the most treatment-resistant diagnoses” and are “adjacent” to the legal system, as Christensen said, having been ordered to the psychiatric hospital in lieu of prison. Her program’s goal is to divert those clients from institutionalization.

Christensen’s company— she is speaking solely as a professional, not as a representative of her organization, so she asked it not be named—treats anyone, “if their condition is in the DSM-5”- children, adolescents, people with cognitive disabilities, homelessness, substance use disorders, mental illness, as well as veterans and senior citizens. 

Her state, Maryland, is in the top ten for mental well-being according to Mental Health America. My state of Indiana lands in the lower half, still quite a bit better than Mississippi and Texas. Here’s the rub: It’s not because Maryland is close to the Capital or the eastern seaboard. Wisconsin, Pennsylvania, and Illinois also make the top ten. It’s the will of the people and their policymakers that creates a difference. 

The data suggests a crisis in communities

Presently in the U.S., the numbers are dire, according to the National Association of Mental Illness (NAMI):

• Mental illness and substance abuse disorders are involved in one of every eight emergency department visits.

• Mood disorders are the most common cause of hospitalization for all people under 45. 

• 37% of incarcerated adults have a diagnosed mental illness.

• Almost 21% of people experiencing homelessness have a serious MH condition.

• 15% of U.S. vets experienced a mental illness in 2019 alone.

• 70% of youth in the juvenile justice system have a diagnosable condition. 

• Serious mental illness causes an estimated loss of $193 billion in lost earnings. 

Consider the pressure these realities foist upon our police officers, legal systems, local hospitals, schools, non-profits, HUD, and many of our households. When community hospitals and jails are the primary treatment options for people experiencing mental illness and substance use disorder, there are huge gaps in treatment, as Christensen laid out. For instance, a community hospital can usually release a person with only two or four weeks of medications while they frequently wait 45-60 days to get continued care. Their medications run out and they aren’t getting therapy.

“There’s a lot of people that are surviving on too little support and are frequent, frequent fliers of high recidivism with only community hospitals,” said Christensen. Hospitals pay for that recidivism under the American Healthcare Act. Prison recidivism costs include court and legal fees, jail budgets, lost wages, rent and house payments skipped, evictions, and repossession of cars. Much of this is avoidable, as Maryland is showing.

Call to action: A system that works

Many U.S. counties are starting where they can. About half have trained a mobile crisis response team—-also called a CIT, QRT, or CRT— according to Yale School of Public Health. These vary by region, but most are staffed with some combination of a social worker, EMT, doctor, therapist, RN, case manager, vocational specialist, substance abuse counselor, and/or peer volunteers. Usually, a member of their team can monitor 911 calls and decide if they will “ride along.” While this helps with diversion, it only works if there are robust multi-tiered services. Christensen’s system offers supports such as respite services for parents, veterans’ services, homelessness outreach, domestic violence shelters, offender treatment programs, many residential options, and police training. Maryland has also recently opened psychiatric urgent care for those experiencing an acute crisis. 

Multi-tiered mental health systems save communities in costs, but importantly they save lives. The American Solidarity Party believes that each individual is intrinsically valuable by virtue of being a human being and that each human impacts others. Our health and safety is a mutual responsibility.

In the meantime, if you or anyone you know needs mental health services, further options are listed at the end of this article.