FALMOUTH — A recent Maine Voices column criticized police use of force in calls involving minorities afflicted with mental illness. However, assigning sole blame to the police for tragic outcomes gives an unearned pass to the more fundamental cause: the failure of our current mental health system to adequately treat and care for the seriously mentally ill.
While one in five adults has some type of mental health condition such as depression or anxiety, only 4 percent suffer from “serious mental illness”: that is, schizophrenia, severe bipolar disorder and other conditions characterized by hallucinations, delusions or severe cognitive impairment. This 4 percent is vastly overrepresented in our homeless shelters, prisons and jails. By some estimates, 30 to 40 percent of all service calls to local law enforcement involve the mentally ill, and our prisons house 10 times more of the seriously mentally ill than do psychiatric hospitals.
It was not always this way. In 1960, the number of mentally ill hospitalized was 535,540, while only 55,362 were incarcerated in jails and prisons. By 2014, only 62,532 persons with mental illness were hospitalized, while 392,037 were incarcerated.
Well-intentioned deinstitutionalization of the mentally ill has been taking place since at least the 1970s, but community treatment options have not materialized in sufficient quantity or quality. The loss of psychiatric beds in Maine has mirrored the national trend of a 20 to 30 percent reduction since 2005 alone. Of the remaining beds, over one-third are needed for forensic patients from the criminal justice system.
The shortage in psychiatric beds has contributed to unconscionably long waiting lines for the seriously ill seeking treatment. On any given weekend in Portland, it’s not uncommon to find 10 to 15 emergency psychiatric admissions backed up on gurneys or in holding rooms while awaiting an open bed at Spring Harbor Hospital or Riverview Psychiatric Center. The delays can last days, even weeks, although many will simply be released to the street or transported to jail holding cells. And these are the wait times for those most in need of treatment.
Without timely clinical interventions, they frequently become trapped in the “revolving door” of the criminal justice system, with repeated arrests for petty crimes leading to more serious crimes and lengthier incarceration. Once incarcerated, the seriously mentally ill are more likely to be victimized by other inmates, are at higher risk for suicide and are more likely to spend extended periods of time in isolation.
Given this new reality, the Portland Police Department has risen to the challenge in a big way. Under the leadership of Chief Michael Sauschuck, the department created a Behavioral Health Response Program that, among other innovations: employs a full-time clinical social worker as a behavioral health coordinator; retains master’s-level interns from the University of Southern Maine’s clinical counseling program; actively connects with other crisis intervention agencies (e.g., Opportunity Alliance); and ensures that each of its 163 sworn officers receive 40 hours of crisis intervention training to increase empathy, learn de-escalation skills and improve overall responses to people in mental health crisis. Chief Sauschuck’s innovation has not gone unnoticed: The Council of State Governments designated the Portland Police Department as one of only six law enforcement-mental health learning sites in the entire country.
But even a nationally recognized police program cannot change the fact that prisons and jails have become the new state psychiatric hospitals. And while it may be unfair to expect police and first responders to substitute for mental health professionals, it is an actual injustice to continue to accept prisons as adequate substitutes for humane medical treatment.
There’s no easy solution for such systemic failure, but a good place to start might be to reduce the statewide shortage in psychiatric hospital beds. To that end, no single reform would have greater impact than the elimination of the federal policy that prohibits Medicaid from reimbursing states for most long-term institutional psychiatric care of the seriously mentally ill between the ages of 22 and 64. Since 1965, the so-called Institutions for Mental Diseases exclusion has created an irresistible incentive for states to move the seriously mentally ill out of hospitals and into community treatment programs that qualify for 50 percent Medicaid reimbursement but often lack the resources and structure necessary to achieve positive outcomes.
The IMD exclusion acts as federally sanctioned discrimination against those with serious mental illness. Getting rid of the policy would improve health care for Maine’s most vulnerable citizens and eliminate a leading cause of excessive deinstitutionalization. I ask Sen. Susan Collins: “Are you ready for the fight?”
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