It’s Time to Strengthen Community-Based Mental Health
Before moving people out of Oregon State Hospital, officials should heed the warning by the U.S. Department of Justice
December 7, 2010 – Individuals with mental illnesses are better served in the community at a lower cost to the state, but I don’t necessarily agree that merely transferring individuals back to communities from in-patient or residential settings improves the quality of care, especially if the reduced cost of care is primarily related to lower Medicaid or state fund payments and no reinvestment of at least a part of the savings in propping up the severely lacking community mental health supports in this state.
As was recently noted by the US Department of Justice, Oregon lacks the supports within the community to appropriately care for individuals with a mental illness. There would be a cost savings but to adequately provide care for those individuals transferred back into the community, it would be necessary to reasonably ensure that the needed services and supports are actually present in Oregon’s communities. For the most part they are not.
It is not often I talk about my own battle with severe depression and post-traumatic stress disorder, especially publically, but I think now is an appropriate time when budgets are running at a deficit and the legislature will be attempting to balance differing needs of Oregonians. I have suffered from severe depression and PTSD for over 30 years. Fortunately now the severe depression is well controlled thanks to an implant and has been for three years.
Before 2007 I spent my share of time in emergency rooms, locked hospital wards and, at one point in a residential treatment facility. I will say that over the past 20 years the availability of mental health care in the community has, in a number of communities, disappeared altogether. I was required to travel to Southern California for residential treatment in 2004 because no adult residential treatment facilities existed in Oregon (and I don’t think they do today).
I am fortunate – I have good insurance that covers the cost of providing care for a chronic condition. A large number of individuals with mental illnesses are not so fortunate. I would highly recommend that the legislature take the time to make sure supports exist in the community to provide quality mental health care before the release of mentally ill individuals into communities where supports do not exist and, because of that, those individuals may well find themselves back in an inpatient setting.
Saving money in these times is a worthy goal but it will amount to short term savings if individuals moved from inpatient care to care in the community may be back in inpatient setting where costs may increase when the ability to cope deteriorates because the lack of appropriate care in the community. Too many Oregonians suffer from mental illnesses and many suffer in silence given the social stigma, the lack of community supports and the lack of the ability to pay for needed care.
Chris Apgar, CISSP, is president of Apgar & Associates, LLC based in Portland. For more of his work at The Lund Report click here.
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Chris Apgar is right. We de-institutionalized the chronic mentally ill in the late 1960s on the theory that community mental health systems and centers would provide more appropriate care at a lower cost. That was correct, but the funding to make it happen never materialized at an adequate level, and has only become poorer over time. So we have our mentally ill homeless, on the streets and in emergency rooms. At least in Oregon, there should be a chance to do this better, and the legislature will have to support that. The net cost will be lower.
It is amazing how much just taking care of yourself costs when you have a mental illness. I have average insurance and yet my medicine still costs over $200 a month, (and that is with all the savings cards and small insurance discounts). Then there are costs for seeing the doctor which can be equally expensive especially if you have to go for monthly medication management appointments (or other things). The thing is I have insurance and a great job so I can pay for this without worrying. But I have had friends that have had to decide between this months rent or paying for their much needed medications (to keep them well). I don't feel like in our modern society people should have to make a choice like that. Also many people cannot work because of disabilities and I have seen them just forced out the hospital with no other options. I defenately agree that if we are going to put millions of dollars into a new hospital (which is great!) then we should also use some money to shore up the community based services and provide preventative services for people to intervene before they get to the point where they need to go to hospitals.