New prescription needed for mental illness
We absolutely must do better.
Is there any other conclusion we can draw when we read the reports of suicides at Lancaster County Prison and study the statistics on suicide among Americans?
Is there any other conclusion to be drawn when John Wetzel, Pennsylvania's corrections secretary, writes in today's Perspective section that "prisons and jails have become the nation's new mental health hospitals"?
Only 38 percent of adults with "diagnosable mental health problems" and less than 20 percent of children and adolescents get the treatment they need, according to the federal government's mental health website.
People experiencing mental health problems often have nowhere to go but the nearest hospital emergency room.
There, they will wait significantly longer for care than patients with other health issues. Their wait for a bed may be measured in days, not hours.
Even after increasing the number of its psychiatric beds, Lancaster General Health regularly has to send patients to hospitals in other counties for treatment.
A sizable portion of its beds often are filled with patients awaiting placement in a long-term care facility.
Even when someone gets a bed in a mental health facility, the goal often seems to be to get that person in and out as soon as possible within three days, perhaps 10. It often takes longer than that for medications to be effective.
Pennsylvania rates highly among states in per capita spending on mental health significantly better than its neighboring states.
Still, there are too few psychiatric beds not only in the commonwealth, but across the United States.
The process of deinstitutionalization began in the 1960s, out of a concern for the civil rights of people with mental illness.
Pennsylvania began closing its state mental hospitals in the 1970s; more closures took place during the administration of Gov. Ed Rendell.
The thinking was that community care was a better option, and the burden of responsibility was shifted from the state to the county.
The reality is that good community care costs a lot of money.
Another reality: Some people need long-term psychiatric care.
And now, with state psychiatric beds severely reduced, they can't get it.
This problem has become so acute that last week, three University of Pennsylvania bioethicists including Ezekiel Emanuel, an architect of the Affordable Care Act published a paper advocating the return of the mental asylum.
The paper, published in The Journal of the American Medical Association, noted that in 1955, "560,000 patients were cared for in state psychiatric facilities."
Today, that number has fallen to about 45,000.
"Given the doubling of the U.S. population," the authors write, "this represents a 95 percent decline, bringing the per capita public psychiatric bed count to about the same as it was in 1850."
James Jordan, executive director of the National Alliance on Mental Illness of Pennsylvania, says "the closing of the institutions without a comprehensive plan ... hasn't worked, and it's getting worse."
Mental illness shouldn't be equated to criminality. But some people with untreated mental illness and without community support make terrible decisions that land them in prison, where their health problems become the responsibility of a system that wasn't set up as a health care provider.
Corrections Secretary Wetzel pointedly asks: "Is it good public policy for the primary deliverer of mental health services in America to be the corrections system?"
The answer is obviously no.
Jordan says he hopes the new administration of Gov. Tom Wolf "will take a fresh look" at how we're caring for people with mental illness in the commonwealth.
We second this hope.
Things cannot go on as they are now. We must do better.