Thursday, December 13, 2012

Tennessee, are you listening?

Editorial: The Detroit Free Press agenda for improving mental health care in Michigan.

The issue: Mentally ill prisoners in segregation
Michigan's 32 prisons hold thousands of mentally ill inmates, including as many as 200 isolated in segregation cells, where they are locked up for 23 hours a day or more, cut off from treatment programs, and often denied needed medications.
The prescription: Michigan should generally ban the segregation of severely mentally ill prisoners. For exceptions made for security reasons, MDOC should ensure that mentally ill inmates placed in isolation are treated as soon as possible at one of its inpatient or residential treatment centers.
Any mentally ill inmate in segregation should be checked daily by a mental health professional. Mentally ill prisoners should not be removed from brand-name drugs with no generic equivalents, if the brand drugs work for them.
The issue: Families of the
mentally ill and civil commitments
More than 500,000 people in Michigan are severely mentally ill. Their condition also affects their families -- an estimated one in seven in Michigan -- who must help them cope, obtain services and guide them through crisis after crisis. Mentally ill people sometimes don't acknowledge their condition and refuse treatment.
The prescription: Make it easier for families, Community Mental Health agencies and others to get a court order for inpatient or outpatient treatment. Probate courts and local Community Mental Health agencies ought to use all standards for commitments provided under the state's mental health code. Now, most counties apply only the standard requiring people to be an imminent danger to themselves or others, ignoring other options, including so-called Kevin's Law, which permits outpatient commitments for people with a history of resisting treatment.
Courts and Community Mental Health programs should document that they have applied all legal criteria to potential cases. In addition, courts should consider a finding by a local Community Mental Health agency that a patient meets the criteria for a civil commitment order an automatic petition for a hearing.
The issue: Homelessness
Nearly 20,000 of Michigan's 100,000 homeless people live in Detroit. An increasing number of them -- at least a third -- are mentally ill and untreated. On the street, they face enormous difficulties in managing the medications and medical appointments needed to control their illnesses and maintain their health.
The prescription: Mental health services and disability benefits must become easier to access. Federally funded clinics targeting the uninsured should integrate primary health with mental health care. Federal and state grants ought to include financial incentives for providing both services at the same site. Make single people with mental illnesses or substance abuse disorders eligible for Medicaid. Streamline the process for Social Security disability benefits by expanding the list of medical providers authorized to diagnose disabilities, including nurse practitioners, physician assistants and licensed clinical social workers.
Supportive, affordable housing offers the best long-term solution and is cheaper than ongoing incarceration, shelter, criminal justice, emergency room stays and other crisis costs associated with chronic homelessness.
The issue: Insurance parity
Unlike 43 other states, Michigan does not require insurance companies to provide the same level of coverage for treatment of mental illnesses, such as schizophrenia, bipolar and depressive disorders, as they do for other medical problems. Michigan law allows insurance companies to, in effect, discriminate against mentally ill people and their families by allowing employers to offer insurance plans that exclude, or limit, coverage of mental health disorders, or charge higher co-pays.
The prescription: Pass legislation (Senate Bill 50) that would require any employer who elects to offer behavioral health insurance to cover a full range of neuropsychiatric disorders, including mental illness, substance abuse and developmental disabilities.
The issue: Police officers on the front lines of mental health care
The erosion of mental health services has pushed tens of thousands of mentally ill people into county jails and state prisons, as well as onto the street. Law enforcement officers with little mental health training have become first responders to mentally ill people in need.
The prescription: Legislators should mandate a standard mental health curriculum for law enforcement officers, at least for those working in urban neighborhoods with many mentally ill people. To reduce police contacts, agencies should double the number of mental health case workers in those areas. Operate walk-in centers -- staffed round-the-clock with peer mentors -- that provide prescription refills, counseling and referrals to Community Mental Health agencies. State and federal grants should provide incentives for law enforcement and mental health agencies to cooperate. Police officers should know where mentally ill people can find help. They should also know caseworkers who can help them with street interventions. Publish mental health emergency lines along with 911 services.
The issue: County jails become largest mental health institution
Michigan's county jails hold nearly 20,000 prisoners -- about one-third of them mentally ill. Cuts in community mental health programs and the closure of most of Michigan's state psychiatric hospitals have put county jails at the center of Michigan's mental health care crisis. Jails generally worsen the condition of mentally ill inmates.
The prescription: Michigan must divert more mentally ill people from jails and find ways to treat those who remain incarcerated. Jails should assess mentally ill prisoners within 24 hours of intake and make sure they continue taking psychotropic and other medications. The state should require communities to develop local interagency agreements outlining procedures for handling mentally ill detainees.
To help county jails get confidential medical information, the state should develop a standard, statewide medical release form. State law should require insurance companies to continue providing mental health care benefits, including prescription drugs, to their jailed policyholders, at least until they are convicted. The state should amend its Medicaid plan to allow prisoners to suspend enrollments while incarcerated -- instead of terminating them -- so that prisoners can resume benefits upon release. State legislators ought to consider a dedicated fund to pay for local efforts to divert mentally ill people from jail, which costs about $24.000 a year per prisoner. Sheriff's departments, working with Community Mental Health authorities, should connect those leaving jails to needed community services.
The issue: Mental health courts
A three-year federal grant -- amounting to $1.65 million a year -- supporting Michigan's eight pilot mental health court programs is set to expire this year. Without replacement money, the promising pilots, including those in Wayne and Oakland Counties, will shut down.
The prescription: The state wisely moved to maintain and expand mental health courts, which already show results in reducing incarceration costs and improving the lives of mentally ill people. For the next fiscal year, Gov. Rick Snyder set aside $2.1 million for the courts to sustain the eight pilot mental health programs, expand their services, and create a new mental health court in Saginaw. He also prudently allocated $1.25 million to expand drug court programs that target high-risk offenders in Genesee, Wayne, Oakland and Saginaw Counties.
The issue: Community Mental Health care
Up to half of the 500,000 severely mentally ill people in Michigan don't get publicly funded mental health services. Underfunded and, in some cases, inefficient local Community Mental Health agencies cannot adequately serve the people who need them. Some severely mentally ill people need longer-term psychiatric hospital care. Michigan closed too many of its state psychiatric hospitals -- 12 of 16 -- between 1987 and 2003.
The prescription: Michigan needs an adequately funded -- and more efficient -- Community Mental Health system. Furthermore, Michigan needs sufficient psychiatric hospital beds to serve the state's most severely mentally ill patients. Michigan ought to put a moratorium on closing psychiatric beds, and it should seriously consider adding some. Finally, the state should consolidate local Community Mental Health agencies into fewer units with stronger statewide standards and increase their funding.

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