Health Policy Report Rounds Up Latest News on Community-Based Mental Health Treatment in Six States
In a feature on the evolution of treatment for mental illness, the Boston Globe reports that over the past 50 years, treatment has shifted away from institutionalization toward community-based care. Since 1950, seven of Massachusetts' 11 state mental hospitals have closed, while 6,237 patients have been placed in homes during that time. While part of the shift coincided with advances in mental health drugs, the transition to community-based care is rooted in a "change in attitude" regarding the mentally ill. The Globe reports, "With one in five adult Americans suffering a major mental illness, it has become clear that the community, rather than the nuthouse of old, is the best place for them to get better." However, thousands are currently on waiting lists for admission into group homes, which is creating patient backlogs "everywhere from psychiatric hospitals to homeless shelters." According to the state Department of Mental Health, 3,000 people are waiting for a slot in a group home and 13,385 are waiting for a case manager to review their files. Such "shortfalls notwithstanding," the Globe reports that the progress made in treating mental illness has been "revolutionary" (Tye, Boston Globe, 4/17).
Community Based Care Nationwide
The following briefly summarizes the latest news regarding community-based treatment in five states:
- Florida: After months of negotiations, the state last week filed an agreement in U.S. District Court to dismiss an 11-year-old class action suit alleging that the state was not improving its mental health system for "abused, neglected and delinquent" children. Under the agreement, the state departments of Juvenile Justice and Children and Families will follow "specific guidelines" instead of "generic plans" to improve delivery of mental health services for children within the foster care system. For example, both departments will train caseworkers to notice signs of mental health problems. A District Court judge must approve the agreement before it takes effect (Daytona Beach News-Journal, 4/16).
- Illinois: In response to a U.S. Supreme Court decision requiring states to provide better care to the mentally ill and substance abusers, state Reps. Lou Lang (D) and Tom Walsh (R) have proposed legislation that would move 250 patients out of state mental hospitals and nursing homes and into small residential settings. The bill, which would expand the residential treatment program called "Choices" to include 1,000 people over four years, passed the state House, but faces a lobbying effort from the nursing home industry hoping to kill it in the state Senate. The nursing home industry alleges that the bill would increase state costs (Biesk, Chicago Tribune, 4/17).
- Maryland: While decades of deinstitutionalization have returned patients to their communities, a new problem has emerged as some patients become "disoriented or dangerous" when they fail to take their medications. Therefore, Baltimore's County Council has approved $1.56 million to create a 24-hour mental health hotline in order to reduce the "reliance" on emergency rooms and the 911 system. A "mobile crisis team" will respond to calls to the hotline and will include a "plainclothes" police officer and a social worker. To prepare for the initiative, six police officers will receive specialized training and health workers will learn to handle "dangerous" police situations. The program will also include a follow-up intervention team and an after-hours clinic (Nitkin, Baltimore Sun, 4/16).
- Oregon: Under his Oregon Children's Plan proposal, Gov. John Kitzhaber (D) has earmarked $3.5 million to treat children up to eight years old who are "at risk" for mental illness. In addition, Kitzhaber has proposed spending $4 million to provide services in local communities for children who have been released from residential/institutional facilities (Sabo, Portland Oregonian, 4/17).
- South Carolina: Under a spending plan approved by the state House, the state Department of Mental Health would have its budget "slashed" by $40 million and would fire 237 employees. In addition, treatment programs at 17 community mental health centers and six inpatient hospitals would be "scaled back." The budget must still pass the state Senate, where some of the fund cuts "may be restored" (Winiarski, Columbia State, 4/12).
