EXECUTIVE
SUMMARY
Mental
Healthcare Study Points
The joint mental health study group of the League of Women Voters of Greater Hartford and the New Britain Area League of Women Voters 2002-2003 requests adoption of the following statement as a concurrence position:
We support comprehensive community-based
mental health systems for children and adults.
These systems should include early detection and intervention with
a range of services to facilitate recovery.
The study group offers the following observations for your consideration:
1. CRIMINALIZATION
In 1992, NAMI1 and Public
Citizen’s Health Research Group released a report, entitled Criminalizing
the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, which
revealed alarmingly high numbers of people with schizophrenia, bipolar disorder,
and other severe mental illnesses incarcerated in jails across the country.
Most of these people had not committed major crimes, but either had been charged
with misdemeanors or minor felonies directly related to the symptoms of their
untreated mental illnesses, or had been charged with no crimes at all.
According to a report issued to Connecticut’s
General Assembly in February, 2000, approximately 12% of Connecticut’s prison
population, 2200 adults, has a serious mental illness.
“Many of these inmates were arrested for charges specifically related
to their illness. Persons with psychiatric disorders spend a longer time in
prison than persons without mental illness, partly due to the lack of sentencing
alternative programs that will accept them because of their special needs.”[1]
A report issued by the Connecticut Mental Health Policy Council in 2002 reveals that 62% of the youth being held in Connecticut detention centers have mental health issues requiring further exploration. Disproportionately, these youth are African American or Latino. In contrast, nationally and statewide, it is estimated that between 14% and 20% of youth have some type of mental health problem. schools; and lack of a clear philosophy for treatment of children and youth with mental health problems entering the juvenile justice system [2]
Significant public resources are now being wasted because community based mental health treatment services are not in place. More than 1300 children and adolescents are still in residential treatment, from $150 to $300 daily. There is always a waiting list for Riverview and the other state specialized facilities for children.1 Approximately 47,877 Connecticut children (6% of all children) have a serious emotional disturbance. Of this number, the CT Department of Children and Families estimates that 16,000 will require publicly funded services.2 By providing comprehensive community based services, a report on the financing of children’s behavioral health services indicated that savings from residential treatment and from untapped federal resources could finance the expansion of community care.[3]
There are 66,000 adults with serious mental illnesses in
Connecticut, 37,000 of whom are in the public system.[4] However, many of these
people are misplaced and mistreated: 6,000 people who are homeless and mentally
ill; 2,200 people with serious mental illnesses in nursing homes, about half
under 65, at a cost to the state of $70,000/year[5]; 2,200 people (12% of
CT’s prison population) with serious mental illnesses in prisons at a cost
of $35,000/year[6]. In contrast, the successful model of supportive
housing costs is slightly over $13,000/year.
The state does have untapped federal Medicaid resources available to it. Based on reports to the state’s Community Mental Health Strategy Board, Connecticut can access between $62,000,000 to $70,000,000 in new federal Medicaid money under the Rehabilitation Option. Connecticut is the only state that has not taken advantage of this Medicaid service.
Per
diem costs: Average daily rate for
long-term inpatient psychiatric care: $660; nursing home care: $232; residential
substance abuse treatment: $100; incarceration: $83; supportive housing: $36.
Sources: Office of Policy and Management (2002), Department
of Mental Health and Addiction Services (2002), Office of Legislative Research
(2001), Yale New Haven Hospital (2001), and Program Evaluation Report for
Connecticut Supportive Housing Demonstration Program (1999).
3. GRIDLOCK
A report in the Hartford Courant (November 12, 2002) depicts the crisis of
gridlock caused by a scarcity of mental health services in our state: “The
number of young people languishing in emergency rooms overnight, and
sometimes for days, has increased steadily over the past two years….Over the
past two years, the state has been unable to break the logjam at
Connecticut's only [state controlled] psychiatric hospital for children and
youth, the 98-bed Riverview Hospital in Middletown, where there is a
constant waiting list. At the same time, many children ready to leave
Riverview are stuck there because of a lack of suitable sub-acute and
step-down programs in the community.”
The factors that contribute to this problem are numerous. Dr. Steven
Wolf
in his March 2000 editorial “Is there no place for the mentally ill?” cites
a failure on the part of the state to expand community-based facilities to
the degree needed,
an increase in the number of children with severe psychological problems,
the closing of large inpatient state facilities. Lacking community based services include crisis intervention, in-home
care, extended day treatment, and outpatient services, which are practically
non-existent for children. “Outpatient programs are stretched far beyond their
limits….All this is to reduce state expenses, and the cost shifts to hospitals.
So patients end up in emergency rooms.”8
4. EDUCATION INITIATIVE/STIGMA
Educational programs in schools and the community are the
best way to
- combat the stigma that continues to surround mental illness
and
- improve public awareness of effective treatment.
Stigma is a major barrier to people accessing care and interferes with people
in recovery. Dr. David Satcher, the U.S. Surgeon General, said that we need
a commitment in this country to "overcome stigma".9 Stigma
breeds shame, fear, mistrust, and outcasting of consumers of mental health
services and their families. Treatment may be delayed or never obtained because
of stigma. Overall approaches to stigma reduction involve programs of advocacy,
public education, and contact with persons with mental illness through schools
and other societal institutions…
A range of effective treatments exists for most mental disorders and their efficacy is well documented. However, public awareness of these treatments is sadly lacking. The public's lack of knowledge of safe and effective treatments for mental illness can
Mental illness is as real as heart disease; patients can
benefit from new
treatments and medications and can recover. New drugs and therapies have
vastly improved the outlook for the 5 million or so people with the most
severe mental illnesses. People should expect to do better than they've ever
done in the past.
| 10-14 | 1.6/100,000 |
| 15-19 | 9.7/100,000 |
| 20-24 | 14.5/100,000 |
Respectfully submitted,
Susan McKnight, Hilary Silver, Margaret Christie, Sheila Amdur
Ellen Russak, Ada Seaman, Margot Anderson, Patricia Passsehl Mag
[1] Conversation with Director of Mental Health, CT Dept. of Children and Families, 2/10/03
[2 ]“Behavioral Health Services for Children,” CT Commission
on Children, January 25, 2000
[4] The Governor’s Blue Ribbon Commission on Mental Health, July, 2000, pg. 10
[5] CT Dept. of Mental Health and Addiction Services
[6] Albert J. Solnit, The Costs and Effectiveness of Jail Diversion, A Report to the Joint Standing Committee of the General Assembly, February 1, 2000, pg. 2
[7] 2002 Connecticut Supportive Housing Demonstration Program Evaluation Report