Having attended the June 16th Prince William County Community Services
Board meeting in Northern Virginia whose purpose was to discuss possible changes
to its mission statement I learned from Director Tom Geib that Inspector
General James Stewart had visited "emergency services" and discovered the staff
weren't familiar with "recovery principles". I can understand the Inspector General wanting
all branches to be familiar with "recovery principles" but emergency services deals with
those who need help, not recovery.
There has been a break in the continuum of emergency services with the introduction of "community
crisis stabilization" services. At present these services include:
Residential crisis stabilization (TDO) - Like the service below, but licensed to accept TDOs, with 24 hour nursing on
site, M.D. daily and on-call for assessments and interventions. All of the current crisis stabilization programs are considering
accepting TDOs.
Residential crisis stabilization service (voluntary) - 24 hour, CSB-operated or contracted, group home
model, available in emergencies, sufficient staffing ratios to provide intensive supports to persons in crisis. Includes nursing
on site and MD consultation/visits. (This model of crisis stabilization is currently used in three communities. The General
Assembly funded seven additional programs 2005.)
In-Home residential support service – CSB staff goes to the
consumer’s home and provide supports during crises, keep consumer safe and occupied. Level of support is matched to
consumer need. Consumer focused, not program-focused
Consumer-run residential support service - “Safe house”
program. CSB/consumer partnership agreement– many consumers prefer to be served by other consumers in a crisis.
All of these programs can be effective. The report mentioned defining crisis stabilization and coming up with alternatives.
This push towards community based crisis stabilization services is intended to offset the high demand for public and private
psychiatric bed space. There is no denying, however, there needs to be more public and private psychiatric bed space. Increasing
community crisis stabilization services won't be so successful that this doesn't need to be done.
Recovery principles come into play with community crisis
stabilization/emergency services except as a means to prevent the mentally ill from utilizing public and private
psychiatric bed space. Self determination, empowerment, and recovery are government code words for saving money and keeping
expenses for the mentally ill down. There is nothing inherently wrong with this if it brings better care for the mentally
ill. However, at a time when many mentally ill are in jails on petty charges; there is very little low income housing for
the mentally ill; and there is a serious chronic shortage of both public and private psychiatric bed space, the President's
New Freedom Commission on Mental Health initiative doesn't recommend any substantial funding for mental health but allocation
of existing resources. Furthermore, it seeks to lower even existing resources for the mentally ill by supporting consumer
operated and run services such as drop-in centers and community crisis stabilization services under the umbrella of emergency
services.
In Prince William County CSB there is already community crisis stabilization services. At Community Apartments residents
have a case manager and the number to emergency services is posted. Folks at group homes have case managers and a number to
emergency services likely is provided. Those who live in section 8 apartments are more isolated.
Community crisis stabilization services shouldn't be a part of emergency services. The fact that only something like
21% of CSB emergency services were familiar with community crisis stabilization services should tell one something. Very
few mentally ill need a doctor or nurse onsite and if they do they probably belong in the hospital. Community crisis stabilization
services should be apart of MH residential services, not emergency services. By tacking on community crisis stabilization
services to emergency services this conveys the impression "medical emergencies" will be resolved in the "community" rather
than the hospital and promoting a shift against the usage of public and private psychiatric bed space. This could have negative
consequences for some mentally ill. The hope of government is community crisis stabilization services under the umbrella of
emergency services will ultimately lessen the need for more public and psychiatric bed space and thus requests for less funding.
Recent
"recovery principles" stems around the motto self determination, recovery, and
empowerment.
The genesis of this was the President's New Freedom
Commission on Mental
Health. Despite the fact the Virginia DMHMRSAS
mission
statement
is, "Our vision is of a “consumer-driven system of services and supports
that promotes self determination, empowerment, recovery, resilience, health,
and the highest possible level consumer participation in all aspects of community life including work, school,
family and other meaningful relationships” there is little actual substance in terms of policy.
Given the problems in mental health, it appears these "recovery principles"
which have no
real substance are a purposeful distraction at the minimum and dramatically
cutting or
eliminating services at the maximum. The best thing about the President's
New Freedom
Commission on Mental Health is it doesn't cost much money. Here
are just some
of the major chronic problems which haven't been dealt with sufficiently:
(a) There is a shortage of both private and public psychiatric bed space;
in Northern Virginia it is serious and chronic.
(b) There are mentally ill being arrested and languishing in jails on
petty charges.
(c) There is a serious shortage of low income residential housing
for the mentally ill.
Self determination, empowerment, and recovery won't address these chronic
problems. Only an influx of state and federal funding will. Lawmakers have known
these facts for years but nothing ever significantly improves. Instead advocates
such as myself are always expecting things to worsen and at best retain services which exist without managed care plowing through. Many accept the status quo.
Unfortunately, the attention and criticism toward the President's New Freedom Commission on Mental
Health was confined to the Texas Medication Algorithm Program (TMAP) and screening of children for mental illness. The colossal
propagandized hoax of self determination, empowerment, and recovery and consumer run and operated services has gone relatively
unchallenged and have been somewhat "successful".
The President's New Freedom Commission's Final Report called
into question the design of many mainstream social welfare programs serving people with serious mental illness, implying that
Social Security's Supplemental Security Income (SSI) Social Security Disability Income (SSDI) are part of the problem
and not the solution. It states, "Moreover, the largest Federal program that supports people with mental illnesses is not
even a health services program - the Social Security Administration's Supplemental Security Income (SSI) and Social Security
Disability Income (SSDI) programs, with payments totaling approximately $21 billion in 2002." There are eligibility requirements
for receiving these benefits as well as Medicaid and Medicare and without them many mentally ill would not be able to pay
their rent and buy groceries. For the seriously mentally ill without SSI and/or SSDI they would be living with family or homeless
on the streets. Without Medicaid and /or Medicare they wouldn't receive any health insurance coverage.
Overall, in fiscal year 2002 twenty-four billion was spent on Medicare
and Medicaid; twenty-one billion on SSDI and SSI; four hundred and forty three million in Community Block Grants through SAMSA
and additional funding for housing, rehabilitation, education, child welfare. substance abuse, general health, criminal justice
and juvenile justice. All together this information suggests around 46 billion dollars a year spent (in 2002).
The Final Report states, "Each program has its own complex, sometimes
contradictory, set of rules. Many mainstream social welfare programs are not designed to serve people with serious mental
illnesses, even though this group has become one of the largest and most severely disabled groups of beneficiaries. " This
is likely measured by their rate of unemployment rather than status of mental health. The report goes on to say,
"If this current system worked well, it would function in a coordinated manner, and it would deliver the best possible treatments,
services, and supports. However, as it stands, the current system often falls short. Many people with serious mental illnesses
and children with serious emotional disturbances remain homeless or housed in institutions, jails, or juvenile detention centers.
These individuals are unable to participate in their own communities."
Actually, the current system works remarkably well despite the Commission's
statement to the contrary. Certainly better without these support systems. It does work in a coordinated manner and it
has in some areas provided the best possible treatments, services, and supports. Because of the complexity of servicing the
needs of the mentally ill in the public mental health system it is impossible to have all services coordinated at the same
time. There are eligibility requirements for Medicaid, Medicare, SSI, and SSDI. If you make too much money at a job you
won't have Medicaid coverage. You won't get Medicare coverage unless you have SSDI. The amount of food stamps you receive
depends upon your income.
Many people with serious mental illnesses and children with serious emotional
disturbances do remain homeless or housed in institutions, jails, or juvenile detention centers. In the cases where the seriously
mentally ill are housed in jails with little or no mental health services and support it is obvious they need to be transferred
to a psychiatric institution. Children with serious emotional disturbances need mental health services and support. It all
gets back to money and whether we as a society think it is worthwhile to provide these services to the mentally ill. Clearly,
we don't.
The "recovery movement" prior to the New Freedom Commission on Mental
Health goes way
back to Dorothea Dix and Clifford Beers whom if they were alive
today would probably not be
totally pleased with the so-called mental health movement today as artificially
pumped up by the
Commission. Rather than language of self-determination, empowerment, and
recovery which
in present context conveys a false hope any disabled person can be like
Mr. Jones down the
street, what the mentally disabled need are dedicated state and federal funding
streams for
hospital beds, more low income housing, more reimbursement to private
providers, more
state oversight of private providers, and heavy fines when there are violations.
This facade of the "consumer" being the ultimate end point must end. Without
links a chain
link fence will ultimately fall down. The emphasis on self-determination,
empowerment,
recovery and consumer operated services/peer support is a camouflage by
this
administration to get out of the business of providing governmental mental
health services. It's
proponents are well aware of this and thus it is a multi-year long term goal.
The recommendations of the President's New Freedom Commission on Mental
Health and the states which are carrying it out in essence is just Darwinism. It is saying to the mentally ill be self-determined,
empowered, and recovered so we don't have to provide funding for you and those who can't stand up on their own will just have
to fall down.
