People tell me the most popular provision of the Murphy Bill for many congressmen is the idea of increasing the use of psychiatric hospitalization. It will probably be a budget buster if they try to do so, but the hope on many people’s minds is that a way can be found.
And it is not hard to understand the appeal. Much of the emotional message of the Murphy Bill is “stop the murders.” On more than one occasion, the claim has been made that had the original bill been passed last year, a specific murder might not have happened and the next one may be avoided. The message is clear. If only we had a more coercive mental health system, this would not be nearly as dangerous of a place to live. Like the war on drugs, Murphy is proposing essentially a war on “mental illness.”
The war on drugs should give us pause before we jump into anything. We were told the best way to win the war on drugs was to lock people up. We ended up with a lot of people locked up and no less drugs. The people locked up were disproportionately poor and disproportionately black or Hispanic. Communities were destroyed in order to save them. Nothing was made better. Violence was done to our people in the name of government intervention and the problems created were far worse than any problems we thought we were solving.
Does anyone expect any different from the war on mental illness?
The plan is supposedly to remove Medicaid and Medicare restrictions on paying for psychiatric hospitalization. There are immediate questions with simply this statement.
You must be on Medicaid or Medicare, and what if you are not?
In about 25 states, thousands and thousands of people still have no insurance. Their states did not expand Medicaid. What happens if they “need” hospitalization? If Medicaid folks are entitled to extended hospitalization, are not the people without insurance entitled to the same services? If you are going to even begin to be “fair,” you have to do that. And if that is the case, will the burden of increased expenses not fall on states, who right now are struggling to pay the current burden? If you also figure in the increased spending for state Medicaid budgets, have you not created a bomb for state budgets? Where is the money to come from? Does it not come from funding for community services that are already stretched to the point of breaking? And if you must decrease community services, are you not in the end just creating the very problem you thought an increase in hospitalization was supposed to solve? What war are we fighting and what are we really destroying?
What about people with private insurance? No private insurance company that I know of will even begin to pay for long-term hospitalization. They stopped drinking the kool-aid many years ago. Will you try to force them to pick up long-term services? Will the state have to pick up the burden for what insurances won’t pick up, or will you, in effect, develop one system for the poor, the people of color, the homeless, the unemployed, and the hurting, and another for those who have money or at least a job that gives them insurance? Will our psychiatric hospitals become the dumping grounds for the poor and disadvantaged? Have we learned nothing from our war on drugs?
Is not the end result of this to save people by destroying them? Am I the only one who can see this coming?
But it goes far past even this:
I do not know of one study or one set of data that shows that long-term psychiatric hospitalization is one of the evidence-based practices Rep. Murphy loves to talk about. We have years of horror in this country that says otherwise.
What is the evidence that people who have had long-term psychiatric hospitalization actually needed it? (And what defines “needing it” and who decides?) I have a friend who survived 24 years in a Florida hospital. He still has no idea why he “needed it,” but what he saw and what he lived was not something for the good of anyone. Bluntly, how many lives have been ruined, wasted or destroyed in treating people for their “mental illness?”
How likely is it that people with “mental illness” will be driven underground? If community resources become less and less, and people understand that failure with community resources may lead to being hospitalized for long periods of time, how many people who could use help, who need help, will simply try to hide their needs for their own safety?
What about the people who now experience trauma associated with hospitalization as one of their mental health issues? Is their experience not at all instructive?
There is a large and growing body of evidence that says that trauma and injury has a lot to do with any mental health issues someone struggles with and that the best treatment is trauma informed. Hospitalization is not trauma informed care.
Even if you decide to allow Medicaid and Medicare payments for long-term treatment, it is not enough. Those payments do not even bring states even with the actual cost to them. It does not cover capital improvements to facilities etc. Nor does it cover increased staff and training and benefits. For Tennessee, for example, it just give them the legal ability to go deeper into the hole than they already are.
Removing the IMD exclusion would cap treatment, as I understand it, at about 30 days. Have we not opened Pandora’s Box, though? What do you tell Rep. Murphy or Dr. Torrey when they tell you 30 days is just not enough time and they need more time? Once the cat is out of the bag, how do you put in back in?
And finally is there anyone who really believes that homelessness, breaking the law, unemployment, or poor health are in any way the result of a deficiency in psychiatric hospitalization? Can you explain how? I don’t mean to hurt feelings, but that seems so simplistic.
The biggest problem with all this is not even all these things (and there are others I didn’t talk about). The biggest problem is that it is a lie. It promises real solutions to real people who badly need help and when all is said and done and we are pointing fingers at who is to blame. I don’t think it will be the people who have started this war on mental illness. It will be the victims.
Larry Drain is the author of Hopeworks Community, a blog concerned with mental health, advocacy, recovery, health care reform and other social justice issues. He is active in mental health advocacy and health care reform in Tennessee and on a national level. Most importantly, he has been married to Linda for 34 years.