On Monday December 14, at 11:00 AM Eastern Time, the National Alliance on Mental Illness (NAMI), the American Psychiatric Association (APA), and the National Association of Psychiatric Health Systems (NAPHS) will host a briefing on Capitol Hill entitled “Nowhere to Go: How Restrictions on Psychiatric Beds Harm People with Serious Mental Illness.” The topic of the briefing is repealing the IMD exclusion in Medicaid.

What is the IMD Exclusion?

The “Helping Families in Mental Health Crisis Act” would largely repeal a Medicaid rule that prohibits federal Medicaid funds from going to individuals under 65 served in “institutions for mental diseases.” These institutions are facilities of more than 16 beds that primarily serve individuals diagnosed with mental illnesses. The IMD rule applies only to freestanding psychiatric facilities. Psychiatric inpatient care in general hospitals is covered by the Medicaid program. Psychiatric inpatient services for children 21 and under are also covered under the Medicaid program.

What’s wrong with hospital beds? Shouldn’t Medicaid pay for this?

In the 1960s, we shut down many mental institutions because they were breeding grounds for neglect, abuse, and death. Sadly, the “One Flew Over the Cuckoo’s Nest” days are not over. Chilling reports coming out of Western State Hospital in Washington State as well as Florida state mental hospitals show that large institutions can be unsafe places for people with psychiatric disabilities. The Service Employees International Union (SEIU), has created a website “Behind Closed Doors” documenting abuses by Universal Health Services Inc. (UHS), America’s largest provider of inpatient behavioral health care. If we repeal the IMD exclusion, we can expect more of these horrific reports.

The IMD rule, which has been in effect since the beginning of the Medicaid program, was designed to limit the warehousing of people with mental health disabilities in psychiatric institutions. This Medicaid rule was enacted two years after the 1963 Community Mental Health Centers Act, at a time when the country had begun to shift away from large psychiatric institutions and develop community-based mental health services. It has been an important incentive for mental health systems to develop community services rather than relying solely on institutional care.

Who would benefit from repeal of the IMD exclusion?

Definitely not people diagnosed with mental health conditions, their families, or people who work in psychiatric hospitals. Who WOULD benefit is the National Association of Psychiatric Health Systems (NAPHS), who is a co-sponsor of this briefing and whose leadership is composed of the top brass in the psychiatric institution industry, including UHS. They would stand to gain billions from this repeal, and are lobbying hard to have it passed.

So if repealing the IMD Exclusion isn’t the answer, what is?

The root of the problem with the mental health system is the lack of comprehensive community-based services that help prevent crisis in the first place. Too often, people cannot obtain services until they are in crisis. Then, they are usually taken to a general hospital (usually an emergency room) or have an encounter with law enforcement. After their hospitalization or involvement with the criminal justice system (often including incarceration), they return to the community without needed services. The response to this vicious cycle is not to build more inpatient beds or to keep incarcerating people, but instead to invest in intensive community-based services that avoid and de-escalate crises, prevent hospitalization, and help people returning to the community to get the support they need. The mental health system needs more funding for services such as mobile crisis teams, crisis respite houses, family and peer supports, and supportive housing — not more institutions. According to the Corporation for Supportive Housing, “cost studies in six different states and cities found that supportive housing results in tenants’ decreased use of homeless shelters, hospitals, emergency rooms, jails and prisons.”

What you can do:

Starting at 11:00 AM on Monday, December 14, Tweet to your or post to their Facebook wall and tell them #HousingNotAsylums!

Our Twitter accounts: @RealMHChange; 

Sponsors’ Twitter accounts: ;

Use HashTags: #RealMHChange #protectPAIMI #HousingNotAsylums

Sample Tweets:

• We need #HousingNotAsylums! Community not institutions!
• Repealing the IMD exclusion will line corporate pockets, while our communities stay impoverished.
• #HR2646 is a rollback to One Flew Over the Cuckoo’s Nest, NOT the #realmhchange we need! #housingnotasylums
• #RealMHChange is crisis respite services that help people and save money — NOT #HR2646
• “I’d rather die than go back to the hospital.” Crisis respite houses are a great alternative. http://bit.ly/1jV3ukZ
• Spend $$ on community-based #mentalhealth services that work, not institutions. #realmhchange
• Crisis respites save lives and dollars! http://www.gjcpp.org/pdfs/2013-007-final-20130930.pdf #housingnotasylums
• Move #mentalhealth services closer to the community, not farther away into hospitals. #HousingNotAsylums
• #HR2646 promotes hospitalization for #mentalhealth needs best cared for in the community. #RealMHChange
• Over-reliance on hospitalization is expensive & less effective than community-based mental health care. #RealMHChange
• #RealMHChange is funding prevention of crisis. #HR2646 would fuel a crisis based system.