Politics & Policy

Save the Hospitals

Discharging the mentally ill from hospitals prematurely endangers them and others.

The media are reporting that Aaron Alexis, who murdered twelve at the Washington Navy Yard, had mental illness, had been treated in a psychiatric hospital, and was released. Martin Redrick, who punched and killed Jeffrey Babbitt in Union Square in New York City earlier this month, had mental illness, had been hospitalized, and was released. Dean A. Friese, who stabbed his mother to death on Saturday in St. Cloud, Minn., had mental illness, had been hospitalized, and was released. Anyone seeing a pattern here?

No one is saying persons with serious mental illness have to be permanently hospitalized. But neither can we pretend that hospitalization is never needed. Discharging sick people quickly may be expedient, but it can also be deadly.

According to E. Fuller Torrey of the Treatment Advocacy Center, the United States is now short 100,000 beds for people with serious mental illness — assuming states have excellent community services, which they don’t. State mental-health directors are locking the hospital front doors, throwing open the back doors, and burying their heads in the sand as patients are turned into prisoners.

Take New York as an example. New York City’s Rikers Island jail already has more mentally ill than all the state hospitals combined. Despite that, the New York State Office of Mental Health is pushing a plan to close more mental hospitals in the state. The details are vague, but the results clear. The plan will put New Yorkers with and without mental illness at risk. New York State couches its cruel plan in self-serving albeit laudable language about helping people with mental illness live in an environment less restrictive than a state hospital. But the consequences will likely be the opposite: more people incarcerated.

New York claims state psychiatric hospitals are not needed and points to California and Texas as role models. They have only five and eight state psychiatric hospitals, respectively, compared with New York’s 24. But both states have more than twice as many mentally ill incarcerated as New York does. In California, the mentally ill are almost four times as likely to be incarcerated as hospitalized. In Texas, it is eight times. The courts have found California’s system to be cruel and unusual punishment, noting that the lack of treatment has caused people with mental illness to be held in telephone-booth-sized cages while wallowing in their feces. Mentally ill defendants in Texas line death row for horrific acts that most likely would never have been committed had they been provided the right care.

Law-enforcement officials, who bear the brunt of the failure to provide sufficient hospital beds, have become the major proponents of preserving them. The sheriff in Ventura County, Calif., is trying to raise funds to build his own psychiatric hospital. Michael Biasotti, immediate past president of the New York State Association of Chiefs of Police, has written movingly about the issue

Police and sheriffs are being overwhelmed dealing with the unintended consequences of a policy change that in effect removed the daily care of our nation’s severely mentally ill population from the medical community and placed it with the criminal justice system. This policy change has caused a spike in the frequency of arrests of severely mentally ill persons, prison and jail population and the homeless population. . . . The deinstitutionalization of the severely mentally ill population has become a major consumer of law enforcement resources nationwide.

There are three times as many Americans incarcerated for mental illness as hospitalized. And it’s expensive. Every jail admission requires a crime, a cop, a district attorney, a defense attorney, a cell, a guard, and a probation or parole officer. Of course, some, like Aaron Alexis, only get a bullet.

More money is not needed. Better leadership is.

In 2014, local, state, and federal government will spend over $200 billion on mental health, more than enough to fund hospitals for the seriously ill or community services that would reduce the need in the long run. But instead of the funds’ being focused on the most seriously ill, it will be frittered away on bullying, bad grades, fighting poverty, improving housing, finding jobs, and other worthy social-service programs that have little if anything to do with the elephant in the room: untreated serious mental illness.

California is the poster child for this mission creep. It passed a 1 percent tax on millionaires in 2004 to provide services for people with serious mental illness and reduce levels of their incarceration. Almost $10 billion was raised, but it funded massage chairs, hip-hop car washes, and advertising campaigns meant to convince the public that California was making progress. But as California mental-health advocate Jeffery Hayden noted, “for the mentally ill, the metaphorical ‘patient’s temperature’ is homelessness, incarceration, death, suicide and despair, and in looking through this framework, the patient is only getting sicker.”

One solution is to make state mental-health departments fiscally accountable for all the criminal-justice costs of the mentally ill who are arrested, involuntarily committed, or incarcerated. This simple accounting trick would remove from states the financial incentive to discharge patients from state-funded hospitals to county-funded jails.

Congress should eliminate from Medicaid the “Institutes for Mental Disease” provision, which largely prohibits federal funding for long-term care of people with mental illness. If you have an illness in any organ of your body other than the brain and need long-term care, Medicaid pays. If it’s in your brain, they don’t. So a state will kick people out of psychiatric hospitals, where it bears 100 percent of the financial burden, to make them eligible for 50 percent Medicaid reimbursement. Whether the state pays or Medicaid pays, the taxpayer pays. But eliminating the provision would reduce crime by those who are released without adequate support.

We’ve previously written on NRO about Pamela Hyde, who should be replaced as head of the Substance Abuse and Mental Health Services Administration. SAMHSA is responsible for developing federal policies to reduce the impact of mental illness on the communities and has failed to do so. Ms. Hyde recently told critics that while she is aware people with untreated serious mental illness have a greater propensity toward violence, SAMHSA would not address the issue, to avoid inflicting “stigma.”

— D. J. Jaffe is executive director of Mental Illness Policy Org., a nonprofit, non-partisan think tank on serious mental illness.



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