Congressman Brian Fitzpatrick, R-1, represents Bucks County and a portion of Montgomery County that includes all or parts of Montgomery, Hatfield, Franconia and Horsham townships plus Hatfield, Lansdale, Souderton and Telford boroughs.
The last several months have been a trying time for our country. The novel coronavirus drastically changed our world. Most Americans have been keeping their bodies safe during the pandemic, by staying indoors and staying away from friends and extended family. Unfortunately, most Americans have likely not taken the necessary steps to maintain their mental health. The stress of a pandemic, coupled with job losses caused by business closures, can be enormous.
In any given year about 20% of Americans will experience symptoms of mental illness ranging from the mild to the serious. Most will get better with treatment, but some will continue to struggle. Those include the 11 million with serious mental illness (SMI) such as schizophrenia and bipolar disorder. Four million receive no treatment, and many end up homeless or jailed. Government policies share the blame for this tragedy and policy must change to save their lives.
In the 1800s the mentally ill were typically imprisoned, tortured and abused. After Dorothea Dix campaigned for reforms, asylums were built across the country to provide more humanitarian care, but that deteriorated. In the 1950s when the U.S. population was 165 million, there were over 500,000 psychiatric hospital beds. Many states, including Pennsylvania, eliminated funding to save money. Patients’ rights organizations joined in by suing states to stop abuse. In the 1960s a new federal policy — the Institution for Mental Diseases (IMD) exclusion — prohibited Medicaid from reimbursing psychiatric treatment facilities with more than 16 adult beds. The goal was to close the big institutions. Today, with a population of 330 million, the number of beds is only 37,000. The results created another cycle of devastation.
The asylums disappeared, but people did not. Our streets and jails have become de facto institutions for the mentally ill. Half our homeless have some mental illness, and 25% suffer with a serious mental illness. Two million mentally ill people are arrested each year. Of our 2.2 million total prison population, an estimated 25-50% have a mental illness, nearly 400,000 are with SMI. Most go untreated. A person with mental illness is 10 times more likely to be in a prison cell than a hospital bed. A Michigan study reported the cost for housing a mentally ill inmate was $95,000 per year, versus $35,000 for prisoners without mental illness, and only $6,000 for mental health services for those not in jail.
Many with SMI cannot take care of themselves, particularly those who are so ill they do not understand they are ill, yet they are sent out to fend for themselves. Many end up back in jails. By failing to treat the underlying disease, states resort to punishing behavior. Society then creates a stigma against seeking mental health treatment when we associate illness with incarceration — not care.
If not jails, some in SMI crisis are taken to overcrowded and ill-equipped hospital emergency departments where they wait for days until a bed is available. Once admitted, length of stays is determined by insurance companies, not doctors, often resulting in inadequate treatment. The cost to hospitals choosing to keep patients longer becomes unsustainable. Without residential treatment centers, many people with SMI will continue to revolve in and out of acute crisis care settings resulting in high costs to taxpayers while patients continue to get sicker.
As the number of beds has plummeted, suicide cases have proportionately increased. There simply is no place else to go for those who need extended inpatient care. Federal policy has eliminated that option.
This year’s proposed budget includes $5 billion for states providing a full continuum of care for SMI. This is a start, but more is needed. Moreover, real reform must include full repeal of the IMD exclusion so that we can provide all those suffering from mental illness the care that they need. The Congressional Budget Office has estimated it would cost billions to provide treatment. However, this static scoring reflects a perverse incentive to save money because Medicaid does not provide any funds while a person is incarcerated or not being treated.
We need sufficient Medicaid funding, responsible care provided by states and counties, enforcement of mental health parity by insurance companies, and supportive housing for those struggling to care for themselves. These are all essential in addressing the gaps in care. Treatment only works if a patient gets treatment.
We must do better. The IMD exclusion has turned into federally mandated neglect of those suffering from mental illness. Repealing the exclusion will remove a major barrier to care for patients and make our communities healthier.