Concerns about mental health treatment have been in the news recently but are often forgotten quickly, as the public has a short attention span, generally speaking. Therefore concerns such as the availability of mental health services, fade quickly from the public’s consciousness, to be replaced by the next breaking story’s controversial content.
I wanted to take a moment, and look at the subject of mental health treatment in the community. I feel it’s a topic that the public should know more about, but don’t. I’m not speaking here of private counseling, but the services in state run community mental health centers. I feel there are some misconceptions, and or blanks in the public’s education on these services.
State run Mental health centers offer services on a sliding scale, to those outside the states sphere of influence. For those within the state system, there are criteria to determine the level of coverage that will be needed for each individual patient.
The majority within the system, of state provided services, have been in inpatient treatment before they come to the mental health center. Inpatient treatment, is provided for short periods, seldom more than 72hrs. By hospital policy, before the release of a patient from the hospital, an appointment is made for the patient at their local mental health center.
When the patient reaches their local mental health center, after their release, an intake process begins. The intake must be completed to determine a patients “Tier”, which is the assumed level of service the new patient will require, from the mental health center. After the intake paper work, interview, and classification, the new patient will then be assigned a doctor and case manager. I feel this is the last sense to the system, especially considering cuts to services past and pending.
The case manager for the client, will be the person they will have the most contact with. Remembering that these patients, now clients, have mental health concerns, I must say, a case manager need not have experience with mental illness psychiatry or psychology, to be a case manager. Here we find the first weak link in the system. An inexperience case manager can do more harm than good for the client, with their lack of experience. This is also a hit and miss roll of the dice for the new client, as there are many qualified case managers, as well as the unqualified.
The doctors at these facilities are generally Psychiatrists, not Psychologists. The reason behind this is the prescribing of medications. In fact the concentration is on medicating the clients. Generally talk therapy, with a qualified psychologist is totally absent, as a treatment option for clients.
The psychiatrists set appointments for clients at 20min intervals, and many times there has been no proper diagnosis of a psychiatric condition before a client see a doctor. However, by the end of the first 20 minute appointment, a preliminary diagnosis will be in the clients file, and the newest, highest cost prescription medications will inevitably be prescribed.
The client, at the time of prescribing, will be given paperwork describing the medications prescribed, their risks and side effects. Unfortunately many clients don’t have the required capacity to understand the risks associated with their new medications.
Many of the drugs used to treat mental health issues have debilitating side effects. While many Psychiatrists will prescribe a medication not approved to treat the perceived diagnosed condition, but will be prescribed for one of the drugs side effects. These are really all effects, as I don’t believe there is such a thing as a side effect. They are all simply effects, no side about it. A short trip to the waiting room of mental health center will show the effects of medications on clients. Also a half trained eye or a short observation, will allow one to pick out many clients whom are simply over medicated.
Even with the criticisms thus far, we should get down to a cost benefit analysis. Especially considering the the cost cutting measures implemented over the last two years, with more cuts to these services yet to come. Not the easiest thing for the public to get behind, because the possible benefits are intangible to the average tax payer. It’s much easier to get an individual to support something they can see and touch, as opposed to something that may be of more benefit, but can’t be seen or touched.
The present cuts to funding have caused a radical reclassification of mental health patients, in the public system, dropping many once covered. This may not be the most cost effective measure, in the long run, As costly hospitals stays become the defensive front line, for those left with no other possible affordable place to turn, when in distress. This I’m sure you can see, is not that rare with those who are or have become disturbed.
There are mental health issues that can make one prone to outbursts. There are conditions that if unmonitored and treated, can put the public at risk. This will be an even larger concern when our generation long wars have ended, and our soldiers all come home. Unfortunately we have seen the government and military do the same thing that has been done, and continues in the public system. They made the call, that only a certain percentage of those returning could be classified with PTSD. The rest are merely classified as having a anxiety disorders. This was to save on treatment costs. It will not save any money, but end up costing more. Not just money, but disturbance of the public, as soldiers and citizens go untreated.
I think we can all agree, that a hospital stay is prohibitively expensive. Even one as short as three days. I also think over medicating, with the latest and most expensive pharmaceuticals, is quite costly as well. I believe that treatment in the community provides safety to the patient, and the public on the whole.
Even with my concerns about public mental health facilities, I see them as performing a invaluable service to the community. The most forgotten benefit, the peace of mind that the quality treatment of those with mental health issues can give the community. Allowing for other subjects to receive top billing, as public policy is considerations. Quality services can mitigate the real risks and the perceived risk by the public. Cutting of services and removing disturbed patients from the mental health centers client list, accomplishes just the opposite.
There are services we cover as tax payers, that may seem unimportant in the grand scheme of things. This can be a trick of awareness. I feel very few consider the benefit of treating the mentally ill. This I’d like to see change. I believe this often invisible subject of the mental health coverage and the community, is an important one. I believe the dispensing of these services, help to keep the community safe, and the costs to the community down in many ways, that are more than just financial . Costs that can be tangible or intangible, but still beneficial overall.. My last thought, no coverage, low coverage, and poor coverage, worry me. Those in the community in need of care, receiving care, gives a peace of mind, that can be priceless.