Commentary –

Mentally Ill? Tough!

By William A. Collins

Cuts in service,

Made with stealth;

Undermine

My mental health.

Can you imagine the hullabaloo if medical care in Connecticut was reduced for heart patients, accident victims, or breast cancer sufferers? No politician could stand against the fury.

So if we must trim the budget someplace, let’s try mental health. The mentally ill aren’t that popular.

Of course it’s not true that we must cut the budget at all – we’re rolling in money. But it is true that the mentally ill are not sympathetic figures. Not only does the nature of their affliction hinder their rallying together, but its stigma tends to keep them in the closet. That makes it hard for them to lobby. It’s no great trick, for example, to produce a witness to say, “I’ve got multiple sclerosis. Look how I suffer.” It’s quite another to produce a witness to say, “I’ve got schizophrenia.” The personal perils of such testimony are too great.

Thus, the mentally ill suffer as much from cynical politics as they do from their own personal demons. As a result, while citing the magic of new wonder drugs and the benefits of community-based care, the state has closed two of its three big psychiatric hospitals. It promised more local facilities instead. Right. In the end, what really happened was severe under-replacement of beds, low pay rates for contractual psychiatrists, and the siphoning off of some of the dollar savings into the General Fund.

One need not be psychic to have predicted the resultant disaster. Today there is often no place for many sufferers to go, for either emergency or extended treatment. Some who can’t cope at all seek sanctuary under a convenient bridge. Those who can cope with the hassle favor homeless shelters. Those more given to acting out get their three-squares-a-day in one of our open-admission prisons.

Real treatment is reserved for those lucky enough to be assigned a bed. Many, of course, do get one; but the leftovers are growing fast. Meanwhile, private hospitals are cutting back on their caseloads because both Medicare and Medicaid have reduced their reimbursement rates. And at state hospitals there is a severe shortage of contractual psychiatrists. That’s not surprising, since they’re paid $27 per hour.

Emergency rooms have thus become our agencies of last resort. Unfortunately, mental health is not their bag. They just happen to have beds you can chain people to, if necessary, until the proper referral comes along. And if the patient happens to be a kid, that search can take an especially long time. Ultimately this delayed, denied, or improper treatment not only injures patients at the moment, but further worsens their long-term prognosis.

Solutions for this inhumane regimen are no great mystery. Connecticut’s own mental health professionals are more than up to it. They seem as smart and as well intentioned as anyone’s. Except perhaps that they’re a bit chicken. They know what can happen if they stand up to the governor by too stoutly defending their budget. They also know that the General Assembly lacks backbone, so why risk their jobs seeking relief at the Capitol?

Certainly they’re correct that small community clinics are indeed more therapeutic than big mental hospitals. But to close the latter before you complete the former is sheer dereliction. So is paying self-employed psychiatrists at half the going rate. So is cutting the reimbursement rate to hospitals, so that they have to close their mental health units. So is ignoring the environmental factors that lead to the growing rate of mental illness.

There once was a time when women were too embarrassed to talk much about breast cancer. That time is now gone, and the money has come. Now it’s time for a Mothers’ March on Mental Illness. Until that embarrassment is swallowed too, the money won’t come.

(Columnist William A. Collins is a former state representative and a former mayor of Norwalk.)