The State of the Mental Health Care System in the US
The crisis has spread to everywhere and even when signs of recovery are spotted here and there we are not out of the storm yet. Actually, we may have to wait for one or two more years to be back to “normal”.
The Mental Health Care System is no exception to this and is being hit really hard from many fronts.
Many states are recalling their off-state clients in Residential Treatment Facilities (RTF) to compensate for the lack of referrals. The problem isn’t that there aren’t enough people with mental issues to be referred, it’s that the Agencies are not funding as many people as before and are also pushing for shorter treatments. There’s one caveat: the human mind just doesn’t work the way they (would like to) think and it’s also completely independent from the economy (no rocket science here).
I reckon that the referring agencies are going through tough times too, but these policies are extremely detrimental to clients. Treatments should not be “canned” and RTFs are no factories either. Each case has individual requirements (i.e.: time, resources, approach). If you want to regard treatments as an assembly line, well, it’s not going to work.
Consider a kid with AD/HD, mild MR, Autism or Psychosis. These types of disorders take time to be treated or stabilized. We are not talking about a blown tire or a broken camshaft, things that you fix. Treatments should last as long as they need to and shortening them will ultimately lead to failures.
To compensate for the lack of psychiatric/developmental disabilities referrals, RTFs are taking in clients from a very different population: juveniles. The judicial system is flooded with teenagers in trouble with the law which makes them a good source to be tapped in this times of drought (in a way, the recession is to be blamed for this too, but we are still not seeing the consequences of it to the fullest. Wait for five years and you’ll see). Families get marginalized due to lack of employment, crime rates go up. The equation is pretty straightforward.
In this regard, RTFs provide a half-way solution for these kids so they don’t end up in jail. They have a second chance to get their record straight. If we go back to the “shortening treatments” thing I’d say that sending these kids to placement is just a delay in their road to lock-down. Success rates for this population are already low (15-20%). Shorten treatments from 6 months/1 year to just 90 days, and conclusions are not difficult to make.
There is another problem that derives from this whole situation. Most residential programs are not tailored to accommodate this population. On one hand, it requires a completely different in-unit programming and treatment and on the other, these individuals co-exist in the same buildings with psychiatric clients and/or clients with mental disabilities. In this complicated landscape centers will have a daunting task. Re-tailor their well trimmed programs to fit the new population.
As centers struggle to retain their occupied beds in this new “high-client-turnover, low referral rate” climate, they face other problems like school districts that haven’t paid them for years, funding cuts from the government and more exigencies from funding agencies.
Projections aren’t good either. Some centers have ceased their operations, laying off hundreds of employees and financial recovery is in the distant horizon (2012-2013). As long as they can keep borrowing money they’ll be fine (bigger organizations are better positioned) but if cash doesn’t flow in, repaying those obligations is going to be hard. Which translates into a lower score, thus no more loans. Conclusion, bankruptcy.
I’d love to finish the article on a higher note, but to be honest, the near future looks kinda grim.
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