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On virtually every front, Medicaid and other government agencies, the drug industry, and health-care providers all play a part in a fragmented system that uses taxpayers' dollars to pay for treatments and drugs that too often don't work. At the same time, wholesale budget cuts, convoluted reimbursement rules, and conflicting funding agencies have helped create a perfect storm of waste, needless deaths, and ineffectiveness. Tragically, this has diverted scarce resources from proven, recovery-oriented programs such as "supported employment" that promotes a guided return to work, or integrated "dual diagnosis" treatment for the 50 percent or more of seriously mentally ill people who are also substance abusers. "Medicaid hasn't given much attention to mental-health reform, just to cutting costs," observes Dr. Robert Drake, the director of the multiyear National Evidence-Based Practices Project who also leads the Dartmouth Psychiatric Research Center. "We're funding vested interests to suck profits out of the system rather than helping the patient."

All told, financing policy plays a central role in a system that President Bush's own New Freedom Commission on Mental Health declared nearly six years ago to be in "shambles." Indeed, Medicaid and the broader public system of health care for people with mental illness is such an uncoordinated mess that a study last year by the National Association of State Mental Health Program Directors reached a shocking conclusion: Mentally ill adults who receive treatment in the public-health system die 25 years sooner, on average, than Americans overall. Excerpt from http://www.alternet.org/story/92406/america's_mental_health_care_s
ystem_in_shambles

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Figures:

Number of ambulatory care visits (to physician offices, hospital outpatient and emergency departments) with mental disorders as primary diagnosis: 67.4 million (average annual 2006-2007)

Number of discharges with psychoses as first-listed diagnosis: 1.6 million

Prison system:

At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.

More than two-fifths of State prisoners (43%) and more than half of jail inmates (54%) had symptoms that met the criteria for mania.

An estimated 15% of State prisoners and 24% of jail inmates had symptoms
that met the criteria for a psychotic disorder.

New federal statistics reveal that the number of mentally ill inmates in U.S. prisons and jails has quadrupled over the past six years.

In 1998, the BJS reported there were an estimated 283,000 prison and jail inmates who suffered from mental health problems. That number is now estimated to be 1.25 million. The rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population.

Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.

Homelessness

According to the Substance Abuse and Mental Health Services Administration, 20 to 25% of the homeless population in the United States suffers from some form of severe mental illness. In comparison, only 6% of Americans are severely mentally ill.

Mental illness was the third largest cause of homelessness for single adults (48% of cities). Mental illness was the third largest cause of homelessness for families (12% of cities).

People with mentally illnesses are much more likely to become homeless than the general population (Library Index, 2009). A study of people with serious mental illnesses seen by California’s public mental health system found that 15% were homeless at least once in a one-year period (Folsom et al., 2005). Patients with schizophrenia or bipolar disorder are particularly vulnerable.

Poor mental health may also affect physical health, especially for people who are homeless. This may lead to physical problems such as respiratory infections, skin diseases, or exposure to tuberculosis or HIV. Minorities, especially African Americans, are over-represented in this group.

Emergency Rooms

Across the country, doctors are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll. This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

More than 70 percent of emergency department administrators said they have kept patients waiting in the emergency department for 24 hours, according to a 2010 survey of 600 hospital emergency department administrators. Ten percent said they had "boarded" patients for a week or more.

"Often you have a patient strapped to a gurney in a hallway outside of the emergency department where social workers are desperately trying to find an inpatient bed," Randall Hagar, director of government affairs for the California Psychiatric Association, said.

In North Carolina, the state has cut its inpatient psychiatric capacity by half since 2005. "Now you are adding in patients who are unsafe to leave but yet have nowhere to go," Dr. Bret Nicks, an emergency physician and a spokesman for the American College of Emergency Physicians, said. "I consider patients with acute psychiatric needs as really the forgotten patient population in the U.S. right now."

In a tiny facility in Spring Valley, Illinois, awoman asked Dr. William Sullivan to switch her prescriptions to drugs that could be found on the $4 discount list at Wal-Mart and other discount stores.

"I didn't feel comfortable doing that," Sullivan said, noting that emergency physicians are being asked to deliver specialized care that should be handled by a psychiatrist. "It's almost akin to having a cardiac patient come in and say, 'I need someone to adjust my defibrillator.' In the emergency department, we can do a lot, but there are some things we should leave with the specialists," he said.

Deinstitutionalization

Deinstitutionalization is the name given to the policy of moving severely mentally ill people out of large state institutions and then closing part or all of those institutions; it has been a major contributing factor to the mental illness crisis.

Deinstitutionalization has two parts: the moving of the severely mentally ill out of the state institutions, and the closing of part or all of those institutions.

Suicide

About 90 percent of persons who completed suicides in all age groups had a diagnosable mental or substance abuse disorder. 10-13% of individuals with schizophrenia and 15% of individuals with bipolar disorder kill themselves.

Each week, two mentally ill patients take their lives while under the care of the public health system - and the situation is far worse than a decade ago. Hospitals are under constant pressure to release unwell patients too early to free up beds, undermining suicide prevention strategies, experts say.

The vast majority of those who killed themselves - 86 per cent in 2009-10 - did so within days of contact with a public mental health service. And the proportion of mentally ill patients who end their lives has jumped from 9.2 per cent of all suicides in 2000-01 to 17.5 per cent in 2008-09.

From 1977 to 2003, suicide rates in the Army closely matched the rates of suicide in the civilian population, and were even on a downward trend. But after 2004, the rates began to climb fast, outpacing the rates in civilians by 2008. The study found that suicide rates were higher among soldiers who had been diagnosed with a mental illness in the year before their death. Studies have shown rising rates of mental illness among U.S. military service members in recent years.
(Figures from DOJ, NIMH, CDC and others)

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they cannot seem to mentally grasp the concept of Pennies Now vs Dollars Later

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