Talking Points for Madison County in Response to Alabama Department of Mental Health (DMH) plan 2012
(Please add to this for your county by working with your local NAMI Chapter)
The DMH is planning to close 4 large regional psychiatric hospitals and transition care to local communities, in order to meet severe budget shortfalls for the 2013 fiscal year. Here are some key points citizens need to address:
1. In order to fulfill the court-ordered treatment of patients who are committed, we will need crisis stabilization units. Local hospitals are not prepared to accept these patients and do not have the capacity—their beds are already over-full with acute care patients. Our MHC has applied for a 16 bed unit. If nearby county mental health centers (MHC’s) also get the units they have applied for, we can meet or exceed our current capacity at North Alabama Regional Hospital (NARH).
2. Money and time is needed to prepare the crisis units. The closure of NARH is planned for September 2012, but NARH plans no new commitment admissions after July 1, 2012. There will be no time or money to build a new facility. That leaves less than 4 months to locate, purchase and convert an existing facility. DMH does not plan to provide these capital funds, so our MHC will have to apply for a loan once they find a suitable location. The MHC has requested a budget to operate the units but has not received a figure for what our county will receive.
3. There will be potential barriers to purchasing a suitable facility. Our community has a history of “not in my backyard” responses to various forms of subsidized housing and group homes. It is unknown how much time/ effort this will require to overcome.
4. Once a facility is purchased, the renovation requirements will be extensive. For example, all existing glass windows will need to be removed and replaced for patient safety. Showers will need to be redone so that there are no rods for patients to hang themselves on. There will need to be “crash bars” installed and safe furnishings purchased. Doors, both internal and external, will need to be secured and fencing must be erected. The crisis units will be used to stabilize the very sickest patients—those who are actively trying to kill themselves, are homicidal, or otherwise severely psychotic. For their own safety and the safety of the community, the facility must be properly prepared.
5. It is unrealistic to expect the crisis units to be complete in less than 4 months, when a site has not even been located nor a budget amount provided. The MHC is not to blame, because they have only been informed of the plan within this month. Our MHC will work as quickly as possible, but there is NO WAY they can have this finished by July 1 in order to accept commitment patients.
6. Current group home residents who have been stable in their placement are now being “bumped” to less supervised settings in order to make room for those being discharged from NARH. Many of these bumped patients have a history of multiple relapses and re-commitment. Without a facility for new admissions, there will be no place for them to go. DMH does not plan to fund expansion of group home beds.
7. We appreciate the DMH’s concept of community care and less restrictive settings, along with the “recovery” orientation. However, national statistics tell us that there is a certain percentage of patients with serious mental illness (SMI) who will always require more intensive support than supervised apartments can provide. Our MHC’s are NOT failing to provide the care that would cause recovery—there is simply no known cure for these tragic illnesses.
8. Madison County, according to the US Census Bureau, had a population of 334, 811 in 2010, 255,460 of whom were over 18. According to national statistics, 1.1% of those over 18 will be diagnosed with schizophrenia, usually in the young adult age. That means we should expect about 2810 of our residents to have this diagnosis. Of those, national statistics tell us that 8% will have recurrent exacerbations despite treatment, and 35% will have exacerbations with a worsening function over time that never returns to baseline. After 10 years of illness, 5% are expected to need hospital level care at any given time. For our county alone, that would be 140 people expected to need residential care in the hospital. If we have only 16 on average, that means we are already well below expected numbers and that our MHC is not underperforming. Even with current MHC group home beds at 60, we are utilizing less highly supervised care than expected. And this is only for schizophrenia! We also have illnesses like bipolar and chronic depression.
9. Our families are filling the gap now, but we are already overburdened and cannot do more. We applaud the plan to increase independence and integration into the community for those who can be helped in this way, but we must acknowledge the reality that some with mental illness cannot live this independently. Our MHC cannot be expected to provide a magic bullet cure when no one in the world has been able to do it.
9. The consequences of failing to transition safely to community care are grim. Even with current services, 10 to 13% of those with schizophrenia eventually kill themselves. Up to 60% of male patients attempt suicide during their illness. If we set up a revolving door between group homes, the community, and re-commitment, there will be even more suicides when those who are most ill fall through the cracks. If there is not even time to prepare safe crisis stabilization units, the risk will be even worse.
10. Most mentally ill patients are more likely to injure or kill themselves than others. Although violence against others and homicide is rarer, when it does occur, it is overwhelmingly more likely to happen to a caregiving family member than to a stranger. Nationally, as many as 6% of patients with schizophrenia are in jail at any given time and 6% are homeless. There is no rational way to bypass our need to provide adequate services—we will pay for it one way or another.
11. Of all the budget shortfalls, a failure to fund treatment for mental illness will be the quickest to show up in tragedy. Failing to fund education may take years to be seen in a less prepared work-force. Failure to fund Medicaid may take months to be seen in higher illness and disability burden. Failure to treat our seriously ill residents, because of their severe fragility, will take DAYS to result in deaths. We cannot afford to roll these dice.
12. Please contact your legislators immediately, as well as the Alabama House and Senate committees preparing the budget, the Governor’s office, and any community groups you think might help us speak up. Time is of the essence. Tell them we MUST fully fund the DMH and we MUST have more time to prepare this transition.
Please see my other blog post for more.