Interesting letter to Governor Bentley from the Bazelon people. This is the law firm involved in the Wyatt vs. Stickney case– if you don’t know about that, there is some good background on it by Dr. Fuller Torrey’s group. It is the lawsuit that resulted in the tragic consequences of deinstitutionalization in prior decades– the burgeoning population of homeless mentally ill, the dumping of sick people into prisons, and the loss of sick persons to suicide. It was intended by some involved to force hospitals into better standards of treatment, not to abandon patients entirely– but the consequences were disastrous.
The letter is a clear threat that if Alabama doesn’t fund our mental health, we are about to get sued– again. Bazelon says Bentley should apply all the funds initially intended for Bryce to use for transitional planning and they seem to think this will be enough. I am uncertain of that– we need not only funds for transition, including capital costs and training of new personnel, but also for the ongoing expenses of our current and future services. Using one-time funds may not cut it– we won’t know until DMH releases a clear plan and estimated expense.
Bazelon’s insistance on closing all the hospitals may be misguided– the Olmstead decision says that we should place people in the least restrictive setting possible, and to integrate them into the community if it can be done. Some people are too sick to make it in the community, no matter how hard we try, until we have a real cure. More will be intermittently very sick, since relapses happen even while on previously effective medicine, and they must have a secure, safe place to get treatment. It is possible we could replace the hospital with local crisis stabilization units– we should be open-minded– but they would have to have capacity to keep people until they are REALLY ready for a lower level of care. Here’s a brief breakdown of what Olmstead requires and does not require, from Iowa– note that it does NOT require all hospitals to be closed! It just says that people can’t be kept in the hospital longer than they need to be there, if it is possible to serve them in a community setting. The pitfalls of over-reliance on community settings are severe. Bazelon is hurting us by over-interpreting Olmstead.
Bazelon has an ulterior motive that conflicts with reality. They do not believe in commitment, even to outpatient care– they think all patients with mental illness should be left to their own devices unless they are right about to kill someone. The reality this conflicts with? There is a well-studied phenomenon in serious mental illness called anosognosia. People who have this are incapable of understanding that they are sick or need treatment, the same way as some people after a stroke will not be able to believe they have a left arm. It is part of the illness itself. Real advocates for loved ones with mental illness have a more realistic approach. We are definitely not in favor of restrictive setttings when they are unneeded, and we fight for the inclusion of patients in making their treatment decisions whenever possible. We want our loved ones to be as independent as they can be and to have fulfilling lives. None of that is possible if they die from suicide or undergo permanent brain damage as a result of inadequately treated illness.
Torrey’s site has a good explanation of why we need approximately 50 hospital beds for each 100,000 population (same as my prior estimate of 140 beds needed for Madison County alone) and a list of capacities per state– notice Alabama is far short.
Bentley and Baugh have promised that they will not close the hospitals until local infrastructure is ready. If they keep that promise, the transition could go well. The reason many of us are not reassured by their words is many-fold. There have been multiple and rapidly changing plans issued from DMH since February, so we are uncertain anything they say is going to remain in place. They have not yet told us how they will pay for it or how they will apply the 2012 proration to DMH without hurting outpatient services. At our regional meeting last week, we were told that DMH couldn’t guarantee a timeline because it depended on funding– which is in direct conflict with saying the timeline depends on having infrastructure prepared.
The threat of lawsuit may be the only thing that saves our mental health system. Will Bazelon be just as ready to sue on behalf of those who become homeless or commit suicide because they have inadequate care as they are to sue for what they consider excessively restrictive care? Don’t hold your breath.