Between 2004 and 2014, the federal government cut mental health funding by about 40 percent. And it’s not as if that funding was adequate in 2004; the federal government has a long and shameful history of shortchanging people with mental illness, whose suffering can be every bit as painful as an open wound.
The chronic crisis in mental health care is often attributed to the movement to get people out of mental hospitals that began in the middle of the 20th century, with the advent of new antipsychotic medications. The idea was that people could be released from hospitals, and that a community-based mental health system would help patients manage their medications and live in their homes.
But those medications were highly imperfect. They often had side effects so severe that people stopped taking them. Many couldn’t afford them.
Worse yet, a community-based system of care was never quite created. Various national commissions and blue-ribbon panels studied the problem over the past several decades, but adequate funding never materialized.
So more and more mentally ill people ended up homeless. On the streets, people often found that illegal drugs or alcohol made them feel better.
We see the result of all this on our streets. There’s the guy who stands on Lacey street corners every day mumbling to himself. He’s been there so long we’ve watched his hair turn grey. There are the legions of people who cycle through our jails and hospital emergency rooms, costing taxpayers millions of dollars. These are often the same people who bedevil downtown Olympia merchants with erratic behavior that scares off customers.
Now these problems are complicated by a national shortage of psychiatrists and other mental health professionals who can prescribe medications. In our community, there is typically a two month wait to get an appointment with one. One result is that on some days, half of the people who show up in the Providence Hospital emergency room are there to get mental health care.
Outpatient care is selective
Traditionally, the outpatient mental health care system has served those who have insurance and are functional enough to show up for appointments.
And mental health care and addiction treatment have been totally separate. People with addictions were often told they had to recover from their addiction before they could receive mental health help; the same people were often told they couldn’t be admitted to an addiction treatment program until they had their mental illness under control.
A real system of community-based care requires integrating mental health and addiction treatment, and taking care to people where they are – on the streets, in the woods, and in shelters. It requires creating outreach teams that build trust with people who have given up on the system, and providing care that is not based on keeping appointments. And it requires recognizing that having a stable, safe place to live is a vital to recovery.
It also means having adequate hospital care for people in crisis – something that has also been in short supply in our community.
Multiple paths to relief
Now, significant progress on both hospital and community-based care is within sight.This year, Thurston County will open a mental health triage center, so that police will have a place to take mentally ill people other than jail. We also have both Providence and US HealthVest vying to open a new, 75- or 80-bed mental health hospital.
And there is a major new effort underway to build a coherent system of care that can serve people who are homeless. If all goes well, a downtown Olympia Community Care Center will open near the transit station this summer. Led by Providence Behavioral Health Care Manager T. J. LaRocque, the center will bring peer support, professional mental and physical health care, housing assistance, and help with basic challenges like getting a birth certificate under one roof. The Center will also include a place to have coffee, visit, do laundry and take a shower.
It is a challenge to get tangled, single-purpose funding streams to merge so this can work, but recent improvements in funding will help. It will require sustained public support.
But the benefits to people who are suffering – and to our whole community – will be enormous. Meg Martin, the director of Interfaith Works Shelter, describes one woman with mental illness and dementia for whom police calls, jail time, and hospital visits cost taxpayers $250,000 in a single year. Her disruptive behavior was also a big problem for downtown merchants. Now, thanks to Meg and a team that is the precursor to the Community Care Center, she is cared for and housed. She is happy, and the savings are enormous.
This is a story that needs to be repeated for many more people. And now we have reasons to hope that it can be.