By Rick Holmes
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It was obvious the two men huddling on a rainy night outside Boston’s Downtown Crossing T stop were homeless, and, to use a non-technical term, not right in the head.
Two social workers with the Mass. Department of Mental Health engaged them, trying to figure out if they were sick enough to qualify for state mental health services and sane enough to agree to accept the help. One took a sandwich from Brian T. Simpson, one of the street outreach workers. The other just wanted cash. Neither had the slightest interest in coming to the DMH shelter a few blocks away.
It’s frustrating to watch sick people get sicker on the city streets when the only help they’ll accept is a sandwich, Simpson says, and that’s not the only frustration.
“When I first started, 20 or 30 years ago, we’d get lots of calls from people saying, ‘We’ve got a homeless guy out here talking to himself. Can you come and help him?’” Simpson says. “Now, homeless guys talking to themselves are everywhere, just part of the scenery, so we don’t get many calls.”
The homeless mentally ill are an especially tragic part of a much larger problem. When it comes to mental illness, America is losing ground.
On most measures, Americans are getting healthier. The federal government keeps score through a Healthy People 2020 list of 26 leading health indicators, and on nearly all, the 10-year goals have been reached, progress has been made or things are stuck in place.
Not on the two mental health indicators. The percentage of adolescents with major depressive episodes has gone up, from 8.3 percent in 2008 to 9.1 percent in 2012. The suicide rate has risen from 11.3 per 100,000 population in 2007 to 12.1 percent in 2010.
The U.S. recorded 38,364 suicides in 2010. That compares to 32,885 traffic fatalities and 16,295 homicides. After the Newtown massacre, which ended in a suicide, everyone talked about the problems of guns and mental illness. Politicians struggled for months to do something about guns, with little success. But nobody did much of anything about mental illness.
“It’s the public health epidemic nobody talks about,” says Dr. Thomas Insel, director of the National Institute of Public Health. Insel cites the depressing facts: Of those with serious mental health problems, only half seek help, only half who seek help get it, and only half of those who get it are successfully treated.
Mental health parity, the principle that treatment for mental illnesses should be covered by insurers just like treatment for physical illnesses, has been written into law several times, including in the Affordable Care Act. But it’s nowhere close to a reality, health experts say. Many psychiatrists refuse to take payments from private insurers. It’s even harder to find therapists who take Medicaid.
There’s an assumption that treating mental illness is expensive, but so is not treating it. The biggest mental health institutions in the country are jails, where housing each “patient” costs up to $50,000 a year. Insel says there are 10 times more people with serious mental illness in jail than in hospitals.
But what’s really expensive is when mental illness comes in conjunction with other chronic conditions, like diabetes, heart disease or hypertension. People who can’t navigate our fragmented health care system just get sicker and sicker.
One health expert I spoke to cited a patient with multiple chronic conditions who had been to the emergency room 36 times in two months. Coming up with a better way to manage that patient’s health care could save a lot of money, and a lot of pain.
That’s one goal of the people building accountable care organizations under new health reform initiatives: coordinating care for the sickest of the sick, the poor, mentally ill and disabled. Some programs are showing real promise.
I also find hope in the research that is unlocking the secrets of the brain, providing new understanding of the chemistry of depression, bipolar disorder, schizophrenia, addiction and other mental illnesses. Psychiatric treatments are increasingly effective, researchers say.
As we walked the streets of Boston, a veteran social worker asked me if I’d seen any changes in the public attitude toward mental illness, and I answered with another hopeful sign. The response to the recent epidemic of opiate abuse has been different from previous drug outbreaks. Almost all the talk has been about harm reduction and treatment, not new laws and punishment.
We’ve got a long way to go, but it’s a start.
Rick Holmes is the opinion editor for the MetroWest Daily News. He can be reached at firstname.lastname@example.org.
Rick Holmes: Bad checkup for mental health
By Rick Holmes