(Oct. 24, 2016) It’s no secret we have a broken mental health system, both in Maryland and the United States. As the program supervisor for the Outpatient Schizophrenia Services at Johns Hopkins Bayview Medical Center, I am a personal witness to our fragmented system, where people fall through the cracks every day.
The conundrum is that treatment works. I see clients get better. I see them returning to school or work, resuming relationships, and leading healthy lives. But unfortunately, the opposite is also true. For reasons such as insurance barriers, lack of resources and long wait lists, many people with severe mental illness do not get the treatment they need. I see people taken to emergency departments, waiting for inpatient beds that they don’t want, or they don’t have insight to understand they need.
What comes next? The inevitable cycle of inpatient admission, discharge, and more treatment non-adherence. Sometimes, the courts can intervene and form a medication panel. The judge and treatment team can order a person who remains unable to care for him/herself, or who is considered dangerous to self or others, to take medication during the hospital stay even if he/she doesn’t want it.
The best case scenario when this happens? People experience less symptoms and return to outpatient treatment along with an increase in overall quality of life and ability to perform activities of daily living such as self-care. They may also become employable.
The worst case scenario? They are discharged from the hospital, stop taking medication and return to a fully psychotic state. Played out even further, they are then at much higher risk for danger to themselves, of getting caught in the legal system for misdemeanors they committed and didn’t understand, and at risk for homelessness.
Maryland is one of a handful of states that does not have an assisted outpatient treatment (AOT) law. AOT programs vary in structure but overall they do one thing: order a person to comply with mental health treatment. AOT is only necessary in a small percentage of patients. If a person with Alzheimer’s disease or another form of dementia could not care for him/herself or recognize reality, we would not allow him/her to become homeless, fending for themselves out of garbage cans and stealing to find food. But we allow this for people with other forms of severe mental illness. It makes no sense.
Additionally, there are a small number of people that have 30, 40 or even more, psychiatric inpatient admissions. What effect does this have on our broken system? Clogged hospital emergency rooms (ER), cycles of short hospital admissions and jailing psychiatric patients, to name a few. The number of psychiatric beds in Maryland has dropped astronomically in my 16 years of clinical practice. Each weekend, I see people boarded in chairs in the ER for days, even weeks, waiting for beds, receiving little, if any, treatment. ERs are not set up to provide treatment. Their purpose is to assess and move people on to a treatment setting. This isn’t happening and it’s only getting worse as beds are further reduced each year.
Who seems to care about this failing mental health system? Only those that it directly affects or their loved ones. I am on a mission to educate people and bring attention to this as it truly affects everyone everywhere both financially and socially. This is why I fully support A Bed Instead. We need to fix this broken mental health system and help individuals living with severe mental illness lead happy, healthy and productive lives.
Krista Baker, LCPC
Maryland
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