Our national and most individual state economies are in rough shape and people are desperately searching for ways to save money. States have prisons to run, schools to fund, police to protect and serve as well as health care costs dealing with both physical and mental health issues. Since mental health clients have traditionally been some of the most often neglected, and ignored they are one of the first populations picked to have services and key programs eliminated. I am a traveling psycho-social rehabilitation mental health counselor in the state of Idaho. The state has announced plans to totally eliminate the psycho-social rehabilitation program. This move would be pure insanity. Here is why.
It will not save money. I will skip the questionable morality and cruelty of such a decision and stick with today's refrain: It will not save money. I am a good example as I am a specialist dealing with adults diagnosed with schizophrenia. We are not talking about housewives suffering from a case of the blues or a period of disappointment or anxiety here. We are not discussing male heavy drinkers or drug abusers who see no problem with their behavior. No, my seven clients all have a history of lengthy mental hospital visits, suicide attempts and/or minor law violations that have ended up with them serving jail time. The theory is that my psycho-social rehabilitation (PSR) services will prevent future episodes that can spiral out of control and lead to more expensive services being required. Well, it is more than theory. It is a fact that I and hundreds of others doing similar work, do save the state money.
The cost for anyone who has to enter a hospital for mental health services is $1700 ( average) per day. The minimum stay is three-days in a regional medical center which comes to a bill of $5100. If more intensive, long-term care is required at a state hospital it could be $51,000 per month. Hence, a half-year stay, not unusual, would be around $300,000. This one stay would cost as much as thirty years of PSR services.
If someone is forced into incarceration at a state or county jail the cost is around $60 per day -$1800 a month and $24,600 a year. This would be two and one half times preventative services. Over 20% of prisoners in Idaho jails are mentally ill at the present time. Cutting preventative services will certainly increase this percentage.
Perhaps some concrete examples would help the understanding. Let me tell you about one of my clients, we will call him Tom. Tom's mother passed away a few days before Christmas. One of the signs and symptoms of schizophrenia in Tom's case is that he will amplify feelings. It is like someone listening to the radio with the volume increased a hundred times. Tom responds to routine and predictability and is medication compliant. He is living an independent life and even works part-time. Immediately after his mother's death, his two sisters whom he rarely sees or has had any contact with over the last two decades, started calling him everyday and questioning him. One suggested she take over his finances and the other wanted him to go get his Social Security disability reviewed. They were trying to help Tom. But to him it was anything but help. To Tom, life is like a melody and when a few new notes are put in without warning his thinking becomes full of paranoia. In one weekend, his thinking was well on the way to becoming a full-blown psychotic episode. Luckily, the housemother at the group home where he lives alerted me to Tom's suddenly aggressive behavior toward other residents which was completely out of character and his incoherent ramblings. I was able to make him a visit and pull him out of the cycle before it got out of hand.
Here is a condensed conversation as we walked toward his favorite restaurant:
ME: "So, Tom, Rhonda told me you were having some problems. Know what she is talking about?"
TOM: "I don't know what's going on. I don't think they're gonna let me keep living there and I'm going to be out on the streets with no money or nothing."
ME: "What do you mean, 'they'? Are you talking about your sisters?"
TOM: "Yeah, they have all my numbers, call all the time, want my e-mail, and are after my money. I heard about this one guy who went in Zion's Bank with his Social Security check for $621 million dollars and he gets over 2 million a month."
ME: "That's a pretty wild story, Tom. But you do know none of it is true, now don't you?" I said as I slapped him on the shoulder. "Want me to call your sisters and tell them to relax? Nothing is going to be done about your Social Security unless you decide and you know how to handle your money just fine. They are just trying to help out. Everything is fine and nothing is going to change. You are welcome at the group home for as long as you want to be there. I think I should call them up. Want me to?"
TOM: "Yeah, would you do that for me?"
ME: "Sure, but only if you promise to call me up if you start feeling stressed out. Deal?"
TOM: "Deal. Can I get a chili-burger?"
Case closed and episode stopped. Rhonda, the housemother, was amazed I could get him re-focused and was very worried at his behavior, attitude and actions which were aggressive and somewhat threatening. She told me her first impulse was to call the mental health crisis team which I am certain would have tipped him over the edge and he would have ended up in the hospital. I may have saved the state at least $7500 by preventing the hospital stay. (This is not some bull about how great I am and all that. I am just telling a story. I get paid for this.)
Here is another example from around Thanksgiving with another guy we will call Sly. His mother asked if I would get him on the bus to a town 85 miles north so he could attend a family gathering. I was going up that way on my days off and so I rode with him, off the clock. I hooked up with him that evening for the return ride and walked up to our meeting place where his mother had dropped him off. He was smoking a cigarette in a area marked no smoking and two cops were around him. I hustled up when I saw this.
COP ONE: "Hey, buddy. Did you not hear me? You can't smoke here. The smoking area is over there." He pointed to an area were two people were smoking about a half a block away.
SLY: "I ain't doing nothin' wrong." He took a puff off the smoke.
COP TWO: You put that cigarette out right now!"
ME: "Officers, I am Sly's case manager. I think I can help." I walked up to Sly, told him I would give him another cigarette if he moved over to the designated smoking area.
SLY: "Okay, but this is my last smoke." (Which is why he didn't want to give it up.)
I thanked the cops and we got out of there.
It is very possible, in fact probable, that Sly was not going to give up his last smoke regardless of what the cops were saying. It would have become an issue, they may have attempted to arrest him, he would have fought like the devil and he would have ended up in jail, without his meds! From that point on, the jail staff would be dealing with a paranoid schizophrenic not on medication in a strange place. He would have gotten scared and his communication skills and understanding can be limited which could be interpreted as someone being defiant. Four years ago in a different town in my area, a good friend's 19-year old kid got thrown in jail, demanded his meds and when the jail staff refused he went ballistic. They tasered him over twenty times and he died in jail. I have lived in fear of this happening to one of my guys ever since.
Another example is from Rick, a now 24-year old University of Idaho student, who was sent to the state hospital when he was 22 for an eight-month stay when the schizophrenia first hit him and caused both visual and auditory hallucinations and extreme paranoia. He was treated, bought into the benefits of the psychotropic medications and took up independent living in the group home. He is a straight A-student, works with a quadriplegic man each weekend, creates amazing techno-music and shows almost no signs or symptoms of his disorder. He called me up in early January and asked me for my opinion on a trip he had planned over winter break. He wanted to drive all the way to Oregon and hook up with a girl he had met on the Internet. They planned on going to a rave.
ME: "A rave? Are you kidding me? I didn't think you were into drugs and all that."
RICK: "I'm not going to do any drugs. I just like the music and want to hang out with this woman."
ME: "Are you going to drive all the way over there in this weather?"
RICK: "Nope. I decided to take the train."
ME: "How do you plan on getting to the rave?"
RICK: "I thought I would take a taxi there."
ME: (Laughing aloud) "You're going to take a taxi to a rave? Now, think about that for a moment. Doesn't that should like a title to a Saturday Night Live sketch?"
We talked and he decided that maybe going on this trip was not such a great idea. He invited the girl over to our town instead and it worked out fine. I will let your imagination fill in the possibilities on this one.
Last, Gary was a brand new client and we were meeting for only the second time. We were eating lunch when he told me that he had eaten two boxes of rat poison before coming to town that morning. We ended up at the emergency room, he was treated, his stomach pumped and sent to the mental hospital for a three-day stay. If he had not shared with me, he would have suffered a slow, agonizing death as he slowly bled to death. I didn't save money on this one but his life was spared. He has had no episodes for two years now and is a productive, happy guy. In my world, that is worth something.
Those were real examples. The state of Idaho has decided that these psycho-social sessions are not urgent enough and important enough care. They plan on cutting 25 million out which means they will also lose about 80 million in federal funds. The millions paid out are to Idaho residents who spend almost all the money in state including paying taxes. They are willing to save 25 million and reduce the state economy by 100 million. That qualifies as insanity in my simple world. Plus, if they dismantle the entire program, how will they ever put it back together? Idaho's economy grew in the last two quarters by 5.5 and 2.7% so a rebound could be on the way. I am using my state as an example but this same scenario is coming to a state near you very soon.
I have heard some nonsense about how volunteers would be enlisted to take my place. Let's see if that makes sense. I have worked with families, students, kids and adults for 40 years. I have over 30,000 hours of direct contact with schizophrenic clients. To think that Aunt Mabel from the Lutheran Church is going to come over and replace me is absurd. I can imagine this:
AUNT MABEL: "Maybe the voices you're hearing could say nice things to you. Here have a piece of pie."
SLY: "Can I have some more coffee? This is pretty good but the coffee from the War of 1812 was a whole lot better. Hey, I can see your tits when you bend over."
I am certain she would rush right back over. Come on get real. Most families are working at least two jobs, have their own families and the state wants them to do more work for free?
I go with this report to save my funding for this important preventative work.
http://news.yahoo.com/...
But I am not confident. Governor Butch Otter is dedicated to pleasing outside groups like the Americans for Tax Reform and pleasing his Southern Idaho buddies. The disabled who would also be hit hard and the PSR mental health program have no ardent or influential voices. They are an easy group to pick on to make political points. The entire thing is morally bankrupt and another example of how hicks think about mental health issues. Most still believe that mental issues are caused by a lack of personal discipline or poor choices. I have fought for mental health parity for years and years.
I heard these type of things:
"Seems like everyone is bi-polar, depressed or schizophrenic nowadays."
"How can a supposed mental illness be on par with a broken leg?"
"It is mostly a matter of personal discipline or a lack of discipline."
Yep, I think my clients and I are totally screwed. In fact, the entire country is screwed. Of the two million in prison, 500,000 are mentally ill. I am a private businessman. I run this business to make a small profit. I invested all my teacher retirement into this. Of course, I got what I deserved. I trusted the lawmakers from the state of Idaho. For that, I should have had my own head examined.
Did I make my case that cutting mental health services is insane? I think I did. But will anyone, anywhere give a damn? God, I live in a stupid state, I didn't mean my mind either.