The Great Recession led to the biggest cuts to mental health services in this nation’s history. According to a report from the National Alliance on Mental Illness, states slashed more than $1.8 billion from their mental health services between 2009 and 2011. That funding decision has had some serious consequences — such as fewer beds in mental health institutions for American adults, creating a situation in which mentally ill people often end up in prison when they can’t access the treatment they need.

But this trend wasn’t initiated by the recession’s budget cuts; it was simply worsened by it. As evidenced by the following graph from Mother Jones (which relies on the National Alliance on Mental Illness’ data), it’s been happening over the past several decades. Since the 1970s, a rapid rise in the nation’s prison population has directly corresponded with a sharp decline in the number of Americans institutionalized at mental health hospitals:

Patients are often pushed into the prison system when they don’t have access to the mental health treatment that helps keep them stable. Without the medication, counseling, and support they need, mentally ill Americans can exhibit behavior that results in an encounter with law enforcement. But another part of the issue is that American society continues to criminalize mental illness rather than recognizing and treating it effectively.

This issue doesn’t just affect adults. A recent survey of Texas’ juvenile detention facilities found that the rate of mental illness exceeds the rate of gang membership among teen prisoners there.

Federal officials have a clear message for Nevada’s Rawson-Neal mental health facility: Stop mistreating patients, or see your federal Medicare dollars disappear. In a curt letter distributed by the Center for Medicare and Medicaid Services (CMS), the federal agency that oversees major entitlement spending warned the hospital — which has been accused of unceremoniously dumping its homeless patients onto buses — that “If we do not receive an acceptable, timely submission, or if a resurvey finds that the hospital is not complying with any [conditions of participation], we will notify you that we are initiating action to terminate the facility’s Medicare provider agreement.”

The beleaguered hospital gained national attention after reports surfaced that it had systematically been dumping homeless patients with serious mental illnesses onto buses to other states. Doctors allegedly told the patients this was necessary due to a dearth of funding for housing and mental health services in the state, suggesting that they would be better off elsewhere. Rawson-Neal allegedly bused at least 100 patients to California in just one year, despite the fact that Golden State is only marginally better at funding mental health care than Nevada is.

Primary reports focused on a schizophrenic patient named James Flavy Coy Brown, who was discharged and placed onto a Greyhound to California with nothing but light snacks and three days’ medication. A follow-up investigation by the San Francisco Bee found that the behavior was nothing new, leading state and federal officials to slam the alleged patient mistreatment:

The Bee followed with an investigative report that said Rawson-Neal had purchased one-way bus tickets for 1,500 discharged patients over five years, some of whom had been sent to locations where they had no contacts.

The revelations prompted the city attorneys of Los Angeles and San Francisco to announce probes into the matter earlier this week. Rawson-Neal patients were bused to both cities, according to the Bee’s findings.

Nevada Gov. Brian Sandoval said in a statement that his office had launched three separate investigations and that disciplinary actions had been taken. The governor’s office determined that policies were not followed in at least one instance. The new policy, he said, provides “additional oversight” to ensure the hospital follows proper discharge procedures.

“I take the concerns regarding Rawson-Neal Psychiatric Hospital very seriously and it is not the policy of the state of Nevada to engage in ‘patient dumping,’” he said in a statement.

State officials have also claimed that the problem is limited to Rawson-Neal, and not reflected through other state-operated facilities.

Now that Rawson-Neal’s Medicare dollars are in jeopardy, doctors and hospital administrators might be more eager to take action. But if the facility buckles under the weight of losing its federal funding — in addition to Nevada’s steep cuts to mental health services through its Medicaid program — then other public facilities in the state would be forced to absorb its patient load. Considering the multiple barriers to providing the homeless with mental health treatment, that could end up being a tall order.

This Friday, House Republican Tim Murphy is holding a hearing on whether the Health Insurance Portability and Accountability Act (HIPAA) “helps or hinders patient care and public safety” in the context of mentally ill patients. The hearing, a followup to his hearing last month in which he reiterated false claims about mental illness and violence, will notably not include a single mentally ill witness. Why not? Because, according to Tim Murphy, mentally ill people are not “competent” to testify about how a relaxation of HIPAA rules would affect their own lives.

Instead, the hearing will revolve around family members, psychiatric professionals, and public health representatives, making decisions with potentially very serious implications about medical privacy for mentally ill people.  This event is occurring in a larger context of national panic about mental health and violence — with few public figures brave enough to stand against the tide, as Al Franken recently did, and warn against continued stereotyping and stigma of mentally ill people.

Rep. Murphy’s claim is that HIPAA “may interfere with the timely and continuous flow of health information between health care providers, patients, and families, thereby impeding patient care, and in some cases, public safety.” In other words: mentally health patients shouldn’t receive patient confidentiality, because mentally ill people are violent, and it’s in the best interest of society overall to lift privacy restrictions that limit the disclosure of their health information. This is part of a larger attack on HIPAA rights for mentally ill people with potentially grave implications that’s wrongheaded from a number of perspectives.

Despite the public perception that mentally ill people are violent and dangerous — one fostered by dangerous pop culture depictions, scaremongering media, and public comments by politicians and other leaders — it’s just not the reality. In fact, the link between mental illness and violence goes the other way round; mentally ill people are far more likely to be the victims than the perpetrators of violence. They also experience sexual assault, financial exploitation, and discrimination at very high rates because they’re viewed as easy victims. Of those who do commit violence, the vast majority engage in acts of self-harm like suicide, not violence against others.

The vast majority of violent crimes are perpetrated by people without mental health conditions. And, in unsurprising news, the largest factors involved in a violent crime that does involve a mentally ill person are lack of access to treatment (a perennial problem in the US) and drugs, which some patients may turn to for self-medication when they cannot get care through other means.

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Our guest blogger is s.e. smith, a writer and editor based in Northern California with a journalistic focus on social issues, particularly gender, prison reform, disability rights, environmental justice, queerness, and class.

22-year-old Chris Reed of Algonquin wants to give young former addicts a place to indulge in some R&R — recovery and recreation, that is. The former heroin addict and president of the recovery nonprofit New Directions Addiction Recovery Services has — with the help of some fellow recovery patients — led the charge in creating “The Other Side,” a completely volunteer-funded “sober bar” set to open in Crystal Lake, Illinois at the end of the month.

Although alcohol and substance abuse are often stratified in everyday conversation, they are rooted in similar dependencies and have a fair amount of interplay. Substance abusers are much more likely to have an alcohol dependency than vice versa, and young people between the ages of 18 and 24 are at the highest risk of having co-occurring alcohol and substance abuse problems. That’s why The Other Side aims to be a space in which young Americans recovering from a drug habit can take a breather — without the temptation of booze and its potential to cause a relapse. “If you’re choosing a sober lifestyle, this will be a healthy atmosphere. It’s an important place for people in recovery,” Reed told the Daily Herald. “We’re still young, and we want to hang out. You can’t hang out with 40 people at your house.”

The whole effort is not-for-profit, intertwined with other recovery groups, and will hopefully become an additional therapeutic resource for recovering addicts:

The Other Side is not a business — everyone involved is keeping a day job, and it’s only open four nights a week, Thursdays through Sundays. Any money raised will fund drug education and treatment initiatives by their nonprofit and others, including Wake the Nation, a Facebook-based drug awareness group led by New Directions board member Cassandra Wingert, 23, of Western Springs. [...]

Falling somewhere between “nightclub” and “rec center,” The Other Side is opening in the warehouse loft space behind Reed’s construction company on Berkshire Drive. It has room for people to relax on couches, watch TV, play pool or video games, listen to live bands, or dance along with a disc jockey. There will be security, and people will be carded at the door to make sure they’re at least 18 years old — and sober. [...]

The Other Side’s creators hope their bar will help people in various stages of recovery by providing them a place to go, and a place to be with others who understand the struggle of addiction.

The space also features photographs of late addicts who succumbed to their struggles with drugs — a solemn reminder of what can happen without a robust support system for Americans who are trying to get clean. Social exclusion, loneliness, and isolation are all significant risk factors for both mental illness and substance abuse, making group-based recovery efforts particularly important. What makes efforts such as The Other Side promising is that they close the gap between the social and therapeutic spheres of recovery, giving former addicts a place to be with both non-addict and addict friends.

A panel of federal judges in California lambasted Gov. Jerry Brown (D) on Thursday, for attempting to end judicial oversight of inmate health care and refusing to reduce dangerous overcrowding in state prisons. The panel found his lack of action was unconstitutional and presented a public health risk — and could lead to Brown being found in contempt of court.

Under the ruling — which the Brown Administration will appeal — California will have to submit a plan outlining how it proposes to reach safe inmate population levels within 21 days. The decision expands on another judge’s ruling last week that court oversight of California prison health care should not end considering the state’s inability to provide inmates with appropriate mental health care due to overcrowding.

The U.S. Supreme Court ruled less than two years ago that California was failing to meet constitutional standards prohibiting cruel and unusual punishment due to rampant prison overcrowding and the resulting inadequate medical services. Brown and other California officials have argued that their efforts to address the issue have been sufficient, and that they should no longer be forced by courts to meet the population standards since the problem has basically been solved:

Deborah Hoffman, a spokeswoman for the California Department of Corrections and Rehabilitation, criticized the judges’ decision in a prepared statement.

“The truth of the matter is that California has invested more than a billion dollars to transform its prison health care system into one of the best in the country,” her statement said. “Our prisons now provide timely and effective health care to inmates that far exceeds what the Constitution requires.”

Currently, the prisons hold 119,542 inmates, or 149.5% of the number they were designed to hold, according to a report released this week by the corrections department.

The jurists…have ordered the state to reduce crowding to 137.5% of capacity. About 9,500 inmates would have to be removed to meet that goal.

Contrary to Hoffman’s and the Brown Administration’s rosy views on the state of California’s prison health system, the Golden State has a horrible record of providing sufficient services to prisoners. That’s particularly significant for the medically vulnerable prison population, which is comprised of a disproportionate number of minorities and low-income Americans — 37 percent of whom have chronic diseases, 65 to 80 percent of whom have struggled with substance abuse, and 13 percent of whom suffer from severe mental illness. With state cuts to mental health funding and California’s bursting prison population, prisons have also turned into de facto asylums, perpetuating cycles of mental illness and poverty in minority populations while enshrining stigma against ex-convicts and mental patients.

The Sacramento Bee published a powerful story on Sunday about James Flavy Coy Brown, a mentally ill Southern man with a history of schizophrenia and depression who was unceremoniously dumped by the Nevada facility that was supposed to be giving him care. Although Brown’s tale is a harrowing one, it is by no means unique, as millions of mentally ill Americans — and especially those with housing insecurity — find themselves falling through the cracks in the social safety net.

Brown, who was being observed at the Rawson-Neal mental health facility in Nevada, was discharged and put on a bus to California. Doctors claimed that he would have better luck finding care there, since Nevada’s massive cuts to mental health services left him with few treatment and housing options in the state. Brown’s story has prompted federal and state investigations into possible misconduct by Rawson-Neal and other psychiatric facilities in Nevada, particularly since the Bee reports that preliminary findings indicate that this isn’t new behavior — Rawson-Neal alone “bused about 100 state psychiatric patients to California between July 1, 2012, and the end of February, and scores more to other states.”

As advocates explain, dumping mental patients onto buses is almost entirely a consequence of insufficient funding for mental health and housing programs:

Brown’s experience starkly underscores gaps in the public health care system that plague mental patients across the country, advocates say, including a lack of suitable housing and crisis intervention care.

His Sacramento saga began in early February shortly after he landed in Rawson-Neal. Although his hospital discharge papers list his place of residence as Catholic Charities of Las Vegas, Brown said his last real home was a small group facility that shut down.

According to a state investigation, he spent 72 hours in the hospital’s observation unit before a doctor discharged him to a Greyhound bus to Sacramento. The discharge orders noted he should be given a three-day supply of Thorazine, Klonopin and Cymbalta to treat his schizophrenia, anxiety disorder and depression, plus “Ensure and snacks for a 15-hour bus ride.”

According to the National Alliance on Mental Illness (NAMI), Nevada — which had paltry funding for mental health services to begin with — instituted the fifth largest cut to mental health funding of any state between 2009 and 2012, with over 28 percent in decreased appropriations. The fact that doctors believed Brown would receive better care in California is a particularly sad state of affairs, as the Golden State is seventh on that same list after making a 21.2 percent cut to mental health services. Those cuts have led California’s sprawling private prison system to become de facto asylums, and in Sacramento specifically, “ERs have seen a spike in mentally ill patients since Sacramento County’s mental health facility shuttered its crisis intervention clinic and closed half its beds in 2009 amid budget cuts.”

That’s partly why advocates for the mentally ill have hung their hats on Obamacare’s expansion of Medicaid, which California and Nevada have both decided to participate in. Between the law’s eligibility expansion, generous federal funding, and parity rules extending minimum levels of mental health benefits to all Americans, some 32 million Americans who previously did not have access to mental health care are expected to gain it in one form or another. That is particularly significant seeing as poor access and excess costs are Americans’ top barriers to receiving treatment.

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Before Friday, sexual assault victims in high-level military or intelligence positions were required to disclose if they sought counseling when applying for a higher intelligence clearance. But in a widely celebrated move on Friday, the Office of Director of National Intelligence announced that these individuals will now be allowed to keep their counseling history private.

The “infamous Question 21“, as former Defense Secretary Robert Gates called it, asks if the applicant has received mental health treatment in the last seven years, in order to determine any psychological concerns. While seeking mental health treatment does not officially disqualify someone from receiving security clearance, it can delay it and expose the applicant to invasive questioning. By multiple reports, sexual assault victims often forego counseling for fear it will affect their ability to rise through the ranks. One woman profiled by NPR chose to quit rather than disclose her rape:

Jennifer Norris was a devoted member of the Maine National Guard.

“I was ecstatic. I absolutely loved serving in the military,” she says.

Norris still wanted a career in the Guard even after she was sexually assaulted by other members of the military. After she was raped, she says she got psychological counseling. But then it came time to renew the security clearance she needed for her job as a satellite communications technician. One question on the form — Question 21 — asked whether she’d sought help from a mental health professional over the past seven years.

“I just could not bear sharing that information with all those people when my husband didn’t even know,” she says.

Norris says the prospect of divulging that information was too much. Instead, she decided to leave the National Guard.

Seeking counseling for sexual assault will now join the list of exemptions currently in place for family, grief and marital counseling, and for post-combat stress. Those exemptions were only added in 2008, as part of the Defense Department’s campaign to encourage soldiers to seek counseling and dispel entrenched hostility to mental health care.

Even though roughly one-third of all female troops have experienced sexual assault in the military, victims continue to bear significant stigma and often stay silent about the assault. One study found that women who were sexually assaulted while serving are nine times more likely to develop post-traumatic stress disorder.

On Wednesday, Cape Cod Online reported on Gov. Deval Patrick’s (D-MA) push to shutter Taunton State Hospital — a Cape-area psychiatric facility that provides long-term care to severely mentally ill patients. Patients’ families are outraged at the effort, arguing that it will eliminate access to essential mental health services. The closest hospitals that provide any sort of comparable mental treatments are over 100 miles away from the Southeastern Massachusetts region.

Patrick and his state’s Department of Mental Health Commissioner, Marcia Fowler, argue that the hospital has “too many beds,” and that patients can receive adequate treatment at other facilities. Shuttering the hospital would save Massachusetts an estimated $12.5 million out of Patrick’s $34.8 billion budget. But the effort highlights the fact that state officials — including those in progressive states — are woefully out of touch when it comes to effective mental health care, often using funding as a conduit for budget savings at the expense of public health. Here are three reasons that Patrick’s decision is the wrong one for sick Americans:

1. It will disrupt effective treatment regimens for the long-term mentally ill.

Treating severely and long-term mentally ill patients isn’t the same thing as treating the flu — patients can’t just pack up their bags, go to a clinic, and expect to receive the same level of care they were getting before. Medical regiments for the long-term mentally ill often involve a combination of social motivation, personal engagement programs, and complex drug cocktails. “You’re not just talking about beds,” said Karen Curtis, whose son is a long-term Taunton patient. “You are talking about a whole program that is unique to Taunton and its campus. They have a transition program (in) four or five cottages right on the grounds. Those cottages are always filled. They have work programs.”

Americans with severe mental illness are particularly vulnerable to disruptions in in their established care regimens. Even short-term changes can have negative effects — especially if patients stop receiving their medication. In an international survey of caregivers for people with severe mental illnesses such as schizophrenia and bipolar disorder, Keep Care Complete found that even doctor-authorized changes to a medication regimen led to a 56 percent relapse rate. That number shoots up to 91 percent for patients who disrupt their established treatments against doctors’ orders.

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