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.
2. Patients’ families will be forced to travel long distances to visit their loved ones.
When it comes to mental health, family visits aren’t just a matter of sentimentality — they are an essential facet of ongoing care, providing stability and support to patients in dire need of it while training family members how to properly approach their loves ones’ mental illness. Caregivers and providers agree that family engagement is crucial, with 40 percent claiming that it is a critical aspect of long-term wellness, and considering that over 80 percent of caregivers are intimately involved with treatment decisions. A report by New York’s National Alliance on Mental Illness (NAMI) chapter specifically states that family education and engagement “can markedly diminish relapses and improve quality of life for patients…. It is helpful to retain strong ties with persons who interact with the patient frequently, who would be most likely to notice any resurgence of symptoms.”
But since the closest comprehensive mental health facility to Taunton is in Worcester, families would have to travel in excess of 100 miles and two and half hours to visit patients who are forced to move out there. In essence, that means that Patrick’s budget cuts will be passed onto both patients and their families in the form of opportunity and transaction costs while adding hurdles to crucial mental health resources.
3. Patients may be pushed into prisons when they can’t access hospital care.
Other states’ experiences with such cuts highlight what happens when there aren’t enough beds and benefits for severe psychiatric patients — the mentally ill usually end up in prison, turning jails into de facto asylums and providing one of the worst environments possible for sick Americans.
That’s particularly ironic considering that the federal government stopped giving Medicaid reimbursements to exclusively psychiatric hospitals with more than 16 patients, in an effort to encourage community-based — rather than institutionalized — care. That’s also part of the reason that Patrick has felt compelled to cut assistance to such hospitals, since the state is entirely in charge of funding them. But while the shift towards community-based care is certainly desirable in theory, the story of Taunton shows that tough budgetary decisions can actually end up undermining that effort.
The governor’s mental health cuts have been going on for years, and were ratcheted up in the face of the recession. The only boost to mental health funding that Patrick has proposed came this year in the wake of the Sandy Hook school shooting. But even that $5 million boost concentrated specifically on “crisis” mental care — which the vast majority of caregivers agree is second-rate compared to long-term treatments.