The "New Reality" is Cuts to Mental Health Care

Sad but true

Yesterday, an article in the Dayton Daily News discussed the closing of the inpatient psychiatric care facilities, as well as cutting back on some outpatient psychiatric services, at Greene Memorial Hospital, a member of the Kettering Health Network.  Patients formerly taken in by Greene Memorial will now be directed to Kettering Behavioral Health Center (the same facility that told me, when I was pregnant and walked in for an evaluation, they could "not ethically" let me leave because I was a threat to myself and my baby...and less than 20 minutes later dismissed me out of hand, because they could not admit me because I was pregnant and pregnancy was considered a medical condition they could not accommodate.  But that's a different story).

A spokesperson for the Kettering Health Network said that "'the new reality is that hospitals will be required to care for more patients with less reimbursement.'"  To get a general idea of how many mental health patients Greene Memorial usually services, the article mentions that they discharged 508 psychiatric patients in the "first 11 months of 2011."  According to US News and World Report, Greene Memorial Hospital has a total of 185 beds across all services, so it's a safe assumption that only a small percentage of these beds are in the psychiatric inpatient unit.  So the bottom line is that the area may be losing only a few total psychiatric inpatient spaces -- but when you've only got a few to start with, every space matters.

What's especially telling is that the amount of bad debt that Greene Memorial faced increased in the past few years, to a whopping 30% -- this while its patient volume actually decreased by 13% (these stats from the same article as I mentioned before).

Here's the naked truth:  mental health care is messy.  As I talked about when I discussed the closing of the Twin Valley Behavioral Health Center and replacement with the new Access Dayton mental health facility, many of the people in the mental health care system are also in some way involved in the courts/legal system -- meaning they have Medicare or Medicaid.  Thus we are right back around to the crux of the problem:  hospitals don't want to treat patients with Medicare, Medicaid, or other similar health insurance.  And it's no mystery why -- it's because the hospital very often doesn't get the reimbursement it needs to keep its services running, which then puts them at a deficit for other services, which messes with their financial solvency, etc. etc.   

I don't usually get real political on here, mainly because if I was pressed to profess an allegiance to any party, I'd say I'm in the Voter Apathy Party and I really just can't be bothered to sift through all the parties' crap to see what I really believe in.  But when I start talking about mental health care, it's a no-brainer.  Our health care system is broken.  It needs to be fixed.  I'm not exactly sure how to do that -- it's like moving a mountain with a teaspoon -- but just because it's a hard job isn't a good enough excuse to not do it.

Almost exactly a year ago, a state trooper  was responding to a disturbance at a trailer park near here (up towards Springfield), and was shot to death in a standoff-then-shootout.  There was much public outcry when it came to light that the shooter been in a shootout almost ten years before, then served two years in a mental institution after being found not guilty by reason of insanity.  Law enforcement called for a more accessible database of offenders found not guilty by reason of insanity, so the officers knew better what kind of situations they were walking in to.  Gee, I have an idea -- let's try to help these ill people so they aren't in another shootout.  I know, crazy -- but just crazy enough to work, maybe?

On a more national scale, one can point to the shooting of Arizona Congresswoman Gabrielle Giffords (and others) almost exactly a year ago, and all the discussion around the fact that the shooter, Jared Loughner, should have been receiving mental health care but wasn't, according to this NPR article, because of the stigma attached to mental illness.

Advocating for mental health care is not just about "taking care of our brothers and sisters," which clearly isn't a good enough reason for many people to take it seriously as a cause (though for those people who consider themselves Christians, it should be).  Mental illness, perhaps more than many other kinds of illness, has far-reaching tentacles that does not stop at the sufferer.  Failure to attain treatment for mental illness can reach far, affecting completely anonymous, innocent bystanders in the most horrific of ways. 

Unfortunately, with the constant closing of mental health facilities like Greene Memorial, Twin Valley Behavioral Health Center, and others all across the nation, I suspect it's going to get worse before it gets better.

Back to the point, part 2

In my last post I started detailing the issues I've had during pregnancy with getting mental health care, which is the whole reason I started this blog in the first place.  I will continue the story with this post.

In late October/early November, I went to my general practitioner because my mood had started getting really bad since going off my meds (Seroquel and Lamictal) in August.  After talking to me, -- which involved a lot of crying on my part-- looking at my medical history, and looking at the cuts I had made on my arms, he put me back on a low dose of Seroquel.  For about a week, I felt not great, but functional, but then things continued back on their downhill spiral.  I was crying all the time, just wanting to sleep, having anxiety attacks, and doing a lot of cutting.  I called my GP back and talked to a nurse, who in turn talked to the doctor, who increased my Seroquel dosage. 

The increase in Seroquel didn't seem to make much difference, other than to make me more tired (something not particularly desirable when you're trying to chase a four-year-old and a two-year-old).  I called my ob/gyn's office to see if she could help out at all.  She put me on Vistaril as needed, which is pretty much just an antihistamine but can kind of mellow you out at the same time. Both my ob/gyn and my GP suggested strongly that I see a psychiatrist, but not wanting to go back to my prior psychiatrist, and with nobody recommending a new one, I was sort of at a loss for who to see.  If you've ever tried to get psychiatric help in Dayton, Ohio, you understand what I'm talking about.  There aren't too many psychiatrists, and those that there are often have a 3-6 month waiting list just to schedule an initial appointment.

In early December, after a few more weeks of generally decreasing mood and functionality, I called my family doctor again and the nurse recommended I go to Kettering Behavioral Health Center, a facility located in Centerville (I think) that has both inpatient and outpatient care.  They also offer walk-in assessments.  I drove myself over there and talked to the admitting nurse for about a half hour.  I explained I was about 21 weeks pregnant (in case she couldn't tell), was cutting myself daily, crying all the time, and generally feeling like utter crap.  I was worried that my mood was hurting the baby, and I needed psychiatric help to look over and manage my medications. She asked the $64,000 question:  "Are you suicidal?  Do you have specific plans?"  I told her that I frequently thought about suicide, but didn't have a specific plan to follow.  I thought about taking pills or slitting my wrists, but hadn't written a suicide note or anything.

At this point she assured me that the facility had an ethical responsibility to help me out, since I was a danger to myself and my baby, based on my suicidal thoughts and cutting behavior.  They wouldn't just send me home and tell me good luck.  She asked me to step out while she called the psychiatrist on duty and talked to him about what to do next.  My sense of relief was tangible -- finally, someone was going to help me.

She came out to the waiting room a few minutes later and told me that the psychiatrist wanted to admit me to try to regulate my medications.  I didn't particularly want to be admitted -- it was close to Christmas, and I wanted to be home.  But, I knew I needed help, so I agreed.  She went back to her office to talk to the admissions people to get the process started.

About 15 minutes later, she called me back in to her office.  As it turns out, they couldn't admit me to their facility, because I was more than 20 weeks pregnant, and they didn't have the medical facilities to help me in out in case of a problem (they are not on the same grounds as the actual hospital).  What they could do is prescribe Klonopin for me, a powerful anti-anxiety drug, increase my Seroquel again, and suggest if I was still having problems to either call my old psychiatrist or go to Miami Valley Hospital's ER.

And with that, despite their "ethical obligations," they sent me on my way.

Next post:  a new psychiatrist and the ER.