Detroit Free Press, November 27, 2011:

After closing psychiatric hospitals, Michigan incarcerates mentally ill



Wayne County Sheriff Benny Napoleon spoke for most sheriffs when he said, during a community meeting earlier this year, that his jail had become his county’s largest mental health care institution.

Over the last two decades, changes in state policy and big cuts in funding for community mental health care have pushed hundreds of thousands of mentally ill people into county jails and state prisons.

Between 1987 and 2003, Michigan closed three-quarters of its 16 state psychiatric hospitals… The state now provides the sixth-lowest number of psychiatric beds per capita in the nation, reports the Treatment Advocacy Center.

The original intent was to replace the lost hospital capacity with improved, community-based mental health care systems. But the promised support for those systems never came. Instead, they’ve received dramatic cutbacks in state funding. The result?

A University of Michigan study last year found that more than 20% of the state’s prisoners had severe mental disabilities — and far more were mentally ill. The same study found that 65% of prisoners with severe mental disabilities had received no treatment in the previous 12 months.

The problem is even worse in county jails, where psychiatric treatment is virtually nonexistent. In 1999, a Department of Community Health study of jails in Wayne, Kent and Clinton Counties found that more than half their populations were mentally ill… If anything, the crisis has worsened since then.

Vermont may be headed down this same path. Governor Shumlin wants to abandon the flooded Vermont State Hospital and replace it (most likely) with a smaller inpatient facility, plus improved community-based mental health services.

Remember that Treatment Advocacy Center ranking? The one that put Michigan sixth-lowest in the nation in psychiatric beds per capita? Coming in just below Michigan, at number five, was Vermont. And that report was written before the closing of the Vermont State Hospital.

There are some in the mental health advocacy community — and in the GMD community — who don’t want a new state hospital. They’d prefer a stronger community-based system. I agree that we need more and better community options. But we still need a state hospital of some kind. Two points:

Promises of improved community-based services are easily made and rarely kept. The Free Press story highlights this concern. You might argue that Vermont won’t make the same mistakes as Michigan. But look at a bit of history: the state hospital closures began under a good Democratic Governor, James Blanchard. But he was followed by a Republican, John Engler, who was firmly dedicated to cutting taxes and spending. You may trust Shumlin to promote a strong community-based system, but would you feel the same way about a future Governor Dubie or Lunderville or Lauzon?

And on this particular issue, I don’t trust the current Administration. Shumlin may have good intentions, but even before Irene, state government was facing some very tough times. Now, state officials are frequently invoking the specter of Irene as a harbinger of even more belt-tightening. I doubt that spending on any program will be increasing much; and mental health is usually at the top of the list for cutbacks.

Community services, no matter how good, cannot completely take the place of psychiatric hospitalization. The vast majority of cases can be — and should be — handled in the community. But there are a small number of people for whom hospitalization is the best option. Or the least bad option, anyway.  

We’re talking about a tiny percentage of people here. Before Irene, VSH had 50 beds. That’s .0008% of Vermont’s population, or roughly 1 in every 11,000 Vermonters. The absence of VSH is already putting a huge strain on the entire mental health care system. Its capacity was barely adequate to begin with, and is inadequate now. The result is poorer care, not only for those who would have been hospitalized, but for those displaced from care by the post-VSH domino effect.  

There are many stories about the horrors of state hospitals. Some are true. Some are true, but are old news; state hospitals are much better places than they used to be. And some are not entirely accurate: hospitalization comes at the lowest point of someone’s life, and is one of the worst events of his or her life. Please don’t misunderstand me; I’m not saying that they’re making it up. I am saying that for all of us, our perceptions and memories are affected by our state of mind at the time.

And if the Michigan experience is at all predictive for Vermont, the most likely alternative to a state hospital isn’t a rugged, well-funded community mental health system. It’s warehousing of the mentally ill in jails and prisons. That would be worse than hospitalization.