State Must Offer More Options for Treating Mentally Ill

By Mary T. Zdanowicz

 

My sister lives in a facility with more than 700 people who are legally considered "dangerous to self, others or property". That is what it takes to be committed to a psychiatric hospital in New Jersey.

Beth is a patient at Ancora Psychiatric Hospital. She was diagnosed with schizophrenia more than 20 years ago and she is among the most ill individuals with this terrible disease. Unlike about 90% of people with schizophrenia, medication doesn't much help the worst of her symptoms.

Imagine a sweet, pretty 46-year-old woman who most days can't hold a basic conversation. When I take her out on day visits, I have to hold her hand because she is apt to walk out into oncoming traffic. I can't take her overnight anymore because she paces and if I dose off, she might wander off. At Ancora, she has 24-hour supervision, good nutrition, medical monitoring, and people who really care about her. Her caregivers have kept her safe for 9 years. Comparable care is nonexistent in the community - believe me, I have looked.

Most New Jersey citizens have no idea of the incredible service being performed every day by the staff of the state psychiatric hospitals. Nor do they realize the incredible duress that both staff and patients have been subjected to in recent years. Even a cursory examination reveals the real question: "How have the hospitals managed to avoid more tragedies?"

Follow the money. It isn't necessary to even step foot in a state psychiatric hospital to see a state of emergency. Look at recent state budgets. My sister was transferred to Ancora when New Jersey closed the 750-bed Marlboro Psychiatric Hospital.  At that time, there were 529 patients at Ancora with an anticipated maximum of 600. Today there are close to 750. That's 150 more patients than the state planned for in facilities and staff when it closed its largest hospital in 1998. For years, New Jersey planned for fewer patients than it served. In FY 2005, the state budgeted for 651 patients at Ancora . . . but served 727.

Thus, it is easy to make hospitals the scapegoats. Yet while state hospital budgets have not even kept up with inflation over the last ten years, contracts with private community mental heath providers have increased 50% over inflation. Between 2001 and 2006, New Jersey poured $109 million into community service contracts specifically to reduce the population in state hospitals. It didn't work. In fact, the hospital census increased 7% during that period. It appears that no matter how much money the state sinks into community mental health, it is the hospitals that continue caring for the most severely mentally ill.

Why isn't the community appropriately serving this population? One difference is that hospitals can require patients to participate in treatment and take their medication. When they leave the hospital, the rules change. New Jersey is one of only 8 states in the country with no option for civil commitment in the community, known as assisted outpatient treatment.

That means that, unlike hospitals, community providers are able to pass on treating the sickest, and often most difficult patients, with the excuse that they can't make a patient take their medication. And based on the position of their lobbyists, like the Mental Health Association of New Jersey and the New Jersey Psychiatric Rehabilitation Association, community mental health providers don't want to do the tough work that psychiatric hospitals do.

They've eagerly accepted the money that Senator Richard Codey advocated for community mental health, but they actively oppose the Senator's legislation, S-1093, that would allow community providers to do the one thing that keeps people from being hospitalized - ensure they stay in treatment and take medication.

New Jersey already closed one hospital and "reinvested" the money in the community. Yet the psychiatric hospitals are overcrowded because community mental health providers can't - or won't - do what is necessary to keep patients out of the hospital. Thus, tragedies among this very vulnerable population are inevitable both in and out of hospitals.  

Blaming the hospitals is the easy way out, and allows the mental health community to again dodge blame for the crisis we are now facing. The community isn't doing its part, and it is far past time to hold them accountable.

There are now more patients in fewer hospitals than ten years ago. Community mental health must step up and do more for hospital patients than just take their money. They can start by supporting and implementing S-1093.

Zdanowicz is executive director of the Treatment Advocacy Center (www.treatmentadvocacycenter.org), a national nonprofit dedicated to removing barriers to timely and effective treatment of severe mental illnesses.

 

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