Wednesday, April 10, 2013

The Many FAILs Behind the Patient Dumping Scandal

It's been funny how this has happened. Since the Newtown massacre in December, some opponents of gun safety reform have tried to deflect criticism of lax gun laws by citing deficiencies in mental health care in America. So did this result in a renewed push for improved access to mental health care?

Not really. While Senators Debbie Stabenow (D-Michigan) and Roy Blunt (R-Missouri) are pushing a bill authorizing Medicaid reimbursement to community health centers for expanded access to mental health care, the estimated $1.4 billion cost may ultimately mean the bill gets lost in the shuffle of austerity madness. So much for that.

In recent days, California and national media have been reporting on the harrowing true tale of James Flavy Coy Brown. He's a former patient at the Rawson-Neal Psychiatric Hospital in Las Vegas. Even though he was in need of more treatment and care, he was discharged from Rawson-Neal... And done so with just a 3 day supply of medicine, some peanut butter crackers, and a few bottles of Ensure. And from there, he was packed onto a Greyhound bus bound for Sacramento.

8 News NOW

Ever since Brown's arrival in Sacramento, California state legislators have called for investigations into Nevada's practice of patient dumping to California and elsewhere. Since then, both Nevada and federal officials have responded with their own respective investigations into this patient dumping scandal. And so far, they've found 99 cases of patient dumping between July 2012 and February 2013.

Earlier this week, Think Progress detailed the policy failures behind the story of James Flavy Coy Brown and the other victims of Nevada patient dumping. Basically, there's a whole lot of blame to spread around.

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.

Unfortunately, even if the Medicaid expansion had occurred years ago, Brown may not have benefited from it due to his housing insecurity. Social exclusion and poverty are significant risk factors for mental illness, and the homeless consequently have sky-high rates of chronic and severe mental health problems. While Medicaid expansion would address the eligibility issue for homeless Americans, lack of identification or a Social Security card presents a nearly insurmountable barrier to enrollment. The Kaiser Family Foundation also finds that literacy and language barriers and a distrust of public institutions makes it difficult to to enroll the homeless in Medicaid or Social Security disability insurance.

And the issue becomes even more complicated considering that certain efforts to improve mental health care can actually undermine efforts to help the homeless. For instance, since the 1960s, states have been cutting down on beds in public psychiatric hospitals in an effort to shift towards more community-oriented, non-institutionalized care. Specialists agree that this is a much more effective form of treatment, since it integrates patients into society rather than sequestering them from it. But in the case of the homeless, who by definition lack a community or support system in which to be integrated, it often leads to untreated ailments and jail time. Brown may have found a happy ending to his story, but millions of Americans don’t — and likely won’t, even under Obamacare.

Think about that. Medicaid is being expanded under the Affordable Care Act, and fortunately Nevada will participate in it. But even with that, it's incredibly difficult to secure the care that the homeless & mentally ill need. And the "TEA" flavored Republicans in Congress even want to cut this. And funny enough, many of these are the same ones who weeks ago said gun safety advocates should be pursuing better mental health care instead of tougher gun safety laws.

And of course, what makes matters worse is that the State of Nevada has a history of stinginess when it comes to any & all kind of health care funding, including mental health care. Over the years, there have been stories of the state administering "Greyhound Therapy". But now, it's finally out in the open. And Governor Brian Sandoval (R) suddenly somehow found another $25 million for mental health care.

So why was James Flavy Coy Brown thrown onto a Greyhound and dumped into California? Nevada didn't want to pay for his treatment any more. The federal government doesn't provide enough funding for treatment. And even though California ultimately accepted him, it's not as if that state funds mental health care all that much more than Nevada (so there are many problems in The Golden State as well). And lost in the shuffle are the people desperately in need of help.

Many in Congress continue to use this gravely serious issue as an excuse to avoid tackling gun safety reform. And both Congress and the Nevada Legislature continue to fight over how little to fund health care. And lost in the shuffle are the people desperately in need of help.

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