published Tuesday, March 5th, 2013

Mentally ill here deserve better options

When 45 percent of the Hamilton County Jail's 500 inmates are on prescribed psychotropic drugs and are deemed mentally ill, we should know we have a problem.

And it's a statewide concern.

Tennessee has failed to help take care of the mentally ill and their families -- and sometimes their victims.

There simply is not a place or a program -- and certainly not a comprehensive policy -- for helping mentally ill people who fall between being in control enough to take medication and being so out of control that they have either committed a crime or threatened to harm themselves or someone else.

The crisis has been brewing since the 1990s, but it has only become a visibly acute problem in the past decade.

"Deinstitutionalization," the emptying of state psychiatric hospitals, became a national movement in the last half of the 20th century.

In 1955, there were 558,922 state hospital beds in the United States for patients with serious mental illnesses such as schizophrenia, bipolar disorder (known then as "manic depressive illness") or severe depression, developmental disabilities, dementia or other chronic brain diseases.

With the advent of medications that made it possible to stabilize many patients, the idea behind deinstitutionalization was fundamentally sound: Most patients could live safely outside a hospital while being treated in community facilities.

The trouble was -- and is -- that not enough alternative community facilities sprang up to take the place of those institutional programs.

Nationally, 95 percent of the nation's public psychiatric hospital beds disappeared, but community psychiatric care exists for fewer than half the patients who need it.

In Tennessee during the five-year period from 2005 to 2010, Volunteer State officials cut the number of public psychiatric beds by 42 percent: from 1,068 to 616, according to research by the Treatment Advocacy Center, a national nonprofit organization.

Here as in other states, when bureaucrats began talking about trimming the high cost of mental institution beds (the cost of housing one patient at Moccasin Bend Mental Health Institute now is $562 a day), the idea was that mentally ill adults would receive treatment in community facilities and, if need be, live in group homes.

That sounded good, but it didn't happen often enough. Not enough group homes were set up, and not enough continue to exist now to serve the population.

By 2010, Tennessee had 9.7 public psychiatric beds per 100,000 population, while nationally, that per-100,000 number is 14. Alabama has actually increased its number of beds, and it boasts 23.4 beds per 100,000 population.

And now Tennessee is virtually alone in not ponying up some court-based help. It is one of only six states in the nation that does not allow outpatient commitment for the mentally ill.

In Hamilton County, it's pretty clear where help -- if you can call it that -- sprang up: the jail.

And as for cost savings accomplished? Well, what is a savings on one budget becomes an expense on another.

The Hamilton County Jail -- and taxpayers -- spend more than $6,000 a month on the 45 percent population that is on prescribed psychotropic drugs.

There is no doubt this is a prickly problem, but it's not insurmountable and we clearly can do better.

We must not wait until there is a victim of a crime before we find the money and backbone and humanity to help the mentally ill. Someone who is mentally ill is no less in need of help than a person whose cells have been susceptible to cancer formation. A mentally ill person can no more help having that illness than an Alzheimer's patient can help losing memory.

What's our excuse?

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