Given all of the mainstream and social media chatter about a major, coordinated approach to reducing mass shootings in this country, I would think that there would be more attention (read dollars) being spent on mental health resources.
I was disappointed to read this report coming out of Sacramento County, California, that reveals a decrease in mental health beds, resulted in a major uptick in EMS and hospital emergency department usage by patients with mental illness.
Most EMS providers probably will not remember that once upon a time, we committed many of the seriously ill psychiatric patients to state mental hospitals, which were large, monolithic buildings that housed thousands of patients. They were not so much hospitals as they were prisons; mental health care was still in its infancy and little was known about treatment. Funding was cut to these institutions in the early 1980s, resulting in a veritable flood of people with mental illness being released to the streets to, frankly fend for themselves.
Mental health care continues to be poorly funded, inadequately managed, and under recognized by politicians and policy makers alike. It’s one thing to pay politically correct lip service to the issue; it’s completely another to actually commit the time, energy and money to make real changes.
Progress for patients with mental illness starts with a true understanding of what mental illness is — an actual medical disorder or disease, just like myocardial infarctions, stroke, multi-systems trauma, and breast cancer. We readily create systems of care and funding to combat these diseases, yet because mental illness is unseeable, it’s treated as a second-class citizen by those responsible for funding health care.
Even in EMS we have difficulty recognizing patients with mental illness as having a real disease. We use derogatory terms like “psycho”, “crazy”, “nutty” and other, unprintable slang terms to describe these patients. I don’t hear slang words for victims of heart attacks, strokes and trauma. We accuse patients that die from suicide of being “greedy” or “selfish”.
Dealing with mental health — partly because of lack of funding and understanding — is not on our country’s top list of things to fix. As a patient or as family or friends, anyone who has had to deal with mental health issues can tell you, it is a painful, cruel and punishing disease, with little known about cause and treatment.
We spend very few research dollars looking for solutions; current approaches often feel like rolling dice. Maybe this drug will work. Then again, maybe not. We just don’t know.
Bottom line? Don’t expect any changes coming down the road in the near future. It’s not being talked about during the early election season, and I suspect it won’t be a top issue in the next year.
The result? Lots of transports by EMS of patients with mental illness who end up going nowhere fast on the road to recovery or remission.
Occasionally, lots of people will be shot and killed. We’ll wring our hands and say, “how tragic.”
The other tragedy is our inability to do the right thing for patients with mental illness.
