The old adage “out of sight, out of mind” pretty well sums up this country’s approach to mental illness. That is, of course, until someone gets to the point where we can no longer ignore them. Then we deal with their issues in the most expensive ways possible – either in an emergency room or through the criminal justice system. We could hardly have devised a more inefficient or costly way to handle such problems.
That was reinforced by a report from Rocky Mountain PBS, that showed that while seemingly the result of car crashes, violence or drug abuse, in fact, half of all visits to the emergency department at Denver Health medical center had their roots in mental illness. As Chris Colwell, the physician in charge of that department said, “The emergency room could have been avoided if they had gotten psychiatric care anywhere else.”
Colwell extends that analysis to two other events he personally dealt with, the Columbine High School killings and the Aurora theater massacre. He treated victims of both crimes and says, “For every one of those that were a big, high-profile event that everybody knows about, there’s a hundred that were either near misses ... or resulted in violence, just not to the same extent.”
Nonetheless, spending on mental-health care has been neglected for decades. Data from the National State Mental Health Program Directors Research Institute show that in 2010, Colorado “spent the equivalent of 20 percent less per person on mental health than it did in 1981.”
Much of that change stems from a well-intentioned but fundamentally flawed alliance between fiscal conservatives and advocates for the rights of the mentally ill. A Reagan-era budget changed mental-health funding into block grants for the states meant to pay for local clinics to serve patients who could then live on their own.
It sounded good, but never worked as planned. The actual result was the issue of homelessness as we know it today and a massive prison building boom, along with further pressure on the country’s emergency rooms as primary-care providers – in every case, the most expensive, inefficient and too often inhumane response to what is a mental-health issue.
An effort endorsed by Colorado Gov. John Hickenlooper after the Aurora theater shooting and signed into law this year will put almost $20 million into walk-in crisis centers and a hotline. Another program will move more money into upgrading state mental-health facilities in Denver and Pueblo with an eye toward increasing inpatient capacity and services.
But as even the most fervent advocates for mental health acknowledge, long-term beds are not the most urgent need. Studies show most patients stabilize within a couple of days. Instead, what is more important is a statewide “crisis-stabilization service” to address the immediate needs of people experiencing mental-health issues.
Perhaps more important is a broader cultural and governmental shift away from blame and judgment toward a better understanding of the centrality of mental illness in so many social problems. Concern for mental illness is too often seen as somehow squishy, a soft-headed way to make excuses for misbehavior that deserves to be treated as crime. And taken too far, it may be.
But a well-funded and well-executed effort to understand and address mental illness could also be the most pragmatic and cost-effective way to approach a great number of problems. Police, courts, jails, prisons and emergency rooms are all necessary – and expensive. They are also fundamentally reactive. How much better to intervene early.
Coping with mental illness should be a greater priority at both the state and federal levels.