Jail is the new state mental hospital. Where are the diversion programs?

@joenegronfl

@MaryLynnMagar

Jail is the new state mental hospital.

and Florida is one of the worst places.

If its “our money” we’d like to keep it and not waste it on housing people. We need a real solution. Stop wasting our money on a solution that doesn’t work and hurts people.

P1-BN290_JAIL_j_G_20130925183605 state of denial

Here is a TC Palm Editorial I found from Feb 2013

http://www.tcpalm.com/opinion/editorial-county-jails-expensive-and-ineffective

“During the 1960s, there were well-intentioned public policies to close most mental health institutions, some of them dens of abuse and neglect, and replace them with community mental health centers, which could dispense medication to people who needed it. But states failed to follow through with either sufficient community mental health centers or funding for treatment.

As a result, many states, including Florida, shifted the burden of dealing with the mentally ill to counties, which lacked appropriate treatment options. Ultimately, jails became the first resort for people whose mental illness contributed to their commission of crimes.

As a result, county jails have become de facto mental institutions at massive costs to taxpayers without resolving long-term problems of the ill, Treasure Coast sheriff’s spokesmen agreed.

Nationally, about one in five inmates suffers from a diagnosed mental illness. Those numbers are even higher on the Treasure Coast, local officials said. And, the numbers have been climbing, in part because of the economic downtown as well as the rise in pain killer addictions.

mentalilljail

The St. Lucie County Jail is the largest mental health institution in the county, housing about 240 mentally ill inmates daily. Over the past year, the jail housed 9,452 inmates with mental health issues, compared to 5,431 five years ago.

St. Lucie contracts for health, mental health and dental services at an annual cost to county taxpayers of about $4 million. Meantime, the mentally ill stay five times longer and cost six times more than other inmates, he said.”

And, while those with mental problems may stabilize with medication in jail, many cannot afford to medicate when they are released and find no other place for treatment.

“This causes havoc with the judicial system,” Tighe said. “The courts have no place to send them. It’s just a vicious cycle.”

http://www.npr.org/2014/01/20/263461940/mentally-ill-inmates-often-locked-up-in-jails-that-cant-help

Officials acknowledge that what’s happening in these wards is reminiscent of the mental asylums of the last century. But they say the only other option is to lock the mentally ill in solitary confinement for weeks on end.

This is, after all, a jail. And this is one of the few in the country with doctors and nurses, psychologists and correctional officers trained in how to handle psychotic episodes. And there are rules: Inmates can only be forcibly medicated with a doctor’s orders. Leather restraints and padded rooms have time limits.

mental_illness_photo_img

“Sometimes I would even commit a crime just to make sure I would get my meds,” says inmate Joseph DeRiggi. “Here, there’s a little more understanding because they know us: ‘OK, DeRiggi, we know what you’re on. You’re good.’ That’s just the way it is.”

But jail is an expensive place to get medication. It costs almost $200 a night to house a mentally ill person here; health clinics cost a fraction of that.

Plus, their cases clog the courts with largely minor offenses. That lengthens jail time for everyone. The average stay is now eight days longer than it was a few years ago. Adding eight days costs county taxpayers $10 million more every year.

http://en.wikipedia.org/wiki/Community_Mental_Health_Act

The Community Mental Health Act of 1963 (CMHA) (also known as the Community Mental Health Centers Construction Act, Mental Retardation Facilities and Construction Act, Public Law 88-164, or the Mental Retardation and Community Mental Health Centers Construction Act of 1963) was an act to provide federal funding for community mental health centers in the United States.

The CMHA provided grants to states for the establishment of local mental health centers, under the overview of the National Institute of Mental Health. The NIH also conducted a study involving adequacy in mental health issues. The purpose of the CMHA was to build mental health centers to provide for community-based care, as an alternative to institutionalization. At the centers, patients could be treated while working and living at home.

Only half of the proposed centers were ever built; none were fully funded, and the act didn’t provide money to operate them long-term. Some states saw an opportunity to close expensive state hospitals without spending some of the money on community-based care. Deinstitutionalization accelerated after the adoption of Medicaid in 1965. During the Reagan administration, the remaining funding for the act was converted into a mental-health block grant for states. Since the CHMA was enacted, 90 percent of beds have been cut at state hospitals.

The CMHA proved to be a mixed success. Many patients, formerly warehoused in institutions, were released into the community. However, not all communities had the facilities or expertise to deal with them. In many cases, patients wound up in adult homes or with their families, or homeless in large cities,but without the mental health care they needed.

Essentially we are spending a lot of money to house people when we could spend smarter money to treat people. In this day and age with all the good medications we have these folks could get jobs, have a life, be a part of the world. Instead they are ignored and live in a world which is really no better than the state hospitals that closed down. Another example of our legislators wasting our time and money and not advocating the people who must be advocated for.

http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf

“Florida
In the Broward County Jail in 2007,
23 percent of the prisoners were
taking psychotropic medication. Polk County
Sheriff Grady Judd said: “Our jails and
prisons collectively are the biggest mental-health
facilities in the state. . . . Jails have
become asylums for thousands of inmates with
mental illnesses whose problems and needs
far exceed what jails can provide.”

Food for thought when we are all binge watching “Orange is the New Black.’

Excellent video about CIT (Crisis Intervention Team Training)

Which is great but we have to have a place where people are bought that not jails.

“Diversion programs work better than incarceration – for everyone. In cities like Seattle, San Antonio, and Salt Lake City, we see that successful solutions are a viable option to help end serious social problems. These services alter the course of people’s lives in a positive way and save taxpayers huge amounts of money. We cannot continue to isolate and imprison people who suffer from mental illness, substance abuse, or homelessness. We must treat them with compassion and care to better serve our communities and our pocketbooks.”

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June is educate your legislators in mental illness month. I said so!

@joenegronfl

who said

http://fcir.org/2012/07/26/florida-slips-even-lower-in-mental-health-funding/

“More specifically, state Sen. Joe Negron, R-Palm City, advocated cuts to so-called soft services, which include mental health and drug-addiction programs, because many of these services address what Negon views as “a lack of willpower, a lack of discipline, a lack of character.” Negron was the chair of appropriations for health and human services in the state Senate.”

This attitude has got to change. We cannot have legislators that do not believe in taking  care of our most vulnerable people and do not believe in science.

Mental illness knows no parties. It is a bipartisan disease.

mental-health1-1050x641

Let’s educate our legislators. Let’s make a difference.

Let’s make June “Educate your legislators on mental illness month.”

Society is Judged By How They Treat the Most Vulnerable.

What does this say about us?

http://www2.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=93487

Mental Illness Is Common
Of Florida’s approximately 18.3 million residents, close to  660,000 adults live with serious mental illness
and about 181,000 children live with serious mental health conditions.
Untreated Mental Illness has Deadly and Costly Consequences
In 2006, 2,440 Floridians died by suicide.
Suicide is almost always the result of untreated or under-
treated mental illness.
Public Mental Health Services
are Inadequate to Meet Needs
Florida’s public mental health system
m provides services to only 26 percent of adults who live with
serious mental illnesses in the state.
Florida spent just $38 per capita on mental health
agency services in 2006, or $686.6 million
Nationally, an average of 70 percent is spent
on community mental health services and 28 percent on state hospital care.
by the numbers
Criminal Justice Systems Bear a Heavy Burden
In 2006, 7,302 children were incarcerated in Florida’s juvenile justice system.
Nationally,
approximately 70 percent of youth in juvenile justice
systems experience mental health disorders, with
20 percent experiencing a
severe
mental health condition.
In 2008, approximately 24,600 adults with mental
illnesses were incarcerated in prisons in Florida.
Additionally, an estimated 31 percent of female and 14
percent of male jail inmates nationally live with
serious mental illness.
Many Residents Rely on Public Services for Needed Care
Approximately 10.1 percent of Floridians are enrolled in Medicaid.
Housing is Unaffordable for People who rely on SSI or SSDI.
The average rent for a studio apartment in Florida is
119 percent of the average Supplemental Security
Income (SSI) payment, making housing unaffordable
for adults living with serious mental illness who rely on SSI.
Here is an article from Science Daily

Brain circuit problem likely sets stage for the ‘voices’ that are symptom of schizophrenia

Scientists have identified problems in a connection between brain structures that may predispose individuals to hearing the ‘voices’ that are a common symptom of schizophrenia. Researchers linked the problem to a gene deletion. This leads to changes in brain chemistry that reduce the flow of information between two brain structures involved in processing auditory information.

Here is a video by ROCHE that is a simple explanation on schizophrenia.

The biology of schizophrenia.

Mental Disorders as Brain Disorders: Thomas Insel at TEDxCaltech

The Asylum Life: House on the Hill.

The Asylum Life: House on the Hill.

What goes around comes around.

It’s still nurses week and I’m giving my brain a rest from the usual suspects.

Danver’s State Hospital was the second state hospital in Mass that I worked in. My third job in psych. I had worked at the “Cambridge Hotline” as a volunteer and Metropolitan State Hospital as  a Mental Health Tech. As a nurses I’ve worked CCSU with kids (South County Mental Health) from 5-18, Home Health, In patient chemical dependency, general psych population, nursing supervisor, and then back to Medicare Home Health.

This is the haunting place.

I drove past this place  my whole life driving from Mass to Maine and always wondered what went on up there on the hill.

Danvers-State-Insane-Asylum23

One woman’s life at Danver’s State

Images of Danver’s State Hospital

So as we learned from the story of Dorothea Dix she wanted the mentally ill separated from the people who were in jail.

The hospital was opened May 13th, 1878.

image from: Wikimedia Commons

image from: Wikimedia Commons

Danver’s was originally established to provide residential treatment to the mentally ill, it expanded its repertoire in 1895 with the opening of a pathological research laboratory.

By the 1920s the hospital was also operating “school clinics” to identify “mentally deficient children”.

It was also during this time period that reports were made of various inhumane shock therapies, forced lobotomies, and the use of experimental drugs and straitjackets.

This is where the frontal lobotomy was born.

During the 1960’s as a result of increased emphasis on alternative methods of treatment and deinstitutionalization and community based mental health care, the inpatient population started to decrease. Danvers State Hospital closed on June 24, 1992 due to budget cuts within the mental health system.
After it closed it was bought by a group that was going to convert it into apartments.

“4-11-08 After fire, Danver’s State complex almost finished By Ethan Forman Salem News

Almost one year after a fire swept through the former Danvers State property, the 433-unit Avalon Danvers apartment complex atop Hathorne Hill is nearly complete.The fire, which burned down three buildings and whose cause was never determined, set construction back six to eight months. All the buildings in the apartment complex are now scheduled to open June 1, with some ready for occupancy May 1. By the time an open house is held in June, the developer expects it to be 80 percent to 90 percent occupied, said Scott Dale, vice president of AvalonBay Communities.

Today, the complex, which cost $80 million to build, sports apartments with lofty ceilings, large windows and sweeping views of the North Shore. Another 64 senior condominiums should take shape over the next 18 months.In a way, this is the second time Danver’s State Hospital has risen from the ground. The push to redevelop 77 acres of the former Danvers State Hospital has meant the demolition of most of the buildings of the former insane asylum, with just one-third of the 1878 Kirkbride building remaining.”

Rents in the Kirkbride building range from $1,300 to $1,700 for a one-bedroom apartment to $1,575 to $2,400 for a two-bedroom apartment.

So the need was there. The state hospital’s were built to separate the mental ill from criminals. Once we started having medications to treat these people instead of frontal lobotomies, electro shock treatment, insulin shock treatment ended and they used neuroleptic drugs.

The Hospitals were emptied out and we supposedly had Community Mental Health Centers.

  1. Is an entity that meets applicable licensing or certification requirements for CMHCs in the State in which it is located; and
  2. Must provide all of the following core services to meet the statutory definition of a CMHC.  However, effective March 1, 2001, in the case of an entity operating in a State that by law precludes the entity from providing the screening services, the entity may provide for such service by contract with an approved organization or entity (as determined by the Secretary) that, among other things, meets applicable licensure or certification requirements for CMHCs in the State in which it is located.  A CMHC may receive Medicare reimbursement for partial hospitalization services only if it demonstrates that it provides such services.  The core services include:
    • Outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and residents of the CMHC’s mental health service area who have been discharged from inpatient treatment at a mental health facility;
    • 24 hour-a-day emergency care services;
    • Day treatment, or other partial hospitalization services, or psychosocial rehabilitation services; and
    • Screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission.

The 90’s was the decade of the brain.

http://en.wikipedia.org/wiki/Decade_of_the_Brain

There was hope.

Here is a fact sheet from NAMI

http://www2.nami.org/factsheets/mentalillness_factsheet.pdf

Here are some recent statistics.

http://www.cdc.gov/nchs/fastats/mental-health.htm

Now the mentally ill are back in jail.

http://kaiserhealthnews.org/news/by-the-numbers-mental-illness-jail/

  • In state prisons, 73 percent of women and 55 of men have at least one mental health problem
  • In federal prisons, 61 percent of women and 44 percent of men
  • In local jails, 75 percent of women and 63 percent of men

The Affordable Care Act—and its expansion of Medicaid—is expected to connect previously uninsured ex-offenders with medical care and mental health treatment. But in the short term, jails and prisons remain the places where those with severe psychosis are housed: There are now three times more people with serious mental illness incarcerated in the United States than in hospitals, and the types of behavioral and mental health problems among inmates are becoming more severe.

This is the kicker.

“In trying to explain the rise in mental illness in prisons and jails, public health officials and researchers point to the closure of state psychiatric hospitals in the late 1960s.”

http://www.newsmax.com/US/prison-mental-health-inmantes/2013/09/26/id/527895/

The nation’s jails and prisons are turning into warehouses for the mentally ill, with the three largest jail systems housing more than 11,000 prisoners under treatment on any given day.

Now let’s bring it on home.
______________________________________________________________________________________________
State Statistics:
Florida
Mental Illness Is Common
Of Florida’s approximately 18.3 million residents, close

to 660,000 adults live with serious mental
illness.
 About 181,000 children live with serious mental health conditions.
Untreated Mental Illness has Deadly and Costly Consequences
In 2006, 2,440 Floridians died by suicide
Suicide is almost always the result of untreated or under-
treated mental illness.
Nationally, we lose
one life to suicide every 15.8 minutes.
Suicide is the eleventh-leading cause of
death overall and is the third-leading cause of death among youth and young adults aged 15-24.
Public Mental Health Services are Inadequate to Meet Needs.

Florida’s public mental health system provides services to only 26 percent of adults who live with
serious mental illnesses in the state.
Florida spent just $38 per capita on mental health
agency services in 2006, or $686.6 million.
This was just 1.1 percent of total state spending that year.
In 2006, 56 percent of Florida state mental health
agency spending was on community mental health
services; 42 percent was spent on state hospital care.
Nationally, an average of 70 percent is spent
on community mental health services and 28 percent on state hospital care.
Criminal Justice Systems Bear a Heavy Burden

The average rent for a studio apartment in Florida is
119 percent of the average Supplemental Security
Income (SSI) payment, making housing unaffordable
for adults living with serious mental illness who
rely on SSI.
How is this better than the Asylums?
How does this fit into the rights of the mental ill?
Then we have sick things like this.

According to the Herald, three former employees of the psychiatric unit at Dade Correctional Institution have alleged that staff at the facility were tormenting and abusing mentally-ill inmates for years. One of the former employees took their complaints to the U.S. Department of Justice last month.

The Herald reports:

In his complaint, George Mallinckrodt, a psychotherapist assigned to the unit from 2008 to 2011, related a series of episodes, including the death of inmate Darren Rainey. The 50-year-old was placed in a small, enclosed, scalding-hot shower by guards and left unattended for more than an hour. He collapsed and died amid the searing heat, suffering severe burns when he fell, face up, atop the drain.

reference sites
How can we continue to go in this direction and not care for the people who need the care? How can we close our hearts and minds?

Dorothea Dix Psych Nurse and Social Reformer

There are wonderful nurses throughout history that have made changes that have benefited us all.  Dorothea Dix is one of my favorite historical nurses.

http://www.biography.com/people/dorothea-dix-9275710

Dorothea Dix was an educator and social reformer whose devotion to the welfare of the mentally ill led to widespread international reforms.

Synopsis

Born in Hampden, Maine, in 1802, Dorothea Dix was a social reformer whose devotion to the welfare of the mentally ill led to widespread international reforms. After seeing horrific conditions in a Massachusetts prison, she spent the next 40 years lobbying U.S. and Canadian legislators to establish state hospitals for the mentally ill. Her efforts directly affected the building of 32 institutions in the United States.

Here are two I worked in as a mental health tech.

My first job as a Mental Health Tech.

metstate

http://en.wikipedia.org/wiki/Metropolitan_State_Hospital_%28Massachusetts%29

Danvers-State-Insane-Asylum23

http://en.wikipedia.org/wiki/Danvers_State_Hospital

It was a good idea to let the Mentally ill be separate from those who are in jail. Unfortunately, what happened next is not a pretty story leading up to the emptying of state hospital and now we are back to where she is now where people cannot get good mental health care and many people end up in jail instead of treatment where they belong.

http://womenshistory.about.com/od/civilwarnursing/a/nurses_circular.htm

The following is a document written by Dorothea Dix to lay out the requirements for women who would work in the nursing service for the Union Army during the American Civil War.

  • Circular No. 8., by Dorothea Dix

    Washington, D. C., July 14, 1862,

    No candidate for service in the Women’s Department for nursing in the Military Hospitals of the United States, will be received below the age of thirty-five years, nor above fifty.

    Only women of strong health, not subjects of chronic disease, nor liable to sudden illnesses, need apply. The duties of the station make large and continued demands on strength.

    Matronly persons of experience, good conduct, or superior education and serious disposition, will always have preference; habits of neatness, order, sobriety, and industry, are prerequisites.

    All applicants must present certificates of qualification and good character from at least two persons of trust, testifying to morality, integrity, seriousness, and capacity for care of the sick.

    Obedience to rules of the service, and conformity to special regulations, will be required and enforced.

    Compensation, as regulated by act of Congress, forty cents a day and subsistence. Transportation furnished to and from the place of service.

    Amount of luggage limited within small compass.

    Dress plain, (colors brown, grey, or black,) and while connected with the service without ornaments of any sort.

    No applicants accepted for less than three months service; those for longer periods always have preference.

    Approved,
    William A. Hammond,
    Surgeon General.

History of Social Reform in Nursing