Mental Health Care: The Myth of Equal Treatment for All

I had a bad case of writer's block this week, and absolutely no idea what to blog about. So I went to a bucket of miscellaneous things I keep under my bed, and found one of the journals I kept while at Richmond State Hospital in Richmond, Indiana. I was originally looking for the list of rights of psychiatric patients and the countless violations of them I've experienced, but found an entry I believe addresses one of the "you can't say that!" issues in psychiatric care: the myth of equal treatment for all.

Journal Entry

5/20/08, 1:30 p.m., Richmond State Hospital Day 44

I'm angry. It's been more than a week since Dr. Mitrione ordered me to receive anger management and DBT. I'm not getting either. I've asked to talk to [unit director] Sheila today--I'll be lucky if I get to, let alone get anything out of her besides "I'll put it in the doctor's book." Yet somehow staff always has time to make us do word searches, play bingo, or junk like that. It's a waste of my time and the taxpayers' money.

There's talk of privatizing the state hospital system. That strikes me as a bad idea. We already have enough mental health services that run with a skeleton staff, minimal oversight, and an emphasis on the bottom line. Before I went to Midtown [a public community mental health center in Indianapolis], I received treatment from a private, not-for-profit community mental health center. The more trouble I had paying for services, the more they cut back on my treatment. The more they cut back, the sicker I became until we came to a mutual agreement to transfer my case to Midtown.

I didn't receive quality treatment at my former provider. More than once I wandered the streets of Indianapolis, delusional and psychotic, with their full knowledge. When I filed a complaint against Community [Hospital] North (which resulted in a citation), they refused to help me through the process and they refused to address the complaint. Midtown hasn't tried that [junk] with me--BU3 [Midtown's inpatient psychiatric unit] is a h[eck]hole, but at least they helped me have a voice in my treatment. I didn't have to climb Mt. Everest to get help.

The myth of treatment for low-income patients

When I wrote that entry, I was receiving absolutely no individual therapy and very little group therapy. Neither one should have taken 44 days to receive.

The unit I was on is now closed as part of a "community-based treatment" emphasis. This shift coincided with budget cuts to the state hospital system.

The main problem at Richmond was a lack of funding. It was everywhere one looked. The bed linen was torn and ill-fitting. A leak in the bathroom covered the floor with water and took four days to repair. The staff were often unavailable to talk to patients in crisis; reinforcements would be called from other units. Staff members often worked double shifts, leading to fatigue and resulting in agitation (I was cursed at once and overheard the f-bomb a few times). A delusional patient managed to wander off during the walk to lunch because staff didn't see her.

Now, would this happen to people with private insurance? Would this happen at the treatment centers you see advertised on the Internet? Patients with better insurance get better treatment or avoid the state hospital system altogether.

The Reality: Better Funding Equals Better Treatment

When former President George W. Bush commissioned the New Freedom Initiative, a study on the mental health system, the Commission on Mental Health identified three barriers to treatment: the stigma surrounding mental illness, "unfair treatment limitations and financial requirements placed on mental health benefits in private health insurance", and the fact that the mental health delivery system is "fragmented and in disarray." The stigma is the reason for the other two barriers.[The report is here.]

A report by the Mentor Research Institute, Community Crisis and Emergency Services: Problems and Advantages, concurs [for those of you daunted by the government report, it's basically the same thing, only stronger and a lot shorter]. However, it makes an ironic observation: "The cost and impact of limiting and denying necessary services can be as high as 30 percent of the total health care cost. There is considerable argument that the cost of limiting services exceeds the cost of the services denied in many cases."

There is no real reason, then, to deny services based on finances instead of need.

We just celebrated Independence Day. Our country talks about equal rights for all. One of those rights should be equal mental health treatment for all. We can start by demanding adequate mental health treatment for all who need it.