Mental health-care cuts cost state, city, lives

By Dwight Lewis
THE TENNESSEAN

It wasn't a sexy topic or even a sexy gathering, but the presenter had his audience's undivided attention.

"Mental illness is the second-leading cause of disability and premature mortality in the United States and is more prevalent than cancer, heart disease, asthma and diabetes,'' the man at the front of the jury assembly room at the A.A. Birch Courthouse in Nashville said Tuesday afternoon as approximately 50 people listened intently.

"Whether it's a large city or small city, you see individuals who are homeless. They are walking down the street. They are talking to themselves. We don't know what they are saying. Sometimes they look intimidating. Sometimes they look hopeless.

"We see people grabbing for things in the air that we can't see, but maybe they can see, and we are going to see an increase of that because what it represents, potentially, are people who have untreated mental illness.''

Then, suddenly, Robert J. "Bob" Benning said the smile comes naturally as he continued addressing his audience. "Mental illness and drug and alcohol disorders can be successfully treated. We know that. It is totally possible. We know that.

"We also know that you have to intervene early. The earlier the better, and it's no different than with physical illnesses. If you are diagnosed with a heart disease because you're getting some symptom and you go to the doctor immediately, the chances of you having a major heart attack really diminish.

"Same thing with mental illness, and especially a major mental illness. If the onset occurs and you get into treatment quick, the chances of your recovery, the same thing with drug and alcohol disorders, you get into recovery, there is a very good chance you will once again become a very good productive citizen. You may not ever recover from the illness, but you can be productive.

"You can lead a life like the one that you and I lead. There are people all over this state and world who can attest to that.''

Benning, who chairs the Tennessee Coalition for Mental Health and Substance Abuse Services, was making a presentation regarding the growing crisis in Tennessee for critical behavioral health services given state budget shortfalls. The focus of Tuesday's meeting was on the impact that reduced services will have at the local level.

Other meetings have been and will be held in other cities and counties across Tennessee.

"In order to help policymakers understand the cost of cutting critical mental health services, particularly to local governments, we feel that it is important to bring together all of the state and local stakeholders, so that we can work together to prevent further reductions to core behavioral health services and the impact such reduction have on our community,'' the coalition said in a release announcing Tuesday's presentation.

As a result of Tennessee's dire budget problems, Gov. Phil Bredesen is said to be looking at cutting about $900 million in spending, some of which would come from the state's payroll. Various state departments will also have to make cuts in services to help balance the state budget.

"More than ever before, this is a critical time to discuss mental health and substance abuse services and how they will operate in these challenging economic times,'' said the Tennessee Coalition for Mental Health and Substance Abuse Services, a coalition of advocate and provider organizations, family members and consumers dedicated to ensuring that behavioral health care and support services are accessible to all individuals who suffer mental health and addictive disorders, in urging people to attend the meeting.

And there was Bob Benning, continuing his PowerPoint presentation.

"Tennessee ranks 48th in the United States in per capita funding for alcohol and drug treatment services,'' he said.

Then, he added, "We should all be ashamed at that. Most of the funding comes in through federal money. That's scary. As the Tennessee Department of Mental Health and Developmental Disabilities looks where it can find more dollars to help balance the budget ... If they start looking at some of those matching dollars, we are going to look at losing more services.''

He also told those present how in 2005, Tennessee had 18.1 state-operated psychiatric beds per 100,000. In November 2008, it had dropped to 13.6 beds per 100,000, and the worse case scenario, with the proposed reductions in July, will drop the number of state-operated beds to 10.9 per 100,000.

Many will end up in jail

"Where are we going to put all the people?'' Benning asked. "A lot of people will end up in jail. That's not where they should be. Law enforcement will tell you that.''

Instead, Benning said, when individuals who have a mental illness or substance abuse problems can get medication management, individual therapy, case management the yearly cost is around $740. On the other hand, the cost of care in a regional mental health institute averages $612 per day or approximately $223,380 per year, and the cost of incarceration for a person with severe persistent mental illness in a county jail averages $15,000 per year.

"A homeless person costs us $8,000 a year, and an attempted suicide costs us $10,000 per attempt. I'm not here to say the world is going to change, but here to say that we know certain things will happen. We know there will be an increase in suicides (with the reduction in services). We know there will be increased incarcerations. We know there will be increased admissions to hospital emergency rooms. And we also know that homelessness will increase substantially.''

Then, before he finished speaking, Benning told his audience, "If we can't get our arms around this, it will get worse.''

Judge Dan Eisenstein, who runs the Davidson County Mental Health Court, was present at Tuesday's meeting and knows firsthand what Benning was talking about.

"When I first took office, I served about 50 actual cases,'' he said. "Now, it's up to 150-200. These are people who have been convicted of misdemeanors and under supervision or probation. We try to keep them out of jail.

"And for many of them we have to find them a place to live, some type of treatment. Most of them have no place to live when they come to us, so we use halfway house, any place you can find for them to live.''

Eisenstein said when things start to fall apart for people with a mental illness or substance abuse, they often stop taking their medication and some end up in trouble.

"We can't stand any further cuts in mental health and substance abuse services,'' he said. "If they take place, it's going to be a dramatic increase in incarceration.''

Additional Facts
MENTAL ILLNESS: THE FACTS
? One in four adults have a mental illness or substance abuse disorder.
? One in 17 has a serious lifetime disorder such as schizophrenia, depression
or bipolar disorder.
? People with severe and persistent mental illness die 25 years younger.
? Mental illness is the
second leading cause of
disability.
? One-third of homeless individuals have a severe and persistent mental illness.