How To Fail In Government, Mental Health Edition
Back in the 1980s, Ronald Reagan drastically cut federal spending on mental health care. One of his initiatives was to discharge residents of mental health facilities who were fairly stable and whose conditions could be managed with medication. What he didn't realize was that many of those patients needed the structure and support systems provided by inpatient facilities in order to maintain their medications. Once on the outside, many of those patients slid downhill. Some forgot to take their medication. Some, as is common with the mentally ill, decided to stop taking their medication. (Sort of a microcosm of the entire Reagan mental health policy: if they seem better, then they no longer need the treatment that made them better, right?) As a result, a whole lot of relatively stable in-patients became highly unstable out-patients: many wound up homeless, developed serious physical illnesses and serious relapses of mental illnesses, used emergency rooms for primary health care, and clogged the criminal justice system. Once all the additional social program, criminal justice, and emergency room costs were factored in, the Reagan mental health system "cuts" cost the taxpayers more money than they saved.
But we all make mistakes, and we learn from them. For instance, if we decided to restructure the way that prescription drugs are paid for, we would remember what happened in the 1980s and make certain that as psychiatric patients were transitioned from one drug plan to another, their treatment wouldn't be interrupted. We'd do this because we've learned that even a few days without proper medication can cause people with mental illnesses to suffer serious relapses, requiring expensive hospitalization and other services. What's more, if we considered ourselves disciples of Ronald Reagan, we'd be especially careful to ensure that patients who were doing well with correct medication didn't wind up back in mental hospitals, because that would undo what President Reagan did. In short, we'd ensure continuity of medication care during the Medicare Drug Benefit transition. Right? If we were intelligent public servants concerned about the people's welfare? Right?
HILLIARD, Fla., Jan. 16 - On the seventh day of the new Medicare drug benefit, Stephen Starnes began hearing voices again, ominous voices, and he started to beg for the medications he had been taking for 10 years. But his pharmacy could not get approval from his Medicare drug plan, so Mr. Starnes was admitted to a hospital here for treatment of paranoid schizophrenia.
*** When [Mr. Starnes] gets his medications, he is stable. "Without them," he said, "I get aggravated at myself, I have terrible pain in my gut, I feel as if I am freezing one moment and burning up the next moment. I go haywire, and I want to hurt myself."
Mix-ups in the first weeks of the Medicare drug benefit have vexed many beneficiaries and pharmacists. Dr. Steven S. Sharfstein, president of the American Psychiatric Association, said the transition from Medicaid to Medicare had had a particularly severe impact on low-income patients with serious, persistent mental illnesses.
"Relapse, rehospitalization and disruption of essential treatment are some of the consequences," Dr. Sharfstein said.
The proper size and role of government is a legitimate ground for discussion. But big, bad government isn't acceptable. Government that fails the weakest among us -- children, the elderly, the mentally ill -- isn't acceptable. We're better than this.
Or at least, we should be.