How changing a federal law can repair the damage for millions of mentally ill people.
In many states the government closed the state psychiatric hospitals. In some states, they are promising to reinvest the savings that come from closing state psychiatric hospitals in community based services. In some states, this worked, In other states, the hospitals closed and the community-based services were not funded.
The psychiatric hospitals closed before the community based services were built. And the consequences were, we ended up trading real services for worthless promises. There are still over 1.000,000 individuals with who need some form of long term care. This is because they are unwi9lling to be treated, do not respond to treatment or are suffering from side effects.
There was intense pressure on states to close psychiatric hospitals due to a very important provision of Medicaid law referred to as the Institute for Mental Disease Exclusion or IMD. Individuals between 21 years old and 65 years old who live in institutions which specialize in the treatment of psychiatric disorders IMDs are excluded for Medicaid benefits.
The IMD exclusion was included in Medicaid legislation because the federal government did not want to pick up what had been a state responsibility: caring for individuals in this category. But the IMD Exclusion has had the exact opposite effect: it forces states to release people out of hospitals so the state can get reimbursed from the federal government for their care in the community.
In order for states to access the federal Medicaid funds, the individual has to reside outside the psychiatric hospital, no matter how sick or inappropriate the discharge is. We see a trend for hospitals to release individuals sicker and quicker and without appropriate access to community based care. This form of deinstitutionalization is being done for one reason.. It has nothing to do with the new treatments, or treatment in the least restrictive environment, or patient needs and wants. It is a way to turn non Medicaid eligible individuals into Medicaid eligible individuals so the state can gain access to federal dollars for their care.
Repealing the IMD exclusion will still allow the states to close hospitals and discharge individuals. And it will still allow them to invest in community-based services. But the motivation for the closures will be in the best interest of the patient and not greed among the states.
These are pictures of some of the major psychiatric hospitals that have been closed since deinstitutilization took effect. Thousands are still homeless, on the streets of the cities, or dead.
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T%hese pictures come from an informative website called Edgewood.com It has the history of the local hospitals that once help millions of people and served with pride and dignity. The loss of these hospitals is a loss to society.
