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The mental health cost shift

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Illinois

Data WBEZ obtained from the the state show startling increases in Chicago. From 2009 to 2013, 37 percent more patients were discharged from emergency rooms for psychiatric treatment. The biggest jump came in 2012, the same year the city closed half of its mental health clinics. […]

[Sheri Richardt, the manager of Crisis and Behavioral Health at Advocate Illinois Masonic Medical Center] saw the same patients rotate in again and again. So she pulled one patient’s files and found that woman had visited the Illinois Masonic Emergency Room 750 times over the course of about 10 years.

Richardt said the patient was picked up by an ambulance or police officer almost daily. Sometimes the emergency department would discharge her, only to have her appear back a few hours later.

“The cost of that for us was two and a half million dollars. Medicaid dollars,” said Richardt. “And that’s only at our hospital. This an individual who went between multiple hospitals and so we don’t have the true cost.”

And it’s not just emergency rooms. Perhaps the largest mental illness residential center in the state is Cook County Jail.

posted by Rich Miller
Friday, Apr 17, 15 @ 11:29 am

Comments

Were the clinics and state mental health centers “wasteful spending”?
Those folks who claim our budget problems result from “wasteful spending” need to identify precisely what they mean by “wasteful”.

Comment by truthteller Friday, Apr 17, 15 @ 11:39 am
Totally agree that spending money on prevention and early treatments are WAY more beneficial than dealing with the more costly results later on. When is Brucie gonna realize this??

Comment by Big Joe Friday, Apr 17, 15 @ 11:39 am
Not just Chicago. The recently-retired sheriff of McLean County says his county jail is the largest mental health center in that area.

Comment by Mister Whipple Friday, Apr 17, 15 @ 11:41 am
How many of these patients were homeless, I wonder. In some cities, the focus has been on getting patients who are homeless into stable, permanent housing first, thus reducing the need for emergency room care.

Comment by Cassandra Friday, Apr 17, 15 @ 11:48 am
Illinois Department of Corrections has a lot of mental health facilities. Once they are moved on from the county jails.

Comment by anon Friday, Apr 17, 15 @ 11:50 am
Pay some to keep people in community settings with supports for medication compliance or pay a lot more for them at the emergency room and in jails and prison.

You can make a good decision or a bad one. So far, it’s been the bad one.

Comment by Aldyth Friday, Apr 17, 15 @ 11:52 am
“Perhaps the largest mental illness residential center in the state is Cook County Jail”

Absolutely. Sheriff Dart has been saying this for years.

Comment by Politix Friday, Apr 17, 15 @ 11:56 am
With out the community support things just got a lot worse. The Gov does not believe in community supports. Grow in Illinois has been here since 1983 and we got a letter. He needs to rethink, what he see’s as essential the hospitals cannot handle the over load now. What do you think it is going to look like in a month.

Comment by bird Friday, Apr 17, 15 @ 12:02 pm
A better debate than “essential or non-essential” would be cost-effectiveness of state programs. How much money does funding mental health services save when you look at emergency room visits, cost of incarceration, and tax revenue lost because many of the people not getting proper treatment and supports are not able to work.

No way every social program is a money-maker for the state. Even with early intervention helping schools need to spend less on special education for some kids with autism and adult services helping people with autism to earn wages and lessen the need for benefits, the math won’t come out on the positive side.

I doubt math works out for that $100 million in business incentives for already-here, already-profitable companies either.

Personally, I’m a big fan of improving the quality of peoples’ lives, but I’d be willing to have that debate in context of financial return on investment, assuming non-imaginary numbers are used.

Comment by Earnest Friday, Apr 17, 15 @ 12:04 pm
Cook county would probably save money if they re-opened and operated the city mental health clinics Rahm shutdown. Cheaper to treat mental health patients in the clinics than in the jail.

Comment by Frank Friday, Apr 17, 15 @ 12:06 pm
BR: Let them pull themselves up by their own straitjacket straps.

Comment by anon Friday, Apr 17, 15 @ 12:18 pm
Actually, Cook County Jail is now the largest mental healthcare provider in the country.

https://news.vice.com/article/meet-cook-county-sheriff-tom-dart-the-man-who-runs-americas-largest-mental-healthcare-provider

Comment by And I Approved This Message Friday, Apr 17, 15 @ 12:22 pm
If I remember correctly, we need changes in law to permit restraining the mentally ill. The current rules result in people wandering around off their meds.

Then we need to fund the mental health system. It may be self funding when offset by fewer people in prison and fewer ER visits. But don’t assume it is immediately self funding. Transitions take time and money.

Comment by Last Bull Moose Friday, Apr 17, 15 @ 12:27 pm
Rauner fails to understand, state services are not there to make a profit, they are there to provide needed services. Closing down critical services is not sensible. The cost shows up elsewhere.

Comment by DuPage Friday, Apr 17, 15 @ 12:31 pm
Unless we have real revenue reform and make our taxes match up to a modern society and service economy we will continue to make cuts to things like mental health, autism and homeless youth which will all result in higher costs to tax payers and lower quality of life for everyone.

Comment by independent Friday, Apr 17, 15 @ 12:38 pm
Compelling the mentally ill to take their medications has been a very hot debate for decades - at least since the days of “One Flew Over the Cuckoo Nest”. You can have all the MHCs you want but if the folks to be served won’t take the Rx that will keep them out of the hospitals or jails you are just spinning your wheels. The cost is just shunted around - each entity can then claim they are the victim or the solution, as the need requires. I’m not necessarily advocating for forced treatment - I am describing what I have seen for the past 25 years in the field. There are no savings to be had here, IMO, no matter what route is taken. Which one do you think is best? Bow to the civil rights of those who don’t want to be medicated - only to see them throng on Lower Wacker Drive? Or a return to lifetime commitments to state hospitals? Or somewhere in between. No easy choices here.

Comment by dupage dan Friday, Apr 17, 15 @ 12:40 pm
I wish this blog had a “like” button….I would have “liked” the comment by anon @ 12:18 pm:

Comment by Outsider Friday, Apr 17, 15 @ 12:42 pm
He cut mental health and gave the money to prisons what does that tell you. It tells me that he will warehouse people I do not think he quite gets it. That is not free.

Comment by bird Friday, Apr 17, 15 @ 12:43 pm
The reason mentally ill people do not take the meds is because that is a short term treatment no med. works forever. The community supports helps people regain there mental health with out them you have revolving door. Our community supports have been cut for years and there are no state hospitals to put people in. Short term units are almost a thing of the past and medicaid has no problem denying people. So please don’t think that community supports do not save this state a lot of money.Just wait you are about to see a land slide of people in the emergency rooms this could be clif that sends this state in bankruptcy.

Comment by bird Friday, Apr 17, 15 @ 12:53 pm
Sorry, Dan, there IS one easy choice:

Actually get humane and available care - including necessary community supports - to every last person who wants and needs it.

Then we’ll be able to see who’s refusing and why and work on the next step.

No need to get worked up into a lather about whether or not to “bow to the civil rights” of our mentally ill fellow citizens.

Those rights are real.

So are our obligations.

We’re not doing our part - why should they?

Comment by crazybleedingheart Friday, Apr 17, 15 @ 12:55 pm
@dupage dan,

Very well stated. And that is what is so frustrating about this for both the individuals affected and society as a whole. One can be dismissive of this situation ‘let them eat cake’ or be simplistic and talk about ‘just get them the care they need’ but you have outlined the situation in a much more realistic, 9and yes unfortunate) manner.

“There are no savings to be had here, IMO, no matter what route is taken. Which one do you think is best? Bow to the civil rights of those who don’t want to be medicated - only to see them throng on Lower Wacker Drive? Or a return to lifetime commitments to state hospitals? Or somewhere in between. No easy choices here.”

Comment by Federalist Friday, Apr 17, 15 @ 1:05 pm
Peoria too.

Peoria County Sheriff Mike McCoy estimates 90 percent of inmates at Peoria County Jail need mental health services, the majority for depression.

Comment by vinron Friday, Apr 17, 15 @ 1:09 pm
==No way every social program is a money-maker for the state.==

I wasn’t aware social programs were supposed to be money makers.

Comment by Demoralized Friday, Apr 17, 15 @ 1:11 pm
As we continue to house the emotionally disabled in jails, the message seems to be that we a lot more jail beds and facilities than we have today.
What do you bet we began outsourcing jail job functions? Or selling the jails so that some rich person can buy them and make a ton of money off that state.

Comment by Belle Friday, Apr 17, 15 @ 1:15 pm
Demoralized, I don’t think social programs need to be money makers. I just meant that, for people not interested in the state not helping people because it’s the right thing to do, I think it would be worth it for them to look at social programs solely from a financial merit perspective. I think it would be more likely to change their views than the positive impact on human lives, which is a sad thing from my perspective, but gotta work towards common ground somewhere.

Dupage Dan, I disagree with the assumption that the majority of people who are not complying with treatment are doing so willfully. I see a great many people who don’t have the organizational skills to keep appointments or have such disruptive living conditions they can’t hang onto their meds or get help to fill prescriptions when they run out or need something different. Giving these people appropriate services would have an enormous impact and we would not have to take away their rights.

Comment by Earnest Friday, Apr 17, 15 @ 1:39 pm
Never fear, with the medicaid cuts the hospital er will close down too. Problem solved.

Comment by Ghost Friday, Apr 17, 15 @ 1:40 pm
Lets be clear about one part of the comment thread.
Study after study shows that the compliance rate for medications is around 50%. This is true of meds for mental health, cancer, flu, pain, heart ailments, diabetes you name it. There is no one reason why people don’t take their meds. But it sure would be helpful if people took what the doctor prescribes and then check back in to report the results.

Comment by Peters Post Friday, Apr 17, 15 @ 1:45 pm
Yes it would be good if they could get the meds get into a doctor and not have a wait list that takes months to get a script. What an ideal world.

Comment by bird Friday, Apr 17, 15 @ 2:18 pm
cbh - “We’re not doing our part - why should they?”

This is not a population you can move about at will. The effects of mental illnesses coupled with years of medication regimens take their toll. Many folks with chronic severe mental illnesses are simply no longer mentally competent to make their own decisions yet are still able to do so because of the way the Mental Health Code and the Probate Act are involved. I have 25 years in this field. I am not omniscient but I have been around this issue for awhile. I also have family who have these challenges (who doesn’t). I am not unmindful of our human responsibilities in this area but realities exist in spite of our intentions.

Comment by dupage dan Friday, Apr 17, 15 @ 4:01 pm
Imagine, Peters Post, that you would be taking a medication for a diagnosis that you perhaps don’t agree with many times a day. A medication that indicates someone else thinks you are insane.

It is simply different from a person who fails to take a blood pressure medication. The results of those failures can be catastrophic for both. But society doesn’t think you are nuts if you have a diagnosis of hypertension. And folks are more stereotypically rational under the effects of such a condition.

Comment by dupage dan Friday, Apr 17, 15 @ 4:05 pm
Earnest - there are issues at the edges that can be nibbled at. To much positive effect. Nonetheless, the high cost of such services that can have such a positive effect on the lives of folks with a mental illness diagnosis simply can’t be ignored.

Comment by dupage dan Friday, Apr 17, 15 @ 4:08 pm
@Dugpage dan,

I too am aware of mental illness up close and personal in ways I do not share to discuss online.

It is tragic for everyone involved.

And having been and still are involved with this issue, I want you to know that your common sense will annoy many.

Comment by Federalist Friday, Apr 17, 15 @ 4:28 pm
I would like the State to create cross-department case managers to work with people who are high users of services. People with mental health issues,drug abuse problems, and children can use coordinated help. Start with 500 to 1000 high service users and see what can be done. That might indicate laws need to be changed.

Comment by Last Bull Moose Friday, Apr 17, 15 @ 5:26 pm
The program the state piloted last year that I have been working in addresses specifically high service users to the ER, provides crisis assessments, outreach, discharge planning and housing- so people will be linked with appropriate levels of service and kept out of nursing home care- which is extremely expensive. The 90 day outreach part of a five part program was eliminated as non-essential in the Good Friday massacre. And the whole program has been zeroed out for FY 16. Again- spending on mental health as long as they are listed as GRF grants- are the first to be cut and identified as non-essential.

Comment by carbaby Friday, Apr 17, 15 @ 6:31 pm