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When my son was diagnosed with juvenile diabetes several years ago, we were immediately engulfed in a system of care that included education about the illness, instructions on how to avoid long-term complications, diet, exercise and medical treatment.
When a person has a serious, chronic illness, we expect a system of care to help manage the illness through a lifetime. But a parent who has a young adult child experiencing early symptoms of a major mental illness like schizophrenia faces a different reality.
When that parent calls my agency or other community mental health centers in Missouri and reports that her child has dropped out of college, paces the floor all night and might be hearing voices, I have to ask if the child has been declared totally and permanently disabled, and if he has been in a state hospital or been to prison. If not, I must tell that parent to call me back after one of those crises, and then we will try to get him into a system of care.
In other words, first crash and burn and then we will see what we can do to fix things. There is no other area of health care that we treat in this way. As of Dec. 1, these are the restrictions placed on our community mental health system in Missouri because of state budget cuts.
The human cost of this approach should be obvious; less obvious, perhaps, is the economic cost.
Two years ago, a group of mental health providers collaborated with staff of local hospital emergency rooms to identify people often referred to as “frequent fliers” or “high users” of emergency room and hospital services.
We started with 291 people with psychiatric diagnoses, and figured out the 50 who had the highest costs associated with their emergency room visits. What we found both was astonishing and depressing.
In fiscal year 2007, our Medicaid system spent more than $3.4 million on 50 people. What was depressing about this finding was that in spite of these enormous expenditures, these individuals were not getting any better. Their lives still were in chaos, and their physical health and their mental health were deteriorating.
We began trying to track down some of these people and found some were dead and some were in prison or nursing homes.
We got the 18 people whom we found still living in the community involved in a comprehensive treatment program called Assertive Community Treatment -- a model that addresses all of the complicated needs of people with serious mental illness and does so in a fashion that focuses on outreach and staying engaged with the person regularly. We saw lives changed dramatically, which we expected. And these changes also were reflected in the cost data.
In 2007, the cost to the state for those 18 individuals was $1.1 million. For those same people in 2009, the cost was $584,457. In other words, after just a year of community-based services, the cost of treatment was cut in half.
This information is particularly relevant now as our governor and Legislature begin a new session in which we know they are looking for ways to save money. What this data shows is very clear: Cutting community-based mental health services will cost money, not save it.
Over and above the cost savings, if you were that parent making that phone call looking for help, what would you want me to say? “Let your child become dangerously ill and go into the hospital or maybe hurt someone and go to prison and then you will be eligible for our system of care.” Or would you want me to say, “Of course we can help. There is hope, and it is good that you called now before things got worse.“
Is this really a choice?
Francie Broderick is executive director of Places for People in St. Louis.
KSDK -- Budget cuts proposed by Missouri's Governor Jay Nixon went into effect earlier this month, including budget cuts for the Department of Mental Health.
The National Alliance on Mental Illness (NAMI) St. Louis and Mental Health America of Eastern Missouri hosted a rally to protest the cuts at the Mental Health America building on Grand Friday morning (December 18, 2009).
The groups say budget restraints are keeping them from helping their clients who need it the most.
Places for People, a local organization that provides mental health services to those who are homeless or cannot afford it, say they're really feeling the cuts first hand. Now, they can no longer take on new clients and they're worried more cuts could be on the way.
"We know that they desperately need help and they're coming here asking for help," said Donnie Winget from Places for People. "And it was frustrating before that we couldn't help everyone. But now it's been limited to whom we can help so narrowly that it's just really frustrating."
Local mental health experts say during the last decade they have seen public mental health services cut significantly -- even though the numbers of people in need for those services is not declining.
On Oct. 15, 2009, Places for People (PfP) will accept a first place “2009 Lilly Reintegration Award” from The Center for Reintegration at its 13th annual awards ceremony in Indianapolis, Ind. Sponsored by Eli Lilly & Company (NYSE:LLY), the national awards program honors treatment teams, individuals, programs and services that provide assistance to people with severe mental illness.
As a first place recipient in the Housing Services category, PfP receives a $5,000 grant helping to continue its comprehensive housing support and services to people living with mental illness. Since its inception in 1972, PfP has assisted thousands of individuals with serious psychiatric disorders to live independently in the community.
“Our staff is honored by this recognition,” says PfP’s Executive Director Francie Broderick. “We hope this recognition reinforces our strong belief that housing is health care and stable, safe housing is a critical component in helping people recover from serious psychiatric disorders.”
Part of the Lilly event includes a day-long forum where Broderick and her peers share best practices and learn about public relations, fundraising, transitional employment and other related topics.
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“It is our duty to create an awareness that helps change public perception,” says Broderick. “By working together and comparing stories we can help our clients reach their fullest potential.”
Since 1997, the Lilly awards program has celebrated the achievements of people who dedicate themselves to improving the lives of individuals with serious mental illnesses, and the achievements of those living with schizophrenia or bipolar disorder that battle tremendous odds to improve their own lives and the lives of their peers.
Recently, Places for People, Inc. (PfP) accepted the first annual 2009 RESPECT Award from the National Alliance on Mental Illness St. Louis (NAMI St. Louis) for Outstanding Mental Health Agency. NAMI St. Louis developed the RESPECT Award to discourage stigma and encourage respectful treatment of people with mental illness in the community.
PfP’s Executive Director Francie Broderick and Board Member Nancy Cripe accepted the award at NAMI St. Louis’ 2009 Annual Meeting. “To be acknowledged with the inaugural RESPECT Award is a real tribute to the work we do,” says Broderick. “To be appreciated in this way by our clients and their families affirms our efforts and moves us to continue finding more ways to be welcoming, recovery-focused advocates for mental health.”
At the beginning of the summer, consumers and family members were invited to nominate an agency or an individual that provided them or their family with outstanding and respectful mental health services. NAMI St. Louis created a St. Louis Consumer Advisory Committee to create award criteria and select winners.
“This is one of the best compliments the PfP staff could receive,” says Cripe. “The client recognition shows what a positive impact the staffs’ dedication and determination can make in a client’s life.”
In the past year, PfP has provided support and services to more than 480 people in St. Louis living with serious and persistent mental illness. Client services include housing assistance, psychiatric rehabilitation, medication and financial management, community resource connection and assistance with daily living skills. Over 80 percent of PfP’s clients live in independent housing of their choice. This is one of the highest rates for any provider in Missouri.
KSDK -- The number of people with mental illnesses living in Missouri nursing homes has jumped more than 75 percent over the last few years, which raises questions about whether they're getting the help they need.
Last winter, Daniel Coleman was at the end of his rope. He was homeless, mentally ill, with no where to go.
"I went to a bus stop and I started to pray," said Coleman. "I started to pray loudly."
Francie Broderick was walking by and heard his prayers.
"She came over and tapped me on the shoulder and said come on, go with us," said Coleman.
As fate would have it, Broderick works for Places for People, an organization focused on finding safe, cost-effective housing for the mentally ill.
"Most people with mental illness can live independently and want to live independently, if the supports are available and if affordable housing is available," said Broderick.
With Broderick's help, Coleman found his own staff-supported apartment and got the help he needed. But his story is not often the norm in Missouri. There aren't enough housing resources to help the mentally ill, so that is why many ende up in nursing home.
Broderick says the patients end up feeling hopeless and trapped. Lost in the system. A spokesperson for the Missouri Department of Mental Health knows the state could do better.
"Funding is the primary problem," said Larry Fletcher, with the Department of Mental Health. "We're working on developing some things, but our options are very limited."
For now, the state is working to build more housing alternatives for people like Coleman, so they can get back on their feet. And finally feel at home.
A brainstorming session, in which local professionals from the mental health community joined Congressman Russ Carnahan and former Governor Bob Holden, discussed how to improve mental health treatment around St. Louis. For notes and highlights of the meeting, please click here.
Sunday, I made the switch. I gave up the $8 hand-held transistor radio that I carried every day on my walks through Forest Park and “upgraded” to an iPod. I had resisted my kids’ efforts for some time, but they finally convinced me it was so easy that “even you can do it.”
It is wonderful, and, better yet, it came with earphones better than the 99-cent models I’ve been using. I never have heard such sounds in my ears before. I was so energized I almost danced as I walked through the woods in the park listening to “Bruce Springsteen Live in Dublin.”
This remarkable bit of technology even was drowning out the worrying that always floods my head when I walk, thoughts of people coming to the agency where I work and us never seeming to have enough to go around.
A glimpse of blue plastic brought me back to reality. Back in the woods next to a tree I could make out a small pile of cans, a sleeping bag and a blue tarp. It was not a Boy Scout campsite.
My mind immediately began playing over the faces I had seen that morning:
Did this tiny outpost belong to the man carrying the backpack whom I saw walking out of the park earlier? Could it be John’s, the man who told me he had lived under an overpass until the U.S. Highway 40 reconstruction began? Or could it even be that lady who sleeps at the bus stop on Lindell? I had not seen her lately.
By that point, I certainly was not dancing. But then I made a conscious decision to replace these faces, just for this walk, with some of the other new faces that I have met this year, people who would be spending their first holiday season with us at Places for People.
The first who came to mind was Jonah. He is 52 years old and had spent almost all of his adult life, literally, living in his parents basement smoking cigarettes and drinking coffee. When we initially encountered him, he had no friends, no hope for something better. The day we helped him move into his own apartment he was so happy he clapped his hands. Now he comes to our club program and has friends and a job he is responsible for. He smiles.
And then there is the tall, handsome young man with piercings and markings on his face who seemed to have such a bright future as a basketball player years ago. He is well known to the police and business owners in the University City area. He has spent much of the past few years living on the street with his mental illness untreated. He bounces as he walks and talks constantly to himself, to his voices. His illness is not managed yet, but I knew we had the beginning of a lasting relationship with him yesterday when I saw him watering the plants in the reception area, his constantly moving body causing spills that he was quick to clean up.
And there is the young man who just breaks my heart when I think of him: He grew up in foster care, the early stages of his schizophrenia making him a hard child to place. After he aged out of the foster care system, he was homeless for more than a year. “It was hard,” he told me, “really hard.” He still looks lost, but now there are people joining him on his journey and too many women who want to mother him! He wants pecan pie for Thanksgiving.
The last face that comes to mind is June’s. Not a young woman, not physically healthy or strong, but what we would call “a handful” nonetheless.
She was being discharged from a short hospital stay and coming to our agency for the first time. My staff went to pick her up, and the hospital social worker asked, “Do you feel safe driving in the car with her?” An unnerving question to say the least! Over the next few weeks, she did lash out physically and verbally several times, and I was starting to think we had met our match.
Then, somehow, the magic of never giving up and the power of community won her over. Last week, when she was being verbally abusive to other clients in our clubhouse, one of my staff said to her, “If you can't stop that, I will have to come over there and hug and kiss you into happiness.” She said, “All right,” and smiled.
As 2009 looms with predictions of cuts in our state funding, of foundations cutting back on their giving, of more people losing jobs, health care and housing, Bruce Springsteen is singing in my ears “Keep your eyes on the prize, hold on, hold on.” We will.
Francie Broderick of University City is a frequent contributor to the Commentary page. She is the director of Places for People, a nonprofit mental health center based in St. Louis..
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