May 9, 2019
By Mark Flatten
When a person with
severe mental illness has a psychological meltdown, what comes next is
predictable—and often tragic.
Maybe the person will
commit some minor crime like disturbing the peace or trespassing, though
usually not. Maybe his bizarre behavior is enough to attract the attention of a
passerby, or to prompt a family member to call for help. Eventually, a police
officer will show up. Next will come time spent handcuffed in the back of a
patrol car, and then a booking into the local jail.
But the trouble will
not end there. A severe shortage of inpatient mental health hospitals means the
person who needs psychiatric treatment will instead sit in jail, usually
untreated, waiting for a spot at an appropriate treatment center to open. That
might take hours, days, or weeks. Then will come the long drive to some
far-flung hospital, riding with one or two sheriff’s deputies who were taken
off their beats to transport the patient to the psychiatric hospital hours away—sometimes
on the other side of the state, because that is the only facility willing and
able to take the new patient.
At each step, the hidden
costs in time and money add up. Dealing with and transporting people with mental
illness accounts for about 21 percent of the average police officer’s time and
consumes about 10 percent of the average police department’s budget, according
to a new study
from the Treatment Advocacy Center (TAC) in partnership with the National
Sheriffs’ Association.
The problem is made
worse by a severe shortage of inpatient psychiatric facilities, where patients
can be held in a therapeutic setting, receive treatment, and have their
medications adjusted. Because of the lack of inpatient beds, people with severe
mental health issues typically end up in jail, waiting days or weeks until a
coveted bed in a psychiatric hospital opens. When a bed does become available,
it falls on police to transport the patients to distant hospitals that are
typically hours away.
The TAC report echoes
the findings of a Goldwater Institute investigation, published last year,
documenting how the shortage of psychiatric treatment centers is driven in part
by anti-competitive laws that block private companies from using their own
money to build badly needed mental health facilities, all to protect existing
healthcare companies from competition.
In its report, CON
Job: Certificate of Need Laws Used to Delay, Deny Expansion of Mental Health
Options, the Goldwater Institute focused on the efforts of different
companies to build new mental health facilities in Iowa, Oregon, and Tennessee,
all using their own money without any subsidies or tax breaks from the
government. But in each case, existing providers used certificate of need laws
to block or substantially delay the state’s approval.
Though they vary, certificate
of need laws in
38 states require government approval before a new healthcare facility can
be built, even with private money. Initially passed in the 1970s, they have
failed in their stated goal of saving money by preventing overcapacity in the
healthcare industry. Instead, they are used primarily by existing providers to
block competitors from encroaching on their markets, according to a series of
reports and letters from the U.S. Department of Justice and Federal Trade
Commission dating back more than 15 years.
CON Job described many of the consequences that the new TAC report
quantified with survey data from police agencies nationwide. Focused primarily
on a proposal in eastern Iowa, where a private company sought to build a 72-bed
inpatient hospital, the investigative report cited the same consequences:
sheriffs’ deputies spending entire shifts transporting mental health patients
to far-away hospitals willing and able to admit them; emergency rooms crowded
with disruptive mental patients they are ill-equipped to handle; judges holding
people who need psychiatric care in jail on minor charges because they are too
dangerous to release and there is no place else for them to go.
While the TAC report
does not address certificate of need laws, it did conclude that “the most
prominent theme emerging from the survey is that the psychiatric bed supply for
people with severe mental illness is extremely limited.”
“Faced with limited
community treatment options and a dire shortage of psychiatric inpatient beds,
those in need of mental health treatment may not receive it until a crisis
occurs and law enforcement intervenes,” the TAC report says. “Law enforcement
officers are thus often on the front lines of psychiatric care, charged with
responding to, handling and even preventing mental illness crisis situations.
The predictable results have been criminalization of severe mental illness and
extreme overrepresentation of people with mental illness in jails and prisons.”
To read the Goldwater
Institute’s CON Job report, click
here. To read the TAC report, Road
Runners, click
here.
Mark
Flatten is the National Investigative Journalist at the Goldwater
Institute.
