Witch Hunting

The Minneapolis Star Tribune reported on 9/7/08 that the cost of health care for people in jail (the article focused on Henn.Co, but included references to other Minnesota jails experiencing similar problems) is way up, driven by the demand for mental health care. The head nurse says the "mental health system is breaking down."

"IS breaking down"? Doesn't that imply that the health care system has been working and is only recently beginning to not work? The health care system has been broken down.

• Hospital capacity has been shrinking by 10% every year since 1980
• Shelters have been turned into psych wards
• According to Minneapolis Police Chief Olson, 40% of their calls were related to some sort of mental illness but hospitals are full so the only place for them to go is to jail.

Does that sound like a broken down system? It has not worked.

Most cops, though well-intentioned, have had only a few hours of sensitivity training, but they aren't mental health professionals and can't dispense meds - the only tool they have is to haul the preson to jail. This doesn't solve anyone's problems, least of all the person suffering from mental illness.

I would like to think that our society has progressed since the days of witch hunts but from the looks of it, we really haven't.

Health Care Form - getting worse

Remember Al? Remember how I was optimistic about him getting dis-enrolled out of "GreenCare"? I was wrong to be that optimistic. Al, a Tasks client, is now caught in the dysfunctional managed care plan which will not provide him the medical care he desperately needs...


Al has a bright and experienced Tasks Unlimited Case Manager, Peg (not real name), who is now advocating for him full time. Since her involvement, I thought that she could help spring him from the clutches of "GreenCare" on Aug. 1, 2008. But I was wrong; I underestimated how difficult it would be. Turns out that it is easier for a court-committed patient to escape from Anoka State Hospital than to dis-enroll from managed care.

• In early July 2008, Al's Case Manager, Peg, had him send his GreenCare Coordinator the dis-enrollment form. But Peg was informed that it was the wrong form.
• Peg requested that the correct form be mailed to her, but the Coordinator didn't have the correct form and referred her to someone else
• The other person didn't have the correct form either.
• This went back and form several times, until it was determined that the correct forms didn't exist. A letter would be sufficient, but it had to be sent to someone else at GreenCare.
• Peg sent the letter as directed, but that didn't work either. The recipient suggested sending the letter to "someone at the State," but she wasn't sure who.
  

Meanwhile, July has ended and August has begun. As I write, Al is still enrolled in GreenCare and is still without the medical services he needs, and still ineligible for M.A. because the funds the government would otherwise use to pay for his health care are still going to GreenCare. Peg will continue to advocate on Al's behalf; maybe Al can get his health care restored in September but I'm now cautiously optimistic.

My theory? There are no procedures for dis-enrollment. During the planning stages of privatization, I (and others) asked about dis-enrollment and were repeatedly told that anyone could dis-enroll at any time, and they continue to insist that this is true. No one at GreenCare, or at any other insurance companies, bothered to come up with a dis-enrollment process. They don't even have the forms!

To the insurance companies I ask you this: If you can't take care of one person, how do you propose you will take care of everyone on M.A.? I want them to explain to Al why he can't get his post-operation check-ups and why all the promises they made don't apply to him.

Cycle of Criminalization

Our society tends toward confusion regarding the needs of people with mental illness; unnecessarily, because it isn’t really so complicated. Even those with serious mental illnesses, like schizophrenia, want, first and foremost, to be normal. They want a good job, a comfortable home, and friends – they want what you want.

Unfortunately, the good job has become almost unattainable, not only because of the very real disability, but also because of numerous barriers our society has created, including the stigma created by Hollywood and a system of financial dis-incentives which penalize a person for entering the work force. Punishing and locking up those with mental illness is not a new idea. .But the most pernicious barrier is the criminalization of mental illness.

We like to imagine that we provide “community treatment” in lieu of hospitalization, and for a small percentage, effective community treatment is a fortunate reality. But has anyone noticed that as the hospital population shrinks, the prison population grows? Does anyone seriously think that’s a coincidence? The National Alliance on Mental Illness (NAMI) reports that, on any given day, there are four times as many people with mental illness in jails and prisons than in hospitals and one in seven inmates in U.S. prisons and jails has a mental illness.

How did they get there? Well, if you call 911 to report a friend or relative experiencing a psychiatric crisis, they don’t send a social worker, they send a cop. It has been explained to me that sending a social worker would be prohibitively expensive. Odd, considering that cops earn more per-hour than social workers. It has also been explained that it would be much too complicated to determine when to dispatch a social worker versus a cop. Odd, considering that when my power goes out, they never send a plumber.

Minneapolis’s Chief of Police brags that 15 percent of his force have had a full week of mental health training. Is that adequate since they report that 40 percent of the calls involve mental illness. And even if a cop has sufficient training to distinguish a mental health crisis from criminal intent, where will he/she take the person? (Hint: the hospitals are always full.)

About 50 years ago, we realized that asylums were a flawed (and expensive) approach, and started closing them. Today, there is less than one-tenth the number of psychiatric hospital beds per-capita than 50 years ago. Does anyone think we have less mental illness? Mental illness, in fact, is on the rise. And yet, resources have decreased. In Minnesota, people who need psychiatric hospitalization are routinely turned away for lack of space.

I know that some will argue that America doesn’t put people in prison unless they actually commit a crime. Okay let’s go with that. But imagine that you were homeless, unemployed, friendless, confused and scared, so you sought help at your local hospital, only to be turned away because your condition didn’t seem as severe as that of others in the waiting room. After a few years, do you think you might commit a crime?

If it were me, and I am thinking fairly straight, I would try for a “victimless” crime – hmmm, I don’t have $4300, so I guess Spitzer’s friend is out. Maybe I could jaywalk or something. But here is a surprising fact: most people experiencing a mental health crisis are not thinking real straight. So they steal food, or they buy drugs, or they scream and holler, or they drive their car into bridge abutments. Whatever it takes…

So now that gaining admittance into any form of health-care facility has become increasingly difficult, and acquiring a criminal record has become increasingly easy, and a criminal record of any kind prevents one from obtaining employment, the circle is complete. If you have schizophrenia, we’re never going to let you have a job. I wonder if that will help with your mental illness?

So, we find ourselves in a peculiar predicament. Mental illnesses are on the rise in our country and adequate resources are diminishing so those who have mental illness can only access varying types of help if they commit crimes. Does that make any sense? There has to be a better way to help those suffering from these very real diseases. There has to be a better way to break this cycle of criminalization and give them the treatment that works so that they can have what all of want: a good job, a comfortable home, and friends.

Introduction

It seems appropriate that I would introduce myself...this being my very first blog. I am John Trepp. I'm still not quite sure what it means to blog. I think it's where I can call bullshit, bullshit.

I have worked for Tasks Unlimited for the last 30 years. Tasks is a non-profit based in Minneapolis serving adults with mental illness. We follow the Fairweather Model which creates an environment where people with schizophrenia and bi-polar disorders can manage their illnesses and lead productive, “normal” lives. I am constantly amazed by the accomplishments of Tasks clients – people who have been told they can’t work or lead normal lives because of their illness, but do so anyway.

Along the way, I have been involved in The Barbara Schneider Foundation, the Coalition for Community Living, the Minnesota Association of Community Rehabilitation Organizations, the Minnesota Extended Employment Advisory Committee, the Hennepin County Mental Health Advisory Committee, the Task Force for Redesign of the Civilian Review Authority, and other related activities. I also wrote a collection of short stories, Lodge Magic, and a stage play (a dark comedy) by the same name, which was a big hit at the Minnesota Fringe Festival.

Through my years, I have found our public mental health care system dysfunctional – mostly because it is designed to meet the needs of staff, not the needs of the service consumer, nor the interests of the general public. My hope is to influence and empower those interested in mental health care to make real change. My passion is to see those with mental illness find what they want most in life, a good job, a nice place to live, and meaningful relationships. My dream is a system which is accountable to those served and those who pay for it.