At Week's End; 223; Mental Health Care Crisis, Elizabeth Merilatt: Stamp Out the Stigma of Mental Illness

Thank you. . .. .. . . . . ..

.. . . Tonight, after the recent legislative session, are we heading for a mental health crisis in New Mexico? So we're getting cut from every angle. We get cut from the state. We get cut from the federal government. And we also have expenses where as salaries need to be increased in order to retain and recouped our professionals, this squeeze is coming from every angle. What can we do for those afflicted with mental illness? If you and I wanted a place to live, we have a choice. If you and I were mentally ill, released from Las Vegas, we wouldn't have a choice. It'd be the streets, it'd be family, or it'd be a vacant bed where someone could find a force. That's not really a choice, and yet we're expected to get better. And Elizabeth Merlett comments on the public's perception of schizophrenia. It's a friendia, it's misunderstood, because we have become so adept at hiding it.

Good evening, I'm Neil Boggs at week's end. $30 million a considerable sum by anyone's scale, until you consider what it represents, the entire outlay voted by the recent legislature for New Mexico's mental health needs for the coming year. $30 million out of a total state budget of $1.7 billion. For mental health, less than half of what Albuquerque will spend for a performing arts center. Why so little for mental health, and is New Mexico really serious about improving the situation? Just two other questions will examine tonight as we look at an approaching mental health crisis in New Mexico. The Las Vegas Medical Center, New Mexico's only state hospital for the mentally ill.

Although once notorious for the poor quality of care administered to its patients, that's no longer the case. At great expense, the hospital is now nationally accredited, and provide services to about 1,000 patients per year. Two-thirds of the state's mental health care budget go to fund the state hospital, and this year the legislature increased its appropriation by $400,000 to increase the number of psychiatric beds. But the state hospital is only one part of New Mexico's mental health care system. 32 community mental health care centers provide regional care. Yet receive only a third of the state's total mental health care budget, and this year receive no increases in state appropriations. The University of New Mexico Mental Health Center, which accounted for more than 10,000 patient visits last year, has received no increase in state funding for more than three years. According to Juan V. Hill, the center's deputy director.

We're getting cut from every angle, we get cut from the state, we get cut from the federal government, and we also have expenses where as salaries need to be increased in order to retain and recruit professionals, the squeeze is coming from every angle. UNM's mental health center has had 42 adult psychiatric beds since 1969, but V. Hill says half of those may have to be cut next year if additional funding isn't forthcoming. For three years now, we have had to dip into our reserves, our fund balances in order to meet expenses. We no longer have that option, so we're basically facing some very hard choices for the 1990. Given the funding that is available for mental health care system, you're going to have a very disruptive service. You're going to have a service that you may have persons coming to the state hospital, and at its best, for example, will receive a level of service care. Unfortunately, then this person is returned to a community, whatever a community may be.

And then maybe that in that community, there is not a proper housing. There's not a appropriate follow-up service care. There is not case management and service system. There is no provision for medication maintenance program. So at its best, it's pragmatized. At its best, then it has difficulties in punishment. It is a system which many in the state's mental health field say is fragmented. Alone state hospital and the numerous mental health care providers, contracting with the state health and environment department, all competing for the same slim dollar. It's a system which the governor's mental health advisory council reports is in need of change. The total funding for mental health care service needs to be seen as an integrated system. You cannot use an institutional system, for example, a state hospital, and use that. But at the same time, you must have also community support service programs, community mental health centers,

residential facilities, job training programs, case management service program that are community-based. We must have that. One cannot exist without the other, nor we can develop one at the expense of the other. It is very expensive to provide the type of service that we provide. And the budgets aren't there. I mean, we don't have the money to do it. And my premise is that unless a state legislature and the governor address the revenue issue, because that's always where we come, that we cannot spend more money than we earn, it's always going to be a problem. With us this evening, our Beverly Jefferson Director of the State Health and Environment Department's behavioral health services, and Dr. Walter W. Winslow, Chairman of the UNM School of Medicine's psychiatry department. Thank you for being with us.

And first question to you, Dr. Winslow, will you give us an assessment of the state's mental health care services? Well, my view is that the state is deficient in mental health services in almost every area. This is probably not the fault of any one individual or one group, but it is the really development over the last 20 years of an attempt to develop a comprehensive mental health system within adequate funding. During the 1970s, great progress was made in putting together and in place an adequate system. It didn't quite make it. And then in the 80s, when funding became more scarce, this really has been sort of put on hold, and we're kind of been coasting for the last, I'd say, six, seven years. I think it's time now that we begin to push like we did in the 70s to put together the system that does now. It's quite fragmented.

And in many areas it is diminishing. The services are decreasing, not increasing. Ms. Jamerson, what we've heard, isn't encouraging. From your point of view are the reasons for optimism, are there any indicators of a turnaround coming? I would certainly hope so. I would say the primary reasons for optimism right now are the fact that people are paying attention to the needs of the mentally ill in the state. They're paying much more attention. There are more people who are interested in and working to develop programs that are appropriate at the community level to educate legislators, to educate the public. And I feel like we have a groundswell started that needs to continue. You see people are paying attention, but as the legislature paying attention, the governor's mental health advisory committee has recommended more community-based programs. Yet this year, the only additional funding from the legislature was that extra money that went to Las Vegas Hospital. Isn't that going just the opposite direction from the recommendation?

I must say, we all cried a lot over that. There is no question, as Dr. Winslow alluded to, we need services throughout the state. We need all types of services. We're deficient in all of those that we do have, and there are many that do not exist at all. That was the main reason that the issue of the pilot projects was pushed during the legislature. It was ultimately lost. It was lost, yes. No funding whatsoever for it. Dr. Winslow, nobody that I've heard of has disputed Las Vegas' need for additional funding, but there was nothing additional for your own mental health program over at the UNM Mental Health Center. What will be the effect there? First, let me say that I feel that the state hospital needs to add extra money and more. The state hospital is a place where we have to send our friends and relatives when they become ill and need that kind of care. The services in the past many years have been inadequate.

For the first time that I can remember, and I've been here almost 25 years, the state hospital is now beginning to provide very qualified competent services. So I don't be glad to them the 400,000. I think that's appropriate. However, it is disconcerting and disappointing that there couldn't have been a few hundred thousand for the community programs as well. We lobbied for that. We tried to get that, but for some reason we did not. Public attitudes, public perceptions, part of the problem we'll be talking about that later. Over at UNM, the lack of additional funding there, could that mean a hypothesis? Could that mean that not having that many means that people will ultimately end up with Las Vegas that could have been cared for here in Albuquerque? It could happen. It probably will happen. If we get the same funding we got last year, and there's no evidence at the moment that we will get more, although we haven't gone into the negotiation period yet, with the Department of Health and Environment.

So I can't be sure what's going to happen because we only have a process of bidding and negotiating. It's spending less ultimately becomes a question of costing more in the long run. Is that right, Ms. Jefferson? If Las Vegas becomes more overloaded because of the lack of funding to treat people at the UNM Center, wouldn't that be a costly proposal? It is always more costly to serve people on an inpatient basis, and frankly if Las Vegas were to become overloaded, we would risk jeopardizing the JCHO accreditation, which would be very costly to this state in terms of the quality of care that isn't currently delivered at Las Vegas. One of the findings of the Advisory Committee in a complaint that has been voiced by mental health care providers is that the system is so fragmented. Can you explain that? Certainly. The system, excuse me, within New Mexico, is set up with one state hospital only, and 35 contracted providers throughout the state who are delivering services for which the state pays a set price. That price does not cover the cost of the services. There is not the tight linkage between those community providers in the hospital that would need to be there to assure that persons who do need inpatient care are well provided for when they are released from the hospital, or that the proper diversions are taking place within the community.

Most specifically, our children's services are appalling in the state. There is one children's psychiatric unit at UNM. There is one adolescent unit at the hospital. We have a few private facilities, but as far as community-based services for children, they're very lacking in this state. Do you, Dr. Winslow, see fragmentation as a problem too, too much competition for too few dollars? I don't think that's the fragmentation. I think the fragmentation at their gaps in services that aren't, that nobody does. It isn't that too many of us are doing too many things in competing. For example, residential services, places where the mentally ill can go and live if they don't have an apartment or a family to live with when they get well enough to be able to live. Those are deficient in all communities, and there's a little competition. We could have a seven or eight, ten in Albuquerque. We've got one, two.

The lack of an environment in which to make an effective recovery, then that would be part of it. That's a very important gap in the services, and I think Beverly would agree on that. Something we've been working toward, made some progress, but not nearly enough. Something we're going to address in the second part of this program, too, let's go back to public attitudes, and funding. There's not more money because the legislature didn't vote the money, but is that because the public didn't press as it should have for the money? They didn't have the awareness, Dr. Winslow? Well, it's pretty hard for me to say what's in the minds of the public. The legislature generally responds, though, to the electorate. They do. And it's obvious that lobbyists or the interest groups, other than mental health, were stronger and more persuasive than we were. And I think we got to overcome that. We've got to make our voice louder and clearer, but that takes a lot of time. Ms. Jimerson, about 30 seconds we have remaining, you're going to have to face the same uphill battle again next year. How hard will the push be then? How can you rally the public behind you to convince the legislature?

I think the public is beginning to rally, as I said earlier. We're not going to give up. We believe very strongly that community programs are the way to go and the way for New Mexico. Ms. Jimerson, Dr. Winslow, will continue the discussion a little bit later, but let's turn now to another aspect of the story. How well the system works or does not work as one matter, but let's not overlook the people that the system is meant to serve. How do the state's shortcomings in help for the mentally ill affect them, particularly that lack of community-based support efforts? If the supports are in the community, the types of supports that would allow an individual to live a better life, improve their quality of life, if they can get help in finding a place to live. Not in receiving those benefits from various entitlement programs and learning how to use the system. And that's used in the sense of obtaining benefits they deserve and being able to develop the skills that allow them to live independently.

I feel that with the appropriate resources and supports, they can move into an apartment of their own choosing and live a much better life than they do now. Without the supports in the community, there is no option. Two years ago, an individual that was discharged and released to Albuquerque didn't have a program where they could go on a daily basis and interact with other individuals trying to develop some social support systems. Several years ago, there wasn't a program in existence that focused on rehabilitation much more than just medication maintenance. That's an existence now, and that's with Brock, the Recreation Health and Occupational Center. This program was the inspiration of parents who saw their children ignored and mistreated by a system who mainly focused on treating individuals in a group or individual therapy style, and thereby seen them once a week or once a month, not focusing on their strengths, not realizing that John Doe may have gotten a bachelor's degree and a master's degree, and all that he needed was a little support and a little nurturance, and he might be able to get back and work part time.

Consumers of mental health services in New Mexico need several things. One is they need a system that's sensitive to their needs. They need to be empowered by the system, by other programs, by directors, by clinicians to seek their rights. They deserve to be treated in a better fashion. They deserve a greater number of services. They deserve to have choices. If you and I wanted a place to live, we have a choice. If you and I were mentally ill, released from Las Vegas, we wouldn't have a choice. It'd be the streets, it'd be family, or it'd be a vacant bed wherever someone could find it for us. That's not really a choice, and yet we're expected to get better. And all of it is attainable if we work together. If Republicans, Democrats, state bureaucrats, parents, and consumers work together and identify common goals and get beyond the rhetoric. Because we get a lot of rhetoric during election years and legislative sessions, and we hear about priorities, and, you know, damn it, it's time that the mentally ill receive what they deserve, and they deserve a lot more than they've gotten in New Mexico.

Joining us now to continue our discussion is Dr. J. Thurman, a psychiatrist who is with Presbyterian Hospital's Department of Behavioral Medicine. Dr. Thurman, we've talked about administration of mental health programs, about budgets, about bureaucracies. Let's bring it down now to the human level. What does a patient need to reenter and remain in society? Yes, a lot of people that have long-term mental illness schizophrenia in particular. What their main need is not more doctors necessarily, not more hospital beds, not more medicines, but sort of a stable environment to be able to go home to. For many of these people, they're living in home with their families. They're in their 20s and 30s years of age, and they've literally turned their houses into hospitals. The environment is not very good for the patient or the family.

Dr. Winslow, an ideal system to carry out what Dr. Thurman has just described, what would it be? Well, you really need the whole continuum from inpatient care, 24-hour services to outpatient care, residential care, case management, etc. The thing which we really miss in Albuquerque is a place for the patient to go that graduates him back into the community at a slow pace. So they can go to a perhaps a transitional place where they can stay for a few weeks, and then when they get settled down a little more with a little support, start to get some roots into the community can move into perhaps independent living, where they have good case management, good medical psychiatric services, good social services, so that they can remain in the community for long periods of time. The problem now is that we get them into the community because we have to, so we push them in too fast, they get under too much stress. They're not monitored carefully enough, helped carefully enough, and they relapse and we get them back into the institutions.

Ms. Jimerson, as the program is being funded now working with what you're given to work with, can this come about in New Mexico anytime soon? It will be very difficult without new monies, as we discussed earlier, there are services that are totally lacking out there, and it becomes a matter of either taking monies from services that are currently meeting needs in order to develop new services or finding new monies. Where do you see the money coming from? That's a very good question. At this point in time we are hustling from the state level, every grant, every federal dollar we can find. We are looking for ways to maximize the resources that are so scarce, and again we will approach the legislature again for more monies, more state funds. Do we see, don't we see, rather, patients cut up in a kind of a cycle the way it is now in and out, in and out? What impact does it have on them? Dr. Fuhrman?

Well, I mean, that's this so-called revolving door, that we get people fairly well. The day they leave the hospital, they go into the community, most of them stop their medicine, they don't come in for follow-up, there's no system to go to their homes and to bring them in or do something to get follow-up care. So, it just creates this continuing revolving door. And a greater cost that would further dilute the amount of money available, Dr. Winslow, any thought you can add on that? Well, that's true. We need to find new ways to do things. I think just having institutions and then home has been proven over many centuries to be inadequate. But we need to get started on better case management. It's easy to say we should have more case management, but when the hospitals are filled in the money is being utilized and who's going to pay for case management, which is another service that requires people. It requires lots of people, doesn't require physicians, but it requires the social workers of these types. And I would like to have 30 more positions for social workers to do case management, but I haven't got the money. As Jimerson, I know that these are things that your department has advocated and would like to have had without the money. But let's go back to the question again of how you can push for it with the legislature the next time.

And the last session, the Governor's hopes for the pilot projects reportedly were pinned on the lottery, which didn't come through. Does there have to be a firmer financial foundation than that? I'd like to clarify that if I may. The Governor had a cap of revenues under which to operate, and the pilot projects were in under the cap in his budget. So he did ask for those not pinned directly to the lottery. Toward the end of the session, the lottery was amended. The lottery bill to allow certain of those dollars to be earmarked specifically for seriously emotionally disturbed children and seriously mentally ill adults. That would have brought an ongoing revenue to the mental health system. But I do want to be clear that he was clear at the very first that the 1.5 million for the two pilot projects was in under his budgetary cap. Let's go back to the revolving door questions. I believe Dr. Fehrman phrased it. What's the impact of that on state resources for treating mental patients?

I believe Dr. Winslow pointed out that certainly there's less cost to an outpatient treatment than institutionalization. How much of a drain is that? That is a tremendous drain on the system. For every admission you have a number of practitioners who must be involved. Each admission to a hospital is far more costly than a regular hospital bed day would represent. So every time a person is readmitted to the hospital, we're eating up more and more of the resources that we need. If we can keep those people in the communities. If we can get community providers, social service agencies, police departments, judges to understand that these persons deserve to live in their home communities as close as possible to their home, to their family, to their communities, then we can save some money. Thank you Dr. Winslow, Dr. Fehrman and Ms. Jimerson. Part of the problem in dealing with mental illness is certainly the public perception of it. A lack of true understanding of it are attitude toward it.

Tonight's guest commentator is Elizabeth Marilat of the Alliance for the Mental Ill. She speaks from her own son's experience. Mental illness is much more common than most people realize. A recent study by the National Institute of Mental Health makes them startling conclusions about one-third of all Americans suffer from an acute mental illness at one point in their lives. Perhaps the most devastating of all mental illnesses is schizophrenia, which strikes one in 100 of us. And yet despite its prevalence, schizophrenia is misunderstood because we have become so adept at hiding it. It is a stigma. This stigma of schizophrenia makes it all a more tragic, schizophrenics have become the lepers of the 20th century. For it is only our ignorance which keeps schizophrenics and other mental ill in the closet.

It is a brain disease due to a biochemical disturbance. Persons with schizophrenia do not have a split personality and are not prone to criminal violence. Their illness is not caused by bad parenting and it is not evidence of weakness of character. The Alliance for the Mental Ill has many goals. One of them is to back more research to find causes and thus ultimately to prevent mental illness. Meanwhile, accepting the mental ill, particularly those who are treatable and most are, into our community is terribly important. You can help combat stigma by objecting to negative stereotyping of mentally ill persons. If you know a mentally ill person, give him your friendship. Take the initiative. Our son is treasure friends, but do not know how to nurture a lasting relationship.

If you are an employer, hire the mentally ill for low stress jobs. One of the best ways to join the mainstream is by holding a job, becoming a productive member of society. Intelligence has not been affected. Many, like our son, have college degrees and one's held responsible positions. But too many employers look at a resume, see a gap in work history and deny the applicant a chance. As the taxpayer help support a good community-based system, help our legislators understand that rehabilitation will be easier and faster and more economical if the recovering person is close to family and friends. As the so often true, the rewards will be vastly greater than efforts. Please help us stamp out stigma.

We invite your viewers on at Weeks In Commentaries. Please write at Weeks In, K&M-E-T-V, 1130 University Boulevard, Northeast, Albuquerque, New Mexico 8702. I'm Neil Boggs at Weeks In. Good evening. Thank you.