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Pushing indigent mentally ill into outpatient treatment

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Early Persian psychiatric treatment.

The Sacramento Bee reports that Sacramento County will spend ”$16 million this year on hospital costs for the severely mentally ill, almost three times more than originally budgeted for care at area hospitals.’

Experts link much of the increase to the greater number of patients showing up because of the expansion of California’s Medicaid program (Medi-Cal) under the Affordable Care Act.

So that jurisdiction, as are many in America, are looking at placing more emphasis on community-based outpatient treatment and less on hospital beds. This suggests more of a focus at improving  other factors besides direct psychiatric care — such as housing and transportati0n — that also affect health and whose shortages drive up medical costs by driving the mentally ill to hospital emergency departments.

“The plan, expected within three months, will include services that help the mentally ill before they reach a full-blown crisis, alternatives for those in a crisis and better assessments to avoid unnecessary hospitalizations,”  The Bee reported.

“Preliminary estimates peg the cost of those services at around $9 million a year, much of which would be offset by federal and state funds and reduced hospitalization costs.”

This is common-sensical. However, at the same time, there’s growing opinion that there should be a revival of hospitals to care for the most severely mentally for the long-term — in the case of some patients, for the rest of their lives. The deinstitutionalization movement has gone too far for some patients and their exhausted families.

The Bee noted that “Efforts to relieve pressure on emergency rooms have led to more psychiatric hospital stays, according to a county staff report.” Not exactly a fiscal triumph for the payers.

The Mental Health Improvement Coalition, which includes area hospitals and nonprofits, said: “The system of behavioral healthcare is fundamentally broken. People in crisis have little option other than to access services through hospital emergency room departments, which are the least conducive environments for behavioral health patients to become well and receive appropriate services.”


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