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For mental health care, look to community

By Debbie F. Plotnick | 11/25/2013, 10:01 a.m.
The mental health system in the United States is fragmented, and reductions in public mental spending have resulted in severe shortages of services, including housing and community-based services.

We know that acute mental health inpatient services are very expensive, just as they are for the medical/surgical side of the health care equation. In recent years, there have been reductions in the number of community hospitals providing psychiatric care, as well as shortened stays. Treatment is increasingly being delivered in alternative/outpatient settings, as is the case for health care in general. This is not necessarily a bad thing, as long as coordinated community-based treatments are available.

Community-based care, particularly when coupled with coordinated and supportive services similar to what is provided for other health conditions, produces better outcomes, helps people recover and reduces overall societal and medical costs.

As part of their Medicaid plans, states such as Pennsylvania and Georgia are offering programs that provide alternatives to traditional services. They not only work well, they also cost less than not providing mental health services.

For example, rather than having people experience long waits in overcrowded emergency rooms or forcing them to travel long distances, mobile crisis services are coming to adults and children (and their families) in their own homes in places as diverse as rural North Carolina, Minnesota and Tennessee, as well as in some of the nation's largest urban centers, including Los Angeles and Philadelphia.

We know that community alternatives to traditional hospitalization are proving effective.

In Lincoln, Nebraska, with its Keya House; at Rose House serving people in the counties north of New York city; and in multiple sites across Georgia, peer support and respite centers provide hospital diversion, a safe place for people in crisis and ongoing support to those at risk for a mental health crisis. Even New York City has recently added crisis alternative services.

Legislators must make the commitment to restore the cuts to state mental health budgets. More state Medicaid plans and private insurance must add services provided by certified peer specialists to their plans to allow people armed with nonclinical training by the state to help others stay on their medications and build social supports.

Municipalities must better coordinate their mental health services and increase the number of mobile and alternative crisis services, and all community members need to understand that mental health is essential to overall wellness.

We know what we need to do to head off tragedies and improve the quality of life for people with mental health conditions, and their loved ones. We need to find the political will to ensure that we address mental health with the same degree of attention as other health conditions, and provide the means and mechanisms to pay for it.

The opinions expressed in this commentary are solely those of Debbie F. Plotnick.

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