Jan 11, 2013

Vice-President Biden, a few new items for your mental health plan

Vice-President Biden

I heard you were going to address gun control on Tuesday. Here's an update on mental health.

In addition to my original post here and my update about states that don't fund the most they can under Medicaid, here are some additional things worth considering that I collected from comments on a LinkedIn forum.


In the housing area, add "changes to the rules governing creation of housing for the disabled." Today's rules make it very difficult to house more than 4 - 6 people with disabilities together. Yet those with significant issues need additional staffing, and the economics just don't work to handle them when housing only 4 - 6 people. The result is that what housing exists goes to those who are the easiest to care for, while those who may have occasional behavior challenges are left out. This is akin to building a hospital, but leaving out the intensive care unit because those patients are too difficult! When the difficult patients with mental illness get ignored, we end up housing them in prisons or having them homeless on the streets, like the woman who pushed a subway rider to his death last week. No, we don't need to return to the days of institutions for 400 people...but we do need some 12, 18, 24, or 30 bed options for those who would do better in such a setting.


This is a very good plan....I've worked on CSU (crisis stabilization unit) for 5 years and these are good points to develop a unified guideline from a national level, with room to tweak at state and city levels.
However our largest population right now are young people 18-25, who resist the belief that they are ill and refuse medication and terrify their families. This group will slip between the cracks, even with this well-developed plan, leaving them to possibly become the most dangerous,,,,,.
I spend every day looking for answers to encourage this group to accept the help they so gravely need.

Establish additional collaboratives in the community to help families learn and identify MH and also to help providers learn about cultures that would prevent folks from getting care.

And one final matter:  Please ask families to start talking to each other about how they feel. Family members are usually the only ones who can sit with a person in trouble to figure out a way forward. This is not some technical issue.

For people who need reminding about how to start a conversation, here is a little script, just four questions.

-- What have you accomplished since the last time we met?
-- What are you facing?
-- Who are your allies?
-- What is your plan?

If someone detects hopeless, isolated, tunnel-vision thinking, follow up with a direct question about suicide: "Are you thinking about killing yourself?" and if the answer is yes, stay with the person, and call the national suicide hotline 1-800-273-8255.

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