Third place APME
The story is local. It happened in El Dorado this past month, but it could just as well be anywhere in the state of Arkansas.
The patient had to leave the hospital. Medicare funding dictated that enough money had been spent on his in-hospital care. So, still quite ill, he was released, but not to the care of his family. They were not available to take up the slack between hospital care and his return to full health. At a time when his health hardly warranted it, he returned alone to an inexpensive rental unit.
His condition deteriorated.
A few days later he was pulled him over for drunk driving.
He wasn’t drunk. He was, according to the report written by area officers, very disoriented and confused. The officer reported that the driver said he had recently been released from a psychiatric unit, but he had not taken his medication that day. The man regained his composure enough to drive, very carefully, back to his place with the officer following him. Inside, he took his medication, was calm enough for the the officer to leave. Nothing else was done, because, as the officer noted in his report, the man did not appear to be of any immediate danger to himself or others.
Ten hours later, nearly to the minute, the dispatcher received another call, this time it was the man calling to report a crime. An officer was dispatched. No crime had been committed. No one had even been in the area where the now obviously, delusional man insisted a crime had happened. According to the second report written that day, the man was obviously mentally and physically agitated and did not calm down or respond appropriately to questions.
Neighbors told the officer the guy had been in an altered state of mind all day long. A local health clinic was contacted. A clinician, acquainted with the man’s history, told an all too familiar tale: the man’s Medicare funding for in-hospital care, had run out before his illness had run its course. His personal life was unstable at a time when he desperately needed stability.
Because of his mental instability and agitated actions, he was taken to the local penal institution, not because he had committed a crime, but because in his altered state, according to the clinician, he was a danger to himself and others. The clinician recommended putting the disturbed individual in protective custody until a petition could be filed for a commitment order to have him re-hospitalized. Although he was obviously in need of help, nothing could be done for him medically without a court order.
So a couple weeks after the state and federal governments refused to fund the man’s care in a medical facility with trained nurses and doctors, the local government was forced to fund his care in a locked facility for an indefinite period of time under the care of untrained guards.
Far too frequently that is the way the state’s mental health system works. Funding for the care of the state’s, indigent, mentally ill is at an all time low. In recent years, the number of psychiatric beds in hospitals has shrunk as psychiatric wards have closed under the financial burden of providing, free, mandated care to indigents without any state mandate to cover funding those beds.
Increasingly, the financial and physical care of the mentally ill has shifted from the hospital to the local jail. If any other part of this man’s body had malfunctioned other than his brain, he would have been taken to the emergency room and his hospital stay would have been determined by his state of health not his financial circumstances. Unfortunately, brain disorders are not treated the same as other disorders in the body in which the brain resides.
The irony is this: his housing and care will be paid for by taxpayers of the state. He can stay weeks or maybe months, in an already overcrowded jail, where his illness will worsen before a bed becomes available in the state hospital or he could be sent to the state hospital and receive treatment until he improves. Where he stays just depends on which institution we, the state taxpayers, encourage our legislators to fund for care and housing of the indigent, severely mentally ill.