Pubdate: Sun, 9 Dec 2007
Source: Concord Monitor (NH)
Copyright: 2007 Monitor Publishing Company
Contact:  http://www.concordmonitor.com
Details: http://www.mapinc.org/media/767
Author: Louis Joselphson, For the Monitor
Note: Louis Josephson is the CEO of Riverbend Community Mental Health 
in Concord, a community mental health center serving more than 7,000 
people each year.

STATE LIMITS OUR ABILITY TO PREVENT CRISES

Mental Patients' Drug Abuse May Go Untreated

A man is shot and killed by the Concord police in his family's home 
after acting erratically. A woman is shot with a bean bag gun by the 
police after threatening behavior. A parent writes to me asking for 
help for her child who has a long history of mental health issues, 
but I can offer only very limited services.

In each of these real cases, families and individuals are concerned 
and frustrated by a lack of responsiveness in our mental health 
system. Frankly, I share their concern. A growing number of people 
who are uninsured or under-insured and have co-existing alcohol and 
drug problems are not getting what they need from New Hampshire's 
mental health system.

Why is this the case? First and foremost, it is about money.

At least 50 percent of individuals with severe mental health symptoms 
have some substance abuse issue too. The good news is that mental 
health centers can effectively serve people with mental health and 
substance abuse disorders. But state regulations forbid mental health 
centers from providing a full range of care if the person's behaviors 
might be caused by substance abuse and not by a psychiatric diagnosis alone.

So instead of offering medication, psychotherapy, interventions to 
improve behaviors, community support to help find a job, housing, and 
healthy lifestyle options, we may only be able to offer a few 
sessions of psychotherapy and refer the person to their doctor for 
medication. These restrictions are about limiting the expenditure of 
state funds and are not due to clinical considerations.

Unfortunately, left untreated or under-treated, people with 
co-existing mental health and substance abuse issues often 
deteriorate, and they may end up

in the criminal justice system or in the hospital at far greater cost 
to taxpayers than the cost of mental health center services.

Other states have restrictions on expenditures for mental health care 
too. Invariably, hospitals, prisons and the public pay the price for 
intervening after things get worse. Sometimes an innocent bystander 
is hurt and a special law is created, like New York's "Kendra's Law," 
to address the lack of resources in the mental health system.

Given the scope of this significant public health issue, it should 
not take a tragedy for New Hampshire to put more resources into 
mental health services. A modest investment in community mental 
health will save money, save lives and make New Hampshire a state 
where people can truly "Live Free" - free of mental illness, free of 
substance abuse and free to enjoy a full life in their community.
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MAP posted-by: Richard Lake