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. - --- MAP posted-by: Richard Lake