Mentally Ill flood ERs as States Cut Services

By Julie Steenhuysen and Jilian Mincer

Reuters

Originally published December 26, 2011

On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

"He had been homeless for about two weeks. He hadn't showered or eaten a lot. He asked if we had a meal tray," said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. "It seemed almost as if he was interested in being admitted."

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies - attempted suicide, severe depression, psychosis - as states slash mental health services and the country's worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

"These are people without a previous psychiatric history who are coming in and telling us they've lost their jobs, they've lost sometimes their homes, they can't provide for their families, and they are becoming severely depressed," said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital's psychiatric emergency department have climbed 20 percent in the past three years.

The entire story is here.

Mental-health cuts: Experts fear long-term costs

By Mary Reinhart
The Arizona Republic
azcentral.com

Arizona taxpayers are providing fewer services to fewer people with serious mental illnesses than they were last year, for annual savings of roughly $50 million.

But the short-term savings from state budget cuts threaten to have long-term consequences for patients, providers and the community, mental-health experts say.

The budget reductions eliminated services for about 12,000 Arizonans who don't qualify for Medicaid, removing the foundation of a system intended to keep the seriously mentally ill healthy and out of emergency rooms, hospitals, jails and prisons.

State lawmakers instead provided money for generic medication and additional funding to beef up a statewide crisis-response system to help prevent people from falling through the cracks. But in the 15 months since this population lost case management, brand-name prescription drugs, therapy, transportation and other benefits, more than 2,000 people have stopped receiving any state-funded services and are unaccounted for.

Local and county jails, emergency responders and hospitals often shoulder the costs when people with untreated serious mental illness, such as schizophrenia and bipolar disorder, fall into crisis.

The precise financial costs to those entities are unknown, but health professionals do know that it's far more expensive to treat people who have spiraled into crisis than to keep them stable. And once in crisis, health professionals say, it's more difficult for people to rebound, which means those higher costs continue to recur.

"It's a penny-wise and pound-foolish approach," said Bill Kennard, former executive director of the National Alliance on Mental Illness' office in Phoenix. "More people in jail and prison with mental illness, more time that law enforcement spends dealing with a health issue as opposed to a public-safety issue."

The costs

The state has not conducted an analysis that compares ongoing treatment with crisis costs.

But a March 2011 study that examined proposed mental-health cuts in Texas put the average daily cost of services at $12 for adults, compared with $401 a day in the state's mental hospital, $137 a day for a jail inmate with mental illness and $986 for an emergency-room visit.

The study, by Health Management Associates for the Texas Conference of Urban Counties, also showed that gaps in services put those discharged from psychiatric hospitals and jail at greater risk of relapse, readmission and recidivism.

Janey Durham, who is in charge of a workshop program at Mesa's Marc Center, said she lost 120 people to the budget cuts, including a man diagnosed with schizophrenia who deteriorated almost before her eyes. The non-profit agency center provides job training and other services to the mentally ill and developmentally disabled.

Durham said the man, a former alcoholic in his 50s, worked hard at his job in the manufacturing warehouse, at maintaining his sobriety and in treating his mental illness. But soon after the budget cuts forced him to switch to a generic medication, Durham said, he stopped taking his medication, started drinking again and grew increasingly paranoid, plagued by voices in his head.

Over the past year his erratic, disruptive behavior led Marc Center employees to call Mesa police at least once. He is believed to be homeless, she said, but contact with him has been sporadic since last winter.

Read the entire story here.

New data spill shows risk of online health records

By Jordan Robertson

AP Technology Writer

Until recently, medical files belonging to nearly 300,000 Californians sat unsecured on the Internet for the entire world to see.

There were insurance forms, Social Security numbers and doctors' notes. Among the files were summaries that spelled out, in painstaking detail, a trucker's crushed fingers, a maintenance worker's broken ribs and one man's bout with sexual dysfunction.

At a time of mounting computer hacking threats, the incident offers an alarming glimpse at privacy risks as the nation moves steadily into an era in which every American's sensitive medical information will be digitized.

Electronic records can lower costs, cut bureaucracy and ultimately save lives. The government is offering bonuses to early adopters and threatening penalties and cuts in payments to medical providers who refuse to change.

But there are not-so-hidden costs with modernization.

"When things go wrong, they can really go wrong," says Beth Givens, director of the nonprofit Privacy Rights Clearinghouse, which tracks data breaches. "Even the most well-designed systems are not safe. ... This case is a good example of how the human element is the weakest link."

Southern California Medical-Legal Consultants, which represents doctors and hospitals seeking payment from patients receiving workers' compensation, put the records on a website that it believed only employees could use, owner Joel Hecht says.

The personal data was discovered by Aaron Titus, a researcher with Identity Finder who then alerted Hecht's firm and The Associated Press. He found it through Internet searches, a common tactic for finding private information posted on unsecured sites.

The data were "available to anyone in the world with half a brain and access to Google," Titus says.

Titus says Hecht's company failed to use two basic techniques that could have protected the data — requiring a password and instructing search engines not to index the pages. He called the breach "likely a case of felony stupidity."

One of the patients affected was Paul Thompson, who learned of the breach from Titus.

The Sugarloaf, Calif., electrician blew out his shoulder four years ago on a job wiring up a multiplex movie theater. His insurance company denied his claim, which led to a protracted dispute. He eventually settled.

Thompson says his injury has been a "long, painful road."

Unable to afford surgery in the U.S. to fix his torn rotator cuff, he paid a medical tourism company that was supposed to schedule a cheaper procedure in Costa Rica. The company went bankrupt, however, and Thompson said he lost nearly $7,300.

To have his personal information exposed on top of that was a final indignity.

"I'm totally disgusted about everything," he said, calling the breach "another kick in the stomach."

Thomson is worried that hackers may have spotted his information online and tagged him for future financial scams. He contacted his bank and set up a fraud alert with the credit reporting agencies.

He says the prospect of all health records going electronic — which federal law mandates should happen by 2014 — "scares the living hell out of me."

When mistakes occur, the fallout can be more severe than the typical breach of email addresses or credit card numbers.

The rest of the story can be read here.