Washington is about to accept a medical provider it previously rejected: the mental hospital, due to the interconnected problems of substance abuse and homelessness.
Lawmakers are about to reverse their decision from nearly 60 years ago, when they prevented Medicaid from providing care to what were then mocked as crazy asylums.
Here are the reasons: Record-breaking overdoses continue despite widespread support for community-based treatment since the 1960s, and locals have had enough of the open drug trade and homeless encampments. There are public health activists who think the rule should be lifted because the rule is outdated and the crises are too big.
Republican lawmaker Michael Burgess, a doctor from the wealthy northern suburbs of Dallas who spearheaded a measure to alter the regulation, stated, “It is no longer the 1960s, and there is no longer the same stigma against the treatment of mental health.”
December 12 was the date of its passage by the House. It would allow states to decide whether to pay for Medicaid patients’ treatment in a mental hospital for up to 30 days if they are addicted. Its chances of being enacted are high because the Senate Finance Committee gave its approval to a comparable proposal in November.
Democrat Ritchie Torres of New York City’s South Bronx, the slums, and a former inmate with a history of mental illness, was Burgess’s co-sponsor.
The new system is backed by state Medicaid directors and public health organisations including the Treatment Advocacy Centre and the National Alliance on Mental Illness.
One of the unexpected consequences of the 1965 law that prevented Medicaid, a federal-state health care programme for low- and middle-income individuals, from paying for hospital treatment is the shortage of mental beds, according to their claims. According to them, a great number of vulnerable individuals wind up in places like jails, emergency rooms, or even dead.
They also claim that the policy continues to discriminate against those who have mental health issues or substance abuse problems, in contrast to those who have physical ailments, from which there is no exemption.
House Republicans are in agreement. Party factions within the Democratic Party are different.
Representative Frank Pallone of New Jersey, who was the leading Democrat on the bill’s Energy and Commerce Committee, was opposed to the change because he was afraid of sending people with mental illness back to institutions rather than providing them with the care they need in the comfort of their own homes, ideally with a multidisciplinary team of medical professionals and social workers.
We know that making sure people in recovery have access to community-based treatment is one of the best ways to assist them in their rehabilitation, he said.
After some initial resistance, Pallone gave down because Republicans committed to expanding Medicaid to include more inmates who are recovering from drug abuse.
However, civil rights activists who are in favour of cutting Medicaid funding are also motivated by concerns about reinstitutionalization. They mention that certain states, such as California and New York, are already trying to force individuals into care, and they worry that this may lead to a return to warehousing the sick.
Lewis Bossing, a senior staff attorney at the Bazelon Centre for Mental Health Law, said that lifting the Medicaid rule would alleviate the pressure to address the true need: expanding community services.
Providing treatment in the community, rather than an institution, leads to better outcomes, he added, including lower rates of hospitalisation, engagement in the criminal justice system, employment, and social integration.
The mental hospital’s ascent and decline
As an alternative to incarceration, states began constructing mental health facilities in the 1800s to treat those suffering from serious mental disease.
However, due to a lack of funding, personnel, and space, hospitals quickly became overwhelmed. A 1946 investigation by Life Magazine revealed rampant abuse: patients were beaten to death, starved to death, placed in solitary confinement, and restrained for days at a time.
In 1963, President John F. Kennedy made the statement that over 500,000 individuals were housed in state mental health institutions, with half of that number residing in institutions that could accommodate over 3,000 patients.