Sunday, February 3, 2008

Mentally ill patients are ill served in USA (Updated)

In an August 2003 article, titled “US notches world's highest incarceration rate,”, the Christian Science Monitor estimated that more than 5.6 million Americans are in prison or have served time there. (That's 1 in 37 adults living in the United States, the highest incarceration level in the world)." Sasha Abramsky, the author of, "Ill-Equipped: U.S. Prisons and Offenders with Mental Illness, tells us, "There are three times as many men and women with mental illness in U.S. prisons as in mental health hospitals. The rate of mental illness in the prison population is three times higher than in the general population."

Over the last 30 years, we have cut treatment, services and care to the point that we have criminalized mental illness, replacing our hospital treatment system with incarceration, abuse and neglect. Our mentally ill wander the streets with no access to treatment. They are arrested for minor violations and then they are held in jail for extended periods of time with no treatment available even by court order.

Former Whatcom County Sheriff, Senator Dale Brandland, knows first hand how a lack of consistent access to medication and treatment can lead a mentally ill patient back to jail.

In an attempt to protect the mentally ill and society at large, Senator Dale Brandland has introduced two bills to protect mentally ill patients from lapses in medical coverage when they are jailed or hospitalized.

The Democratic Caucus has not issued a statement on this measure.

SB 6584 would require DSHS to suspend, not terminate, medical assistance benefits for any person enrolled in medical assistance who becomes incarcerated in a correctional institution or inmate for mental diseases (IMD).

In a 2004 letter, the Center for Medicaid and Medicare Services encouraged state medicaid directors to "suspend" and not "terminate" Medicaid services while a person is an inmate of a correctional institution. Federal guidelines allow for public assistance to be provided to persons on home detention, who do not receive food and shelter from a penal institution.

State law provides that a person who is an inmate of a correctional institution or an inmate for mental diseases (IMD) is not eligible for medical assistance.

SUMMARY OF BILL REPORT: “Suspended medical benefits must be reinstated immediately upon the person’s release, without requiring a new application. DSHS may not require an inmate to recertify eligibility for public assistance while he or she is incarcerated, but if the inmate’s recertification date has passed, DSHS may require the inmate to recertify immediately following release. DSHS must provide public assistance benefits to eligible persons on home detention. DSHS must accept and process public assistance applications from jail inmates who do not have an established release date, and from any inmate who is within four months of an established release date. DSHS must extend its expedited medical assistance review program to all inmates who are likely to be eligible for medical assistance benefits, even if the person was not enrolled in public assistance within five years prior to incarceration.”

Why is this important? Today, jails and prisons have become de facto mental health institutions. Sheriffs, corrections professionals, prosecutors, defense attorneys and criminal justice advocates agree that this is a function that they are poorly equipped to serve.

A Human Rights Watch report released in 2003, documented that one in five jail inmates and one in six prisoners is mentally ill, and the number of mentally ill in prison exceeds the number of patients in mental health hospitals. Consequently, incarcerated prisoners receive little or no treatment while in jail or prison. The study, “I’ll equipped: US Prisons and Offenders with Mental Illness” documented that the mentally ill are punished by prison staff for displaying symptoms of their illness, such as head banging, self mutilation and suicide attempts. Many wind up in solitary confinement where isolation can push them into acute stages of psychosis.

The study concluded that the high rate of incarceration of the mentally ill is a consequence of under funded, disorganized and fragmented community health services. Neither private health care insurance - nor public health care benefits guarantee that those who are mentally ill will receive the health care they need to function in society. Many are poor and homeless, or struggling with substance abuse. If they do commit a crime, they are jailed and lose the limited benefits they had prior to incarceration.

Fiscal Note for SB6584: The Department does not anticipate any fiscal impact with this legislation

SB 6583 would change the definition of “categorically needy” so people who are in custody because of mental diseases would not have to prove 6 continuous months of spending on medical bills to qualify for health coverage.

Under the state medical plan, a citizen may qualify for health coverage under the Medicaid program if that person is "categorically needy," meaning that the person is disabled, blind, or voer 65 years of age and meets income limits. DSHS has ste needy income limits at $637 per month for a single person or $956 for two persons. A disabled person whose income exceeds this amount, but who has medical expenses that effectively reduce his/her income below this level may qualify for medicaid under the "medically needy" program, but only if the person can prove that he/she spent all of his/her "excess income" on medical bills for six months. Persons who are released from a correctional institution or institute for mental diseases are unable to qualify for Medicaid under the "medically needy" program due to the requirement to proving six months worth of medical spending. DSHS may change the income limit for the categorically needy and medically needy Medicaid programs within parameters authorized by the federal government without sacrificing matching funds.

DSHS services must set the categorically needy income limit which determines eligiblity for Medicaid Coverage for citizens who are disabled, blind or over the age of 65, at a level that is at least 100 percent of the federal poverty level.

(In suppport) "This makes it easier for mentally ill inmates to qualify for benefits while they are in prison or hospital. Not having benefits contributes to recidivism. Many organizations support this bill. Without coverage, people put off getting care until they have to go to the emergency room. Prevention is less costly and more effective. Administration costs would be saved by shifting people out of the medically needy program. May thousands of people would be able to access timely medical care due to this legislation. The bill would help older people access dental care. Disabled inmates released from jail can't qualify for spend down during the critical first months following release." (No one testified against the measure).

Fiscal Note:

Granted, this is only the beginning, but let's hope that Senator Brandland's bills recieve the support they need to be enacted by the legislature.

Additional information on this topic can be found at the following links:

"I'll Equipped: US Prisons and Offenders with Mental Illness" Report:

Dissident Voice:

Mental illness and the Criminal Justice System:

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