The mental health system is not making it. It is trying to do too much for too many with too little. And it promises to get worse. Much worse. The only hope that seems realistic at this point is if President Obama’s stimulus plan adds enough money to offset some very real budget cuts.
What follows is a description of Maryville, Tennessee where I live. My hope is in Maryville you can find something that explains the situation that you are in. I think Maryville is probably much better than many situations. I am sure it is worse than others. I do think though that there is something to be learned about all examples by looking at one.
First some basic facts.
- The Blount county area (includes Maryville) has about 113,000 people. For a population of that size they should have about 13 suicides a year. Blount county had about 26 this last year and is on pace to break that mark in 2009.
- There are 2 major mental health centers in the county. A third has a more minor presence.
- The current assessment is that about 12,ooo people in Blount County are without insurance, but that number is rising.
- The jail has about 420 prisoners. About 30% of those are on psychotropic medications. That number appears to be on the rise.
- Although many people in the county are on TennCare, there are very few TennCare providers. This is especially true in Mental Health since reimbursement rates are so small. Many providers including inpatient psychiatric hospitals are trying to decide if they can “afford” TennCare this year.
- There have been major loss of jobs. With that is a rise in uninsured.
- Sometime in the spring about 150,000 Tennesseans will lose their insurance. About 20,000 of them will have major mental health diagnosis. The portion of these people who come from Blount County is unclear.
If you view mental health as being as much a community issue as you do an individual issue it is not hard to see where all this seems to be going for Blount County:
- If the accepted estimate of the prevalence of mental illness is true in Blount County that means that about 25,000 people a year suffer from mental illness.
- Because of the low rate of reimbursement for TennCare there are no private practice psychiatrists in the county who accept TennCare.
- There are somewhere between 4-7 private practice therapists who accept TennCare. Most of them are not accepting any new patients.
- With the rise in unemployment and the loss of TennCare coverage there will be a rise in the number of people needing mental health services who are either under TennCare or who have no insurance at all.
- Currently there is a 6-8 week wait for psychiatrist appointments at the mental health centers.
- One of the larger mental health centers has made the decision to at least temporarily close the door to new patients until they feel like they can get a handle on providing better and more timely services to the patients they do have.
- Even though the amount of uninsured should rise the state has made the decision that TennCare will no longer pay for services they had been paying for under the assumption that they would qualify for TennCare (the state only category). They will also no longer provide reimbursement to those who are judicially committed.
- As times get harder it seems likely that more and more people with mental health issues will end up in the correctional system. The 33% of prisoners on psychotropic meds should rise and the Blount County Jail will remain the largest treatment facility in the county.
Many people will not just fall through the cracks. They will live there. The mental health centers will get hit with a tsunami of demands at a time when they are having greater and greater difficult dealing with small waves. The possibility of tragedy both on an individual level and on a community level seem very real.
Maryville is a great place to live and has many strengths. They have a dedicated and committed mental health system. They are aware of what is headed there way and seem to be trying to get ready to deal with it. But given the facts as I have shared them what chance do they really have?
What really scares me is that I am afraid that Maryville is a best case scenario. A lot of other communities are probably looking at much worse prospects. It is a scary thought.
