Just before the New Year, Phoenix police found the body of an unidentified woman sitting on a couch ceremonially enshrined in towels. The corpse had been there for days; almost immediately the suspect was found…a 39-year-old, seriously mentally ill woman, who insisted that the body was her own.
There are lots of chronically mentally ill people on the streets and in prisons in every city in American because the seriously disturbed have been shamefully neglected, abandoned, and left untreated.
We got into this position in the 1960’s and ‘70’s when there was a concerted effort to de-institutionalize the chronically mentally ill. It was a noble idea; close down the medieval, locked wards of State Mental Institutions, and get people back into the community where they could be supported and followed. The result has been that over the last 50 years, the number of psychiatric beds has shrunk from 650,000 to 65,000; the most seriously disturbed wound up in the streets and in prisons (the police have become the first responders for the chronically mentally ill). What’s happened is, the funds that were promised were never delivered. The money was siphoned off by a delivery system that was ripe for fraud.
The recent report by Dr. E. Fuller Torrey and colleagues entitled, Fraud, Theft, Waste and private profits: The Fate of Money Intended to Treat People With Serious Mental Illness (Mental Illness Policy.Org, Sept. 28, 2015) offers depressing evidence that billions of dollars allocated by the states to provide mental health services for the chronically mentally ill have been siphoned off by fraud, theft and private profits.
Torrey estimates that between 6-10% of a States mental health funds ($4-$8 billion/year) are being lost to fraud; most to excess profits taken by for-profit managed-care companies. Administrative costs in for-profit psychiatric hospitals are 32% higher than nonprofit psychiatric hospitals, and 83% higher than public psychiatric hospitals. The profit motive in healthcare delivery does not mix well with our social responsibility or our humanity.
The profoundly mentally ill in this Country are vulnerable, powerless, and unrepresented, and a national disgrace. I applaud Dr. Torrey’s scholarship, consciousness, and courage to tell us clearly what we need to do. We must hold State Mental Health Agencies responsible for assertive oversight in how mental health monies are spent; and we must expand the Federal Health Care Fraud Prevention Task Force to deal with crooked institutions and practitioners who are defrauding the system.