If you think police officers spend a majority of their time dealing with criminals, think again. Due to a better understanding of mental illness and because of a decrease in available services, cops are often the first -- and frequently the only -- responders to people with mental illnesses.
"Probably half our calls deal with someone who may have a mental disorder," says Carl Thompson, senior officer for the Spokane Police Department. "We're the agency first called when someone is acting bizarre.
"Several years ago," Thompson continues, "we had an individual on the Monroe Street Bridge. He was sitting on the railing, outward toward the river. As two units came on scene, we could see he had a headset on and was cutting his face with a razor blade. He was perched on the railing and he was obviously suicidal and was about to jump. We got him off the railing, coaxed him down and he told us about the voices that were telling him that when a certain song came on, he was going to jump."
Although suicide attempts have traditionally been handled by police and in the emergency room, a vast majority of people's other mental health behaviors have become a daily part of the job description for emergency response personnel.
"It's becoming much more obvious to us that other safety nets are disappearing quickly," Thompson says. "And we're the ones, as emergency response, who are dealing more and more with it."
It's estimated that on any given day, 20 to 30 percent of the people incarcerated suffer from a mental illness.
"Emergency costs, whether it's [police] or the ER, not only take us out of service for others, but are extremely expensive and only a temporary solution," Thompson says.
For mental health professionals, the increased stress on emergency systems isn't surprising; it's one of the consequences of a long over-stressed and under-funded system.
"The crisis may be more recognizable now, but it's been coming down the tracks for about three years," says Kasey Kramer, director of Spokane County Community Services. Kramer says because of renewed and vigorous enforcement from the federal and state levels regarding how mental health services can spend Medicaid money, more people with mental health problems are being denied treatment.
"What we've been able to do historically is take whatever [money] is left over and spread it among people without Medicaid," Kramer says. "I'd summarize it simply: Medicaid is an entitlement, but you have to be financially qualified to get it. Taxpayer dollars go into the system and the Medicaid system has now said, very firmly, 'We understand you've been able to squeeze more dollars out [to cover those who aren't on Medicaid], but now you can't do that anymore.' They've taken a gray line and made it a black and white line."
While the changes aim to protect people on Medicaid and use taxpayer dollars wisely, what's happening is that people with mental health needs who don't qualify for Medicaid yet can't afford insurance, are taxing systems by resorting to ER services or police -- the most costly forms of intervention.
There are other problems, too. Even those who can afford insurance are finding that mental health care isn't covered comprehensively. Those with depression and anxiety aren't getting the care they need because mental health isn't covered the way physical healthcare is.
"Mental health care coverage across the nation is very poor," says Susan Hammond, a registered nurse and director of psychiatric services for Sacred Heart Medical Center. "Even in blue ribbon health plans, the number of [mental health] visits, coverage, pre-existing -- all of it is poor. If you think about it, you'd never see in a health plan agreement a cap on the number of broken body parts one can be covered for. But always there is a cap on the number of dollars for services for mental health."
As more and more people seek mental health services, for everything from mild depression to severe, chronic disorders such as bipolar and schizophrenia, there is an increasing burden on a system already straining for funds. Mental health experts say that insurance companies don't have comprehensive mental healthcare coverage for a variety of reasons, especially because there's often no specific cure available, as there would be for broken bones. Hammond says mental health is an ongoing process, not a set procedure; determining chemical balances in the brain often turns out to be a long, guess-and-check process that includes therapy, medication and support services.
"In our community, we're not funding healthcare in out-patient support services and with a case manager, which is the cheapest," Hammond says.
According to the American Medical Association, depression costs the United States about $44 billion a year in lost productivity and absence from work -- not counting the cost of care. Mental health advocates argue that we can't afford to ignore this. However, funding cuts continue, and so does a culture of misconception, judgment and shame about mental disorders.
"People with mental illness are not good at advocating for themselves," Hammond says. "[Mental disorders] are frightening for most people; there is a chronic myth that it's something you've done wrong or there's something you could do to not be mentally ill. There's not an understanding that it's not something you can just will yourself out of. Mental healthcare is at the bottom of the pecking order. It's poorly funded, and the people working in the sector are poorly paid."
They are overworked, too. Kramer says when he first started, three people did the work he now does on his own. Spokane County's Regional Support Network, runs at about a 3 percent administrative cost, the lowest in the state. Spokane Mental Health runs at around 10 percent.
"There are many additional requirements that are now part of our contract," says David Panken, CEO of Spokane Mental Health. "There are growing administrative burdens, but we've reduced our administration."
In 2003, Sacred Heart Medical Center was forced to shut down its 24-bed geriatric psych unit, one of several cuts the hospital has had to make to its mental health services. Psych wards are frequently the first services to go when hospitals have to make budget cuts, as has been the case all over the nation, because they're often the least profitable. Sacred Heart has subsidized its psych wards since it opened them.
Despite enduring what most experts agree to be a crisis in mental healthcare, Panken is optimistic that people are beginning to recognize the impact of mental illness on society.
"Most families either have someone in their family or know someone who has been treated for mental illness," he says. "I think there is greater recognition and perspective on mental health issues. To put it in a broad perspective, remember it was in the mid-'50s that the first psychotropic medications started."
But as science develops newer, more beneficial medications, the costs of those treatments continue to rise.
"Are they as costly as lost productivity, unnecessary hospitalization or incarceration?" Panken asks. "Are they as costly as disintegration of the family because someone goes untreated? I don't think so."