Dear Senator Alexander…on the IMD exclusion and other concerns

Below is a copy of a second letter sent to Senator Alexander explaining my concerns about the bills before the Congress.  Again this is  merely meant as one way that people can address the issues with their Senators.  If it is at all helpful to you I am very pleased.

Dear Senator Alexander,

My name is Larry Drain and I live in Knoxville, Tennessee.  This is my second letter to you regarding  S2680.  After reading my first letter  I realized there was another major concern that I wanted to address and I appreciate your patience and interest in considering what I have to say.

The issue I want to address is the debate over what to do about the IMD exclusion.  As you know the bill from the House codifies into law a rule change made by the federal government that would allow placement of a person in an IMD for up to 15 days.  I know from just following the debate in the Senate that there will be an amendment suggesting that length of time be still increased.  I know that this is one of the most controversial issues that you will be faced with in the coming debate in the Senate.

I think it is a big mistake to increase the IMD exclusion for any longer period of time greater than that already done in the federal rule changes.  The expenses alone make it prohibitive.  If you judge the probable  consequences against the certain expenses I think it is clear that any further increase is unwarranted.  But my main objection to all this is not the financial one.

I think the proposal misses the most important point.  The real point is not the expense of people being put into the psychiatric hospitals but the very real financial and human cost of being readmitted into the hospital and readmitted and readmitted.  I know people who have experienced double digit admissions into the hospital and checking with any state department of mental health, like Commissioner Varney in Tennessee, will tell you this is a common occurrence.  The truth of the matter is that there is little, if any, evidence placement in a psychiatric hospital makes it any more likely that person will cope successfully in his community after discharge.  The evidence is overwhelming that community services make the difference.

Increasing the length of hospitalization has not, to my knowledge, made success any more likely.  To by legislation increase the accepted length of psychiatric hospitalization will I am afraid start us down a dangerous path.  As people continue to be unsuccessful the pressure for longer and longer hospitalization will continue to grow.  The expense of psychiatric hospitalization, which at one point in time threatened to sink the system in Tennessee, will only grow larger and larger.  In the end the money must come from somewhere.  State Medicaid budgets are all right now largely on life support and the money must come from somewhere and eventually, like before, community services will end up being picked to the bone to pay for state hospital programs.  The result will be a very vicious cycle that will not be a positive reform but just a bigger and bigger problem.

Many states have proactive programs trying to deal with the issue of hospital readmissions and increasing the chances of patients to be successful in their communities.  Tennessee has been a leader in innovation in this area.  There are as many people admitted to crisis stabilization units in the state of Tennessee as there are admitted to state hospitals.  Our network of peer support centers serve people with severe mental illness and has significantly reduced the rate of rehospitalization among the people it serves.  The peer-link programs run by the Tennessee Mental Health Consumer Association reduced the rate of rehospitalization of the people it served by 77%.  The issue is not finding a place to put more people for a longer period of time but to build a system that is more responsive to the needs of the people it serves and maximizes the chances of anyone it serves ultimately being successful in the communities in which they live.

To much of the conversation is being driven right now by the tragic stories of families who found that the chances of their loved ones being successful in the community in which they lived were basically zero.  The tragedies are real but the answer is in far more than reflexive judgements.  The challenge is to create a system that works and this system does not work.

This is more than a simple answer and while I understand the motivation behind those who want to address the tragedy that so many people have lived with the goal must be to create a system that addresses the real failings of the system.

Unless we try to create a system whose goal is to improve the chances of people to be successful in real life I am afraid we will find it is impossible to hospitalize people long enough to make a difference.

Again thank you for your leadership in such a vital area.  It is long past time for mental health reform that matters and I really appreciate the commitment and effort you have shown to make it a reality.

Yours truly,

Larry Drain


One thought on “Dear Senator Alexander…on the IMD exclusion and other concerns”

  1. Go Larry! Thank you for pointing out that the “stimulus package” for institutionalization will come from gutting community services. And kudos to you for working to keep Mad people in the real world and OUT of those hell-pit hospitals!

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