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Commentary


Discovering the true costs of deinstitutionalization

Vol. 7, No. 5 / May 2008

I work in a state-run, long-term care facility for mentally ill patients in northern Minnesota that is scheduled to close within a few weeks. I have seen the results of the transition to community-based services and the effects it has on mentally ill patients. The Minnesota governor calls it “mental health redesign.” The state’s Department of Human Services commissioner cites the U.S. Supreme Court case know as the Olmsted decision as the reason these institutions must be closed. The court ruled that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability. On one hand the lawmakers use the Olmstead decision to promote their policies, but ignore the conditions that are set forth in that decision [treatment professionals must have determined that community placement is appropriate, the transfer is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with mental disabilities]. I doubt if the lawmakers who endorsed this legislation have read the Olmsted decision.

In his editorial, Dr. Nasrallah states that he is perplexed that there is no public outrage about the misery of the seriously mentally ill. Many of us are outraged. However, as residents of our communities, we are guilty of trusting the integrity of our elected and appointed officials. We believe what we are led to believe. Furthermore it is human nature to be frightened by what we do not understand and avoid what scares us.

Many people believe that there is a stigma associated with being in a psychiatric institution, but I believe the stigma lies with mental illness itself.

I have spent 24 years caring for the mentally ill as a nurses’ aid. For the last 5 years I have tried repeatedly to raise the awareness of state lawmakers about the hidden costs and consequences of deinstitutionalization, but without success. Many people do not know that community-based services are 3 to 4 times more costly than institutional care. However, I believe that the driving force behind this trend lies in the federal IMD (institution for mental disease) exclusion. Persons living in a psychiatric institution do not qualify for Medicaid dollars, but the same patients who live in the community do qualify. In Minnesota we are told that it is all about the client, but in fact it is all about the dollar.

I fear that the situation will not change until there is a major event that really raises the public’s hackles. Policies will not change until the right person has to live through the tragic consequences related to deinstitutionalization. Eventually the pendulum will swing the other way, but at what cost?

Lisa K. Lemke
Laporte, MN

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