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OPINION: Michael Douglas: How will Ohio treat mental health?

Akron Beacon Journal - 10/14/2018

Oct. 14--Families affected by severe mental illness know the persistent dread, the apprehension about the phone call, perhaps in the middle of the night, about a crisis, or worse. They also know the support system, or lack of one, the strengths and weaknesses of the providers and agencies they need for help.

Few are more keenly aware than those at the National Alliance on Mental Illness Ohio, its board members with harrowing experiences about how mental illness has shaped their lives. So it should matter to the rest of us that the NAMI Ohio board recently surveyed the system, looking to see how it could be enhanced.

That word "enhanced" was chosen by NAMI for a reason. There have been advances, for instance, the Medicaid expansion bringing care to many suffering from mental illness. The attention of Gov. John Kasich has aided in countering the stigma still presenting a barrier to treatment. Summit County responds more effectively than others. What NAMI emphasizes is that the system has much room to get better.

How? The organization sets five priorities.

The first calls for adding hospital beds. The state has a glaring shortage with roughly one-fifth the number of beds recommended by medical experts. In that way, it didn't help when Aultman Hospital in Canton closed its psychiatric unit last month.

As NAMI tells it, patients either cannot get into the hospital or they are kept there for a short time, a week or less. Both pathways result in inadequate care, such a period insufficient for stabilizing most patients. Thus, parents often plead to keep their son or daughter in the hospital.

They fear what could come next. The suicide rate is 14 times greater than average during the 90 days following release from a psychiatric hospital.

Ohio has reduced its psychiatric hospitals by nearly two-thirds since the early 1990s. Today, it has six. The thinking was to increase local services, but that hasn't happened as hoped. Just last month, NAMI opened the start of an answer in Athens, the first residential mental health rehabilitation center in the state, where patients can get long-term care, say, 60 days to 90 days, following their release from the hospital.

Add such a center near each state hospital, and Ohio would take a leap forward in treating mental illness.

The second priority goes to addressing the lack of options in a crisis, many Ohioans without immediate access to trained professionals when an episode hits. Families may go the emergency room or wait as the trouble deepens. When they seek an appointment with a psychiatrist? NAMI responds with a question: Can you imagine leaving a toothache untreated for nine months?

An appointment can be that tough to get. Which raises the larger problem of parity. The country has committed to treating mental and physical ailments the same. Insurers provide coverage for mental illness. Yet the trend has been to reimburse mental health providers at lower rates, leading, for instance, to shortages of psychiatrists, especially those for children.

NAMI wants to see mental health crisis centers in communities, open all day, a "central receiving center" where police officers and family members could take people in need of care. Unfortunately, in its recent Behavioral Health Review, the state missed the opportunity to elevate crisis care.

The third priority involves making available safe, affordable housing. That includes the care and services necessary to sustain treatment and recovery. The continuum is plain and logical, from crisis to rehabilitation center to long-term housing.

For its fourth priority, NAMI cites the need for improved early identification and intervention, especially in adding to the capacity of schools, professionals on site and insurers, including Medicaid, reimbursing for care provided there. Fifth, NAMI urges more attention to suicide prevention, particularly in a state where the suicide rate has outpaced the country the past two decades.

Actually, act on the first four priorities, and the suicide rate would track the wider turn for the better. And what would all this cost? NAMI proposes $75 million, or a relative pittance for a state that permits $9 billion a year in assorted tax breaks. Then, there is the impressive return on the talent rescued and lives saved.

Douglas is the Beacon Journal/Ohio.com editorial page editor. He can be reached at 330-996-3514 or mdouglas@thebeaconjournal.com.

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(c)2018 the Akron Beacon Journal (Akron, Ohio)

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