Holes in the Safety Net

I feel the need to bitch about the state of Massachusetts Mental Health system.

It works as though the Powers That Be sat down and said, "How much money can we spend and not actually solve any problems?" and went from there.

A few years back, they closed all the state hospitals. This basically meant finding all the mental patients to be cured and shoving them back out on the street. It was a cost cutting measure.

OK, fine. If we feel that "this ain't no hippy commune, you're on your own," that can work. Not exactly compassionate, but a valid philosophy.

Here's the rub. We still pay for it, we just don't get results anymore.

As an example, we got a call to respond to the phonebooth outside McDonalds for the man who was having suicidal thoughts. Fair enough. We headed out, finishing our coffee en route, because I'm not dumping out my $1.97 worth of caffeinated happiness for some guy who can't handle life's slings and arrows, and we find this gentleman at said payphone.

He has evidence of bilateral Samsonite Sign (suitcase in each hand), and wants to go to a Holy Family hospital, which is farther than the town hospital we normally use.

Me: Why the Hole?

Him: I was just there *hands me envelope of discharge instructions*

Me: *scanning papers* OK, you were released from the mental health floor yesterday. Have you been taking these meds?

Him: No.

Me: Ok. Have you called this doctor for follow up?

Him: No.

Me: O....K... So, what's going on today.

Him: *recites list of symptoms exactly identical to those outlined on his discharge instructions*

Me: So, pretty much the same thing that was going on before you were hospitalized.

Him: Yes.

Me: And this is their recommended solution, and you aren't doing it.

Him: *Long, "life is complicated" soliloquy. No ride to the pharmacy, can't make his doctor appointments, etc.*

Me: Uh-huh. So what do you want to go back for, if you're not going to follow the instructions?

Him: Oh, I was fine when I was there. I was at McLean's (another mental hospital) twice this month, then I was at Holy Family, and I'm fine when I'm there.

Me: *Reads more of his paperwork, finds that he was at McLean's from the 12th to the 16th, back from the18th to the 23rd, out for four whole days in the wicked world, then at the Hole from the 27 to the 29*

So, did McLean's talk to you about some follow up or a discharge plan?

Him: Yes, but *life is complicated soliloquy resumes*

Me: *aware that partner wants to get lunch soon* OK, hop in.

Clearly this guy cannot take care of himself out in the real world. Medicaid will pay for a 4 day stay at a short term psych ward, then he'll be given THE SAME FUCKING instructions, and sent out, so he can call me long about the 5th of the month to take him back.

Now, the guy has issues. Just looking at him and talking to him, he's not one of the guys who games the system and has a breakdown two days before the rent is due so he can live for free for a few days. He has real, honest to God issues. He does ok in an institution where they monitor him and make sure he gets his meds. So well, that they boot him out in four days with a list of follow up stuff.

But, he can't hack, and needs to go back.

Now, when we had this guy in a state hospital, it cost the taxpayers money. But now, in three weeks, it's cost them four ambulance rides, four ER visits, and sixteen days of stay at mental hospitals, plus the benefits he gets while on the outside for food and housing. And, guess what, It doesn't work. He's still just as nuts as he was last month.

Now, to put him in a facility long term, and make sure he can handle outpatient treatment before his release would be an expensive solution. Bopping him on the head and dropping him in the river would be a cheap solution. What we are doing is an expensive lack of solution.

God, I hate the way the government saves me money.