JoCo Mental health failures
Two decades ago the nation’s health care scholars established a blueprint — a set of litmus tests — for community mental health care. It was in the newspapers and everything.
Not everyone paid attention. Nowhere is this failure to follow the lead of modern medicine more vivid than in America’s upper middle class — the affluent suburbs. Consider Exhibit A — Johnson County, Kansas. Ninety-six percent of all Johnson Countians consider it a great place to raise a family, according to a Board of County Commissioners report. The commissioners don’t indicate how many folks consider it a great place to be treated for depression or bipolar disorder, which is to to be expected from officials who use the word “infrastructure” when measuring quality of life.
Mental health Litmus Test #1 was cited by a 1999 U.S. Surgeon General Report. You can look it up. The test looks for the existence of a local “surveillance: system that tracks the incidence of depression, suicidality and other emotional disorders in local population. One cannot reach the countless mentally ill persons in a community if nobody bothers to count them. One cannot discount the possibility that established surveillance methodologies were too confusing or awkward for Johnson County’s leadership.
The well-educated often prefer mathematical shortcuts, which, for all we know, can be accomplished by wild guesses or taking photographs during the county’s annual Old Settlers Parade. The county mental health department calculus involves yet another twist. The department uses national percentages for mentally ill children and adults and then applies them to Johnson County. Sounds like something your kids would do, right? Imagine there were no local weather forecasts, only a national weather “average” published for all 50 states. Imagine using these forecasts to plant crops. Imagine using such forecasts to decide what to wear to work tomorrow. While you’re at it, imagine that the Board of County Commissioners has better data on the number of QuikTrips in town than the number of mentally ill residents and suffering loved ones.
Mental Health Litmus Test #2 involves the number of local inpatient psychiatric hospital beds. This number is so easy to calculate that almost no one ever does it. The inventory of psychiatric hospital beds is important because — and here we must get technical — the seriously mentally ill often require hospitalization. Shawnee Mission Hospital has 44 psychiatric beds, which are nearly always full. Forty-four beds that are never available counts as zero beds if your loved one attempted suicide last night. The only other Johnson County inpatient psychiatric beds are found Cottonwood Springs in Olathe, which has just more than 70 beds. These, too, are always in demand because, hey, there’s no room at Shawnee Mission and hardly any of the local QuikTrip’s accept Medicaid payment.
Olathe Medical Center, southern Johnson County’s gleaming pride and joy, offers zero psychiatric beds at all. If the police arrive at the emergency room with a patient suffering a bipolar episode, the patient may be kept for brief observation of his insurance benefits. Then he is shipped across ton to Rainbow Mental Health in Kansas City, Kan., which, frequently overcrowded, may ship the patient to Osawatomie State Hospital, which, frequently in disarray, claims it cannot find psychiatrists to hire. A psychiatric hospital without psychiatrists is a situation beyond the reach of humorous metaphors.
That puts the supply of psychiatric beds in Johnson County of — population 550,000 — somewhere between zero to 115. Availability will very on weekends versus Monday trash pickup night. The acceptable national minimum is 50 beds per 100,000 residents.
Thus far, one is tempted to say that Johnson County is failing its mental health litmus tests, but such finding seems prematurely harsh. It depends on who is keeping score and what is being scored. Until further notice, the tally is a 0-0 deadlock. One “0” belongs to those community leaders who claim, without defense, no knowledge of the solutions. The other goose egg belongs to those who, having knowledge, have refused to act.
Such mental health litmus tests must proceed with vigor in Johnson County and other communities where voters want to inspect the line between what has been done and what should have been done by now. Mental health litmus tests mark the end of anonymity for those responsible. It ushers out the era of “blamelessness.” There now exists worldwide — from butcher to baker to candlestick maker — a consensus that emotional disorders can be identified early, and fatalities prevented. When the preventable is not prevented, let the blame throwing begin. Let names be named and fingers be pointed. Questions will be asked and the answers will be questioned.