Jail, ER spending traced to systems shortcomings
CHARLES TOWN – An expert panel told the League of Women Voters Monday that the Eastern Panhandle is in desperate need of a comprehensive system to address drug addiction and untreated mental illness.
The panel consisted of Jim Gaynor, CEO of Grafton Integrated Health Network, Paul Macom, president and CEO of EastRidge Mental Health Systems, and Jim Auxer, vice president of primary care with Eastern Regional Jail.
Auxer said a lack of addiction and mental health services is causing jail overcrowding. He said that, in his estimation, between 85 and 90 percent of inmates he sees have either drug addictions, mental illnesses or both.
“Making people do more time doesn’t keep them from doing drugs, and certainly doesn’t help with mental illness,” he said. “They need help before they come to jail. You have a mentally ill person or an addicted person – who can they call to get somebody to come out and help them? Those people often don’t have insurance.”
Those with mental illnesses often wind up in jail when as a consequence of their symptoms.
“People with Alzheimer’s are going to jail,” he said, explaining that they are sometimes arrested for obstructing an officer when they become confused and combative.
Among the most pressing needs, panelists agreed, is an inpatient facility capable of both substance abuse and mental health treatment. The nearest such facility is in Beckley, Auxer said.
Macom said EastRidge is currently looking for a site at which to operate an eight-bed inpatient facility – many fewer beds than he said are necessary to address local needs – which is projected to cost $750,000 a year.
“The nitty-gritty is money. Period,” Macom said. “We can’t establish a treatment facility, we can’t sustain a treatment facility without funds.”
Macom said mental health treatment belongs in a “continuum of care,” that begins with starting with detox, then moving to a residential facility, and finally transitioning the person into the community.
“However, success is highly dependent – almost totally dependent – on what happens when that individual leaves the brick-and-mortar facility and go back into the community,” he said. “If they go back into the same physical and social environment, they will fail nine times out of 10.”
Macom said the existing system virtually guarantees that addicts will return to drug use. “They leave the jail – no job, no food, no clothes, no money, no place to live – so they do go back … to their families who often have a history of drug addiction, alcoholism and/or mental illness.”
Patients, Macom said, need “intensive after-care with almost daily face-to-face contact.”
“Not only do we have to be concerned about their use of substances, we need to be concerned about appropriate living arrangements. We need to be concerned about employment, vocational goals, spiritual goals, the whole package,” Macom said. “If we take away any piece of that, then we increase the likelihood of failure.”
Macom said that substance abuse treatment programs might be able to achieve a 50 percent success rate if a commitment is made to providing comprehensive, integrated care.
Gaynor said that, although the price tag of inpatient facilities may seem high, the costs associated with treating addicts and the mentally ill only through emergency rooms and the prison system are much higher on health care consumers, taxpayers and the community.
“It is costing everybody a hell of a lot of money to not have the right system in place,” Gaynor said. “We spend 19 percent of our gross domestic product on health care; that is almost six Pentagons.”
Gaynor said building the system for mental health care correctly would be an investment in the community, rather than an expense to it.
He said current treatment of substance abuse and mental illness often centers around emergency rooms, which he said is costly and ineffective.
“If there is a bed and they have insurance, they get in,” Gaynor said. “If there is a bed and they have Medicaid, they get in. If they are indigent, they get a bed if there are any beds left and it doesn’t disrupt the payer mix, which is kind of a sorry state of affairs, but that is just how some of the payments and incentives are so misaligned in the current health care system.”
Gaynor said the Affordable Care Act took some steps to promote a more integrated approach to patient care by penalizing hospitals with high readmission rates.
“No health care reform is going to be successful without more and more seamless integration across multiple levels of care,” he said. “They’re going to start paying a price for recidivism.”
Gaynor also said that promised grant funding from the program had been used for political ends, however. He said Grafton had nearly won a $30 million federal grant, but, in the end, most grants went to large hospitals and research institutions in swing districts.
Sheriff Pete Dougherty said the Sheriff’s Department has to dedicate substantial man-hours and resources to mental hygiene cases in which a judge has deemed that an individual is in imminent danger of harming him or herself, or another person.
“The problem is that the assignment system is such that it is the next available bed, no matter where it is in the state,” Dougherty said. “And so lots of our transportations … are (to) Huntington, Charleston, Beckley, Bluefield, Princeton.”
Dougherty said that his department has invested around 1,800 man hours and 1,600 miles of driving dealing with such cases this year alone.