The Magic 5:1 Ratio
California considering law to ban smoking in vehicles with children present

Emergency Rooms burdened with Psychiatric patients


In the May 10th, 2004 issue of the US News and World Report, there is a short article describing how the lack of psychiatric services is burderning hospital emergency rooms which in turn makes it more difficult to deliver medical care to other patients in emergency rooms.

Having worked in mental health for over 35 years, I witnessed, and worked in one of the finest systems ever built when the Community Mental Health Centers Act was finally implemented in the late 70s and 80s where there was federal as well as state funding for five essential services: outpatient, inpatient, partial hospitalization, emergency, and consultation and education. In order to qualify for federal funds, a Community Mental Health Center had to provide these five essential services and serve a defined catchment area of 75,000 - 200,000 people. It was an exciting time because this model worked providing excellent care to individuals and communities. Then the feds cut their funding, and states cut theirs, and the HMOs started restricting authorizations for care, and the system fell apart. Now we are at a point where things are a mess and it is having negative repercussions on the delivery of other health care services.

It is funny how short our memories are because we had a system that worked well.

Politicians respond to the squeaky wheels, and well oiled wheels that work well don't squeak. When they don't squeak the politicians and the voters don't think there is a problem so they start cutting and dismanteling programs that are preventing those squeaks. Eventually, they start to squeak again 20 years later, and we have to start all over again.

This observation makes me cry, and then my cynicism kicks in and I laugh through my tears. They say it is better to laugh than to cry, but I still cry for the good work that my colleagues and I did in the 60s, 70s, and 80s, and I watch it crumble. Then a new generation stands around and wonders what happened!? They have no idea because it was taken for granted. What is the old saying about history being doomed to repeat itself when people are unaware? Emergency of the mind (5/10/04)


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