Use mental health funds more wisely

By Dr. Alan Whitters

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There have been several articles and editorials regarding mental health and criminal behavior (e.g., Clark Kaufman, June 20, “Advocates: Many share blame for suspected rapes,” and Carroll Edmonson, July 11 guest column, “Magistrate ruled on information presented”).

I am the psychiatrist for Cedar Valley Ranch (Benton County) and Penn Center (Delaware County) and was previously at Abbe Center for Community Care (Linn County). I continue to work in psychiatric settings both as an inpatient and outpatient psychiatrist, since 1985.

Over these past 26 years, I have seen the elimination of psychiatric beds both at Iowa's mental health institutes as well as at our general hospitals. “Deinstitutionalization” has seen the fall of our psych beds from more than half of all hospital beds to levels unseen since the mid-1800s.

The positives of local care seem pretty clear-cut. Families are more proximate to their loved ones in a local supported environment. Many patients with chronic mental illnesses have been able to work in either structured or competitive settings. Moreover, there is a normalization of the individual's life.

However, there are limitations and downright negative aspects. Our county care facilities have become the new MHI with ever-increasing psychiatric severity. Admission to psychiatric hospital has become a lottery system of care.

Due to lack of psych beds, we have had to send patients as far as Omaha or Minnesota. Many times, our suicidal and psychotic clients end up on a waiting list, never able to receive needed treatment. Might that be a reason as to why half of our prisoners have a serious psychiatric disorder? Currently there are three times as many psych beds in prison than in hospitals.

There are solutions that other countries have successfully utilized. I worked in New Zealand last year where I observed a coordinated system with extensive inpatient (never full) and outpatient (including strong case management and residential) support. While New Zealand is relatively poor, appropriate mental health care was deemed a right and a responsibility.

Commitment laws allowed for easier involuntary treatment for patients without insight. Specialized treatment facilities ensured that violent and sexual offending patients were not housed with other vulnerable patients. Their drug formularies were nationalized with understandable criterion that allowed psychiatrists to prescribe needed treatments immediately.

We need to spend better, not necessarily more.

Dr. Alan Whitters of Cedar Rapids has practiced psychiatry for 26 years. Comments: alwhitters@yahoo.com