After years of deep cuts, mental health staff feels hope
When Harriette Munn stopped abusing drugs, her lingering mental illness and the traumatic memories of childhood sexual abuse flooded her reality.
By the numbers
For every 100 people, 5 have serious mental illness.For every 100 people, 20 have any mental illness (mild to serious).Mental illness is a leading cause of disability in the U.S.For every 100 inmates, about 16 have a serious mental health disorder. Only 60 percent of adults with serious mental illness had received care in the past year. Cost was the primary deterrent (44 percent).Source: Substance Abuse and Mental Health Services Administration, the Alliance for Health Reform, NAMI
For years, she'd masked her PTSD, depression and anxiety with everything from heroin to pain pills, whatever the numbing demanded and the streets gave forth. Homeless, she stayed with friends, in motels or on the streets. She went in and out of jail.
“I didn't want to get out of bed,” she said. “But I could if I took a pill.”
At least twice she tried to commit suicide and landed in a psychiatric hospital. But as each crisis passed, so did her involvement with the mental health system. She returned to drugs and homelessness.
Last year, she sat in a jail cell, forcibly sober and newly determined.
“I said, 'This is it. I'm tired of it. I want to stay clean,'” she said. “'I want my own home.'”
But there is none for her.
The Charleston Dorchester Mental Health Center used to operate four of its own group homes called community residential care facilities. But the homes closed due to severe budget cuts.
They are just one example of reductions in services and staff inflicted by a slumping economy and slashed budgets, said Deborah Blalock, the center's executive director.
Today, the Charleston Dorchester center operates with one-third less money and half the staff it had in fiscal 2004. The Berkeley Community Mental Health Center operates with 22 percent less money and 39 percent fewer staff members than a decade ago.
Yet centers like these across South Carolina are responsible for treating seriously mentally ill adults and children who are least able to access care otherwise. The vast majority of their patients are on Medicaid or among the working poor who lack insurance to pay for private mental health care.
And experts say such severe cuts cost taxpayers more in the end to house the mentally ill in jails and to provide higher levels of care as they become sicker with less access to care.
But community mental health workers feel renewed hope.
They saw their first budget increase last year when state lawmakers boosted the S.C. Department of Mental Health's funding by $18.7 million for the budget year that ends in June.
And now, the General Assembly is considering a budget proposal from Gov. Nikki Haley that includes $11.4 million more in mental health funding for next year.
“For two years now, we've gotten robust support from the governor and the General Assembly,” said Deborah Calcote, executive director of the Berkeley mental health center. “That's encouraging.”
It reflects a new nationwide focus on the mentally ill.
Since the horrific Connecticut school massacre six weeks ago, calls for better access and treatment have resounded from South Carolina's Republican governor to the nation's Democratic president. President Barack Obama has called for a national dialogue about mental illness, and new bills nationwide are trying to address various issues.
Experts caution, however, that new laws and funding should improve access to treatment — not further stigmatize the mentally ill as inherently violent.
“It's the good that can come out of these tragedies if we take a serious look at the needs,” Blalock said. “The mentally ill are often the victims of crime, not the perpetrators. It is a vulnerable population.”
More than a quarter of people with serious mental illness are victims of a violent crime each year, a rate more than 11 times higher than the general population, according to the U.S. Bureau of Justice Statistics.
That leaves many, like Munn, to endure the psychological aftermath of trauma while also grappling with their mental illnesses.
Costs hit us all
In May, Munn's mental health caseworker, William Cramer, found her a place to stay at Crisis Ministries homeless shelter where she has food, a bed and folks to help her out.
Costs hit us all
“The shelter has given her the most stability she's had, strange as that sounds,” Cramer said.
At 43, Munn's drug use has caused myriad health problems. She contracted hepatitis C and suffers circulatory problems that make it hard to walk. Yet, she could live fairly independently.
With her felony history, she presents too much risk for most landlords, including public housing. The mental health center no longer has its group homes. Private ones so far won't accept her, nor does she have money to pay for one.
She doesn't receive disability benefits (she has been denied twice and is appealing). She has no income or transportation.
And emerging from a lifelong drug cloud, she is facing her underlying mental illness and the nightmares about her past life and the abuse she suffered as a child. Psychiatric medications have helped, but she still struggles to sleep.
She talks to herself in the shelter's shower each morning. She tells God and herself that she must keep trying, that her life will get better.
“I've got to make it through another day.”
It's not just her battle.
The cost of uncontrolled mental illness in folks like Munn touches us all — in taxes and health care dollars to pay for jails, emergency room visits, hospitalizations and homelessness.
About 20 percent of all inmates at the Charleston County detention center now are prescribed psychiatric medication, according to the Charleston Dorchester center's forensics team.
The mentally ill appear to be arriving sicker to MUSC's emergency room. The hospital's 93 Institute of Psychiatry beds, which provide for the most-acutely-ill patients, are nearing capacity more often.
And readmissions — patients who are released but wind up having to return — are creeping up, said Steve Rublee, administrator of MUSC's mental health service line.
Some local mental health caseworkers have seen their patient rosters top 100, making it difficult to keep close tabs on those who suffer serious illness and to spot problems before they become severe.
The Charleston Dorchester mental health center's Mobile Crisis Unit sees the effects of all of this firsthand. The state's only psychiatric emergency response team goes out into the community to help people in crisis, often when police are called.
“With budget cuts, we're definitely seeing people more in crisis and ending up in ERs or jails,” said Esther Hennessee, the center's special operations director.
Few people were surprised when NAMI gave South Carolina's mental health system a D (along with most of the nation) on its most recent report card, citing severe budget cuts.
It's not just a problem in South Carolina. Mental health budgets nationwide have been slashed as the economy sputtered.
“It's probably not an exaggeration to say that it is a nationwide crisis,” Rublee said.
As Munn sat in a Berkeley County jail last year, she had a clarity that her drug abuse had not allowed until then.
At 43, she thought of her sons. She thought of how much she has let them down.
She thought of her own life, of her depression and the sexual abuse.
What if she had gotten help earlier?
It was too easy to slip through the cracks. Mental health workers didn't pursue her, she said, nor did she pursue them — until Cramer received her case. Along with the local Mental Health Court, he coerced her to seek and cooperate with treatment.
As mental health center staffs have dwindled, so have the number of experts able to treat and monitor patients.
For instance, at the Berkeley center, the administrator has become the back-up van driver and recently mopped the bathroom floors.
The center used to have its own vans to help patients access care. Not any more. They were too expensive.
But if there's one thing that keeps Calcote awake at night, it's knowing her staff must turn people away. If people are not seriously mentally ill, or if their needs are more short-term, the center lacks the staff to treat them.
Consider someone who has lost a parent and is still struggling a year later with grief but lacks the money or insurance to pay a private counselor.
“They aren't sick enough,” Calcote said. “That is a horrible situation, to start saying no. But we were at a point where we weren't serving anyone well enough.”
Today, the Berkeley center treats about half the patients it did a decade ago.
“People need optimal service to really recover so they can achieve things and be productive,” Calcote said. “What happens to that if the level of care is diminished?”
If lawmakers approve more money this year, Calcote wants to hire more clinicians, the hands-on staff who treat people.
Ideally, she'd like to see mental health teams available to go to schools, other clinics, anywhere they can reach people before they reach a crisis point.
“It doesn't have to be in these four walls,” Calcote said. “Would we go to Walmart? Sure. Access is the key.”
Taylor Crews sees first-hand what consistent care and recovery can mean for patients' lives.
One crisp recent morning, the mental health nurse pulls her state-issued van into a North Charleston public housing complex and rapped lightly on the door of a man diagnosed with serious schizophrenia.
A big guy with a teddy bear demeanor, Robert Martin shuffles along, leading her inside his tiny apartment. With a ginger pride, he shows Crews a certificate he received for 10 years of work at Goodwill.
Crews asks about his holidays, his upcoming week and his medications, all things that hint at his larger frame of mind. Then she explains, again, how to administer insulin for his diabetes and sifts through his myriad medications to be sure he is taking them all.
She notices one is low and calls in a refill. Cognitively, Martin doesn't grasp what to do when his medications run out. But with her help and a daily pill reminder box, he takes his medicine reliably.
In turn, he is able to live independently, socialize and work a few hours each day.
Donning surgical gloves, Crews gives Martin an injection of the antipsychotic drug that treats his schizophrenia. She checks his blood pressure and blood sugar. It all looks good.
With a smile and encouragement, she offers to get his refill for him.
“I don't want you to go without it,” she insists.
Crews is grateful that her job has escaped the budget cut ax. She is the only nurse from her center who takes mental health care directly to those who can live independently with help getting and taking their medications. Her patients don't drive and most lack the support at home to get to myriad medical appointments.
Without medication, they would become sicker and risk landing in an ER or jail or even become homeless.
It is a risk that grows in tandem with larger caseloads — a risk Crews hopes renewed calls for mental health funding with ease.
“People are stretched too thin,” she said. “We need to keep people out of the hospital and from decompensating because then it gets really expensive.”
At her next stops, Crews gives another schizophrenic man and a schizoaffective woman their injections, then delivers freezer bags full of complex prescription refills and pill planners to two patients, convinces a seriously depressed woman to try a socialization program and figures out an insurance payment problem for one who is about to go without her medication. Another patient isn't home.
Crews is finally about to head back to the office when her cellphone rings. Another patient's medication refill is ready. She zips over to the pharmacy to pick it up so he won't risk going without.
“It doesn't take very long to decompensate and wind up in the hospital,” she said.
And that is what she's trying to avoid — both to save money and to preserve her patients' quality of lives.Reach Jennifer Hawes at 937-5563 or subscribe to her at www.facebook.com/jennifer.b.hawes.