Over and again on the Web there are calls for more long term mental hospitals whose costs would be covered by Medicare and/or Medicaid, which do not pay for long term hospitilizations now.
Individuals in mental hospitals do not hold long term mental hospitals are asylums but would rather be Anyplace But Here, which is the name of 1979 documentary by Bill Moyers. Moyers investigates a long term mental hospital is 1979 which is not one of the snakepits of the first half of the 20th century still no one wants to be there. The hospital is overcrowded and underfunded. Patients can be attacked both by other patients and by staff. There is no freedom. Indivduals in long term mental hospitals become totally dependent on the hospitals. The Moyers documentary is fair and does not present then available community treatment programs as anywhere near perfect.
Medical costs keep growing and growing in the US. Costs of long term mental hospitals would be a lot, lot more now than in 1979. There will be huge budget deficits for the foreseeable future. Cost savings are said to obtainable by cutting programs for the ‘worried well’. These programs are not going to be cut. Given that Medicare and/or Medicaid paid for long term hospitilization costs would rapidly balloon as there would be massive attempts to place individuals into long term care. Advocates argue than only the sickest individuals would be placed in long term care but who is the ‘sickest’ would depend on family dynamics, different allowances between jurisdictions for strange behavior, whether corporations could be reimbursed where corporations would have armies of attorneys arguing corporations should be reimbursed and that two or three years in a ‘caring community’ could be bring lasting change, the personal predilections of psychiatrists sitting on boards deciding as to long term hospitilizations, whether or not patients take to the total treatment programs of mental health clinics etc. Simply due to terrific cost increases there is a high probabilty that ending the Medicare and Medicaid exclusions for long term mental institutions would result in the return of the snake pits of the first half of the 20th century which the taxpaper would foot the bill for.
Homelessness is a huge problem for individuals with major mental illnesses. Housing First is a solution that works. Housing First is the low cost solution and is good for individuals with major mental illnesses. Individuals with major mental illnesses who reject treatment may not so much be rejecting medications, which are the cornerstone of treatment, but rather could be rejecting the more or less total loss of control that can come with being in the belly of the mental health system. With housing and some gain of control individuals with mental illnesses could be more accepting of parts of the mental health system that work for them such as medications.