The mental health system is fragmented, complicated and has been since the 1980s when deinstitutionalization occurred without the funding to replace it.
That said, Chuck Clark, president of the Parkview Behavioral Institute and CEO of Park Center, sees hope for people with mental illness and their families with a new statewide initiative that began with the rollout. of the federally funded 988 program.
Essentially 911 for people on the brink, state and local officials hope 988 will be a triage for suicide and mental illness. It will provide hospitalization if necessary, treatment and, in some cases, help during a telephone call. The 988 program is seen as a way to reduce the prison population and serve people better.
Clark spoke at the weekly Legislative Meeting of Allen County Commissioners by invitation as part of the Commissioner’s Weekly Jail Update. The county is building a new jail that would include a mental health facility, something along the lines of what Marion County has done.
The stumbling block has been money for sanity
With at least 44% of inmates having mental health issues, prisons have essentially become mental health facilities, say Clark and others. However, it is the coordination of treatment and its payment that has been so difficult in the decades since President John F. Kennedy decided to close mental health facilities in the 1960s and direct the money to other options.
Mass institutional closures in the 1980s left communities and prisons on their own without promised funding. With community and legislative resolution, the problem is being resolved, says Clark, who spoke to WANE 15 after the meeting.
Interview with Chuck Clark, President of PBH and CEO of Park Center
Here are some answers to our questions.
DECLINE 15: What roles do Parkview Behavioral Health and Park Center play in local mental health?
Clark: “Parkview Behavioral Health (PBH), as it is known, is an 89-bed inpatient facility. In total, PBH has 124 beds.
“The only place we take people directly from prison is to the Park Center, which is a substance use disorder treatment program, a 30-day residential facility. At PBH on Beacon Street, most of these people go through the emergency department or are referred by a professional.
Police take people to Parkview Randallia ER
“More than 2,000 people a year come to the Parkview Randallia emergency department, brought by police for a psychiatric assessment. The officers determine that rather than arresting this individual, they believe it would be preferable for this individual to undergo a psychiatric evaluation.
“When an officer brings someone to the emergency room for a psychiatric assessment, we have assessors who come through there, talk to a psychiatrist about whether a hospital admission is necessary. If that person doesn’t want to be admitted but the doctor thinks they should be, then there is a decision to be made – are they a danger to themselves or to others? Thus, the doctor could decide to detain for 72 hours.
“If they don’t meet those criteria but still need inpatient care, it’s really the choice of the individual or the patient whether or not to pursue that care. They can just choose to leave the emergency department. I know it’s frustrating for officers because they think they brought that person in for help and that person didn’t ask for help.
People have rights and it’s always a choice and the exception to that is if a doctor thinks they’re such a danger to themselves or others that they need to be hospitalized, Clark said.
Watch 988, 911 for mental health crises
DECLINE 15: How will the federally created 988 program improve mental health treatment?
Clark: “In a mental health system that has been very fragmented, people often don’t know what to do when a loved one is in trouble. And so the only thing they know how to do is take someone to the emergency room, which is not always perfectly adapted to take care of people suffering from psychiatric disorders.
“So instead, we are going to 988, 911 for mental health. It really allows someone to make a phone call, talk to someone about what I’m doing, whether I’m in a crisis, feeling a little depressed, or just depressed. Or maybe I have a loved one in an acute crisis. What do I do?”
“It’s been done in other parts of the country, 988, and actually 80% of calls are resolved on the phone or someone doesn’t need to go to hospital. And then they can set up care for them on another site on another day.
DECLINE 15: Where are we with the 988?
Clark: During the rollout of 988, most regional providers were identified, but implementation is underway, Clark said.
“In any situation, the earlier you intervene, the better. This means “the more you do to press the easy button to get help, to talk to a professional, to guide you or your loved one through the system”.
It’s complicated – the system – and there are so many types of providers and so much stigma around mental illness. For many people, there is a reluctance to talk about it.
DECLINE 15: Where are we with future prison mental health services?
Clark: “One of the big obstacles today to providing services in prison is that there is no way to be reimbursed for it. And in a community mental health system whose resources are already stretched thin, putting significant resources into the prison without any reimbursement makes the task even more difficult.
Look for community behavioral health clinics
The state is hoping to move to certifying community behavioral health clinics and that would be more like federally licensed community mental health centers and that will change our funding so we can deliver services in prison, expand what we do throughout the criminal justice system and actually receive reimbursement for it.
Clark says the word “clinic” is confusing, but if you are a CCBHC-accredited Community Behavioral Health Clinic, it indicates that certain access and service standards have been met and there is a response team. associative mobile.
“It creates a lot of standardization and a lot of your primary clients or stakeholders that you serve are the criminal justice system and work with people inside the criminal justice system.”
So what’s the deal with mental health drugs in prison?
DECLINE 15: If there is medical care in the prison, what is the problem? Why are inmates not being treated and getting their medication?
Clark: “I think there’s a Medicaid formulary, which if you think about it, people with severe mental illness and taking particular drugs in the community, let’s say they stop taking those drugs, stop taking them take, have complications and end up in jail. The formulary inside the prison is very narrow and often they cannot get the drugs they bought outside. And so that has an impact on their care.
DECLINE 15: Why is that?
Clark: “Cost.” Clark said he wouldn’t name any particular medication and instead wanted to defer to a psychiatrist.
Note: Allen County Jail’s medical provider is Carmel-based Quality Care Control, Inc., a for-profit company that has contracts with more than 75 of half of the state’s jails.
QCC relies on drugs that don’t require a second opinion, Scroggins told WANE 15 on Friday.
“Indiana law allows for therapeutic substitutions to save county taxpayers, but never impacts care. A form is standard practice. When the nurse enters the order, it goes to the medical director and if it’s not a form, he has to sign it,” Scroggins said.
Some cheaper drugs are easier to find once an inmate leaves prison and will help keep the offender clean. The real problem is that offenders lose their Medicaid coverage once they’re jailed, and once they’re out again, it can take up to 30 days for benefits to resume, Scroggins said.
Medicaid benefits shouldn’t end with incarceration
“If we really want to reduce recidivism in prisons, why are benefits taken away from someone when they enter prison if they are on remand and innocent until proven guilty? ” said Scroggins. She mentioned that it was part of her “soapbox” that Medicaid benefits should continue for continuity of care.
“If somebody can afford bail, they don’t lose their benefits,” Scroggins said. “If they’re in jail for more than 30 days, they lose their benefits. We are only creating hardship for a very vulnerable segment of the population.
To defend his business, often criticized by inmates and their families, Scroggins says QCC has launched a non-profit Q360 Health Care Alliance which now has a presence in around 50 counties and a mobile dental service which will provide a range of health care services. dental and preventive.
“Some people haven’t had their teeth cleaned in 30 years,” Scroggins said.
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