Thoughts on the slaying of a psychiatrist in 2008

Cure The System, Treat The Patient

February 17, 2008

A recent incident in which one mental-health provider in private practice was slain and another seriously wounded in New York City [News, Feb. 14, "Doctor Hacked To Death In Office"] should stimulate outrage at the systematic dismantling of our mental-health system caused by cuts in funding for programs serving the seriously mentally ill.

Over the past few decades, thousands of individuals lost access to long-term treatment when states eliminated hospital beds to shift costs onto an overburdened Medicare and Medicaid system, pushing increasingly ill patients onto an ill-equipped private sector.

Private insurers have reduced hospital lengths of stays to dangerously short periods. Even if patients could afford to pay for longer stays, these hospitals had to modify their programs so that little if any therapy occurs.

Advances in psychiatric treatment have been dramatic and inspiring. Severe mental illness, however, is associated with actual loss of brain tissue. New treatments help to re-grow brain cells, but this can't occur if patients return to the same environments that triggered their episodes.

Our haphazard medical system pays for procedures costing hundreds of thousands of dollars to prolong someone's life for several months. But it denies payments for respite and psychiatric rehabilitation services at a fraction of the cost that may restore patients to normal levels of function.

The failures of this inequity are seen in tragedies reported in New York and in cities around the country. The irony is that society pays the costs in increases in crime, swollen prison populations and lost job productivity.