HCI3 Update From The Field: Locking Problems Away Does Not Solve Them

Submitted by francois.debrantes@hci3.org on Friday, February 21, 2014 - 12:49

Newtown, CT – February 21, 2014

It's often more politically convenient to lock away some problems than to deal with them, and that certainly is the case today with the mentally ill – As reported in September by the WSJ and more recently in the NYT, many jails and correctional facilities around the US have turned into the 21st century's version of Arkham Asylum…or, more to the point, Fairfield Hills. Built in the early part of the 20th century, Fairfield Hills in Newtown CT became the state's premier mental health hospital and housed a number of the then-labeled criminally insane. Like most facilities of this type, it was closed down in the mid-1990s and, since then, patients who would have found themselves committed to that facility are instead convicted of various crimes and recidivism and sent for long terms in prison. Shortly before Fairfield Hills was shut down, the Garner correctional facility was built on its back hill. In a twisted irony, Garner has slowly turned into the prison for the mentally ill of Connecticut. And so a stone's throw away from the prior facility sits another, tucked away from sight. The cost of keeping an inmate in prison is roughly $60K and many of these mentally ill prisoners will be in for a long time given the way they are cared for. Which brings us to another Connecticut quirk. Years ago, in the happy days of easy patronage, the CT Department of Corrections gave the charge to the University of CT's Medical Center (UCMC) of providing health care services to all inmates in the state. This year, the check is for $90 million. It's a capitated fee that includes all professional and ancillary services but excludes hospitalizations. If an inmate is hospitalized for any reason, they are immediately enrolled in Medicaid and the costs of the stay (including professional services) are borne by Medicaid and reimbursed by the federal government… the taxpayer pays either way. UCMC performs its own utilization management, deciding whether inmates qualify for specific treatments. It also self-reports self selected metrics of quality care. You can't design a worst set of incentives and we're paying as big a price for this lunacy as are the inmates.

What this means to you – As a society, we've pretty much decided that mental illness is not a subject to address. Employers carefully carve out these services to a separate administrator, which stops patients who need it most from getting truly integrated care. States refuse to deal with the challenge of the mentally ill and simply dump them into prisons at an exorbitant cost to the patients and society. In CT, insult is added to injury by allowing one provider a free lunch on the backs of taxpayers, and essentially preventing any oversight on the quality of care provided to regular inmates as well as the more vulnerable. What chances do any of the mentally ill inmates have to reintegrate society as useful contributors? None. And that's the tragedy being played out. Great strides have been achieved in treating mental illness, but the lack of integration with other aspects of medical care is likely one of the reasons why we read of repeated tragedies of senseless killings. The black hole that has become the medical treatment of prisoners have thrown us back into the dark ages and it's time that light and clarity penetrate that darkness. Employers need to carve mental health care back into the routine of medical care, and states have to address the quality of the care received by inmates if we hold any hope that human beings can and should be treated with equal dignity. The cost in blood and treasure has become far too great to simply lock this problem away.