D. J. Jaffe taught me something that I had no idea about.
President Obama should focus any incremental expansions in social-service and health-care programs on those who need it most. Ninety percent of people with the most serious mental illness, schizophrenia, cannot work and therefore do not have private insurance — they rely on Medicaid. The new regulations will mean little to them. Medicaid reimburses states for roughly 50 percent of the cost of caring for the truly indigent. But an obscure provision of Medicaid law called the “IMD Exclusion” prevents Medicaid from reimbursing states for the care and treatment of people in state psychiatric hospitals. As a result, states bear 100 percent of the costs of state psychiatric hospitals and have learned that, by kicking people out of such institutions, they can get reimbursed by Medicaid for fifty percent of their care in the community. So kick them out they do.
A report I co-authored with lead author Dr. E. Fuller Torrey of the Treatment Advocacy Center found that, in 1955, ten years before Medicaid was enacted, there were 340 public psychiatric beds available per 100,000 Americans. In 2005, there were only 17 public psychiatric beds available per 100,000. In other words, the number of beds per capita dropped 95 percent from 1955 to 2005. We are now short over 100,000 beds for the most seriously mentally ill — and that assumes we had perfect community services, which we don’t.
That's pretty bad. If the President wants political wins, I think this is worth pushing for. It's something that seems like it would really help and—in the wake of mass shootings by mentally ill individuals—he has a good chance of getting the NRA and other groups to support it.