Imagine the outcry if patients with cancer or any other chronic condition lacked standard, appropriate care. Such ill treatment would not be tolerated.
Yet the U.S. health care system routinely fails to provide basic care to Americans with mental illness, says Patrick J. Kennedy, a former congressman from Rhode Island and co-founder of One Mind, an organization seeking new treatments for neurologic and psychiatric diseases of the brain.
For a series of articles in USA Today, Liz Szabo quoted Kennedy on mental health care in America: “The failure to provide treatment and supportive services to people with mental illness – both in the community and in hospitals – has overburdened emergency rooms, crowded state and local jails and left untreated patients to fend for themselves on city streets.”
The burden of inadequate mental health care falls on individuals and families, but also on emergency rooms, hospitals, jails and other institutions, making this topic well worth the rich and deep coverage Szabo and other journalists have committed to it. Such coverage is important, as reporters have found in Colorado, Idaho, Oklahoma, and Wisconsin, and it can be rewarding because it forces journalists to confront and explain some most challenging health care issues in our society.
In November, for example, The Denver Post ran a heart-wrenching four-part series, “Breakdown: Mental Health in Colorado,” written by Jennifer Brown and including photographs by Craig F. Walker and video by Mahala Gaylord.
“More than 50 years after states began shuttering mental institutions, the system hasn’t recovered — leaving emergency rooms, jails and shelters as last-ditch stops to handle the most severe cases,” Brown wrote. “Each year in Colorado, about 260,000 adults and children need treatment for the most severe mental illnesses — schizophrenia, bipolar disorder, major depression and serious emotional disturbances. Yet tens of thousands go without care; nationally, only about a third of people who need treatment get it.”
Many factors contribute to the crisis, one being higher health insurance payments to hospitals for patients with physical illnesses than for patients with mental illnesses, Brown explained.
Brown’s Denver Post series took eight months (although not full time), she said by email. One of the challenges was finding sources. “It took a lot of time to find the right people willing to share personal stories about something that still has so much stigma attached,” she said. “Since the series, these families have been overwhelmed with support from coworkers and friends who had kept their stories hidden.”
In October, Audrey Dutton, who covers health care for The Idaho Statesman, partnered with Emilie Ritter Saunders, a multimedia journalist for Boise State Public Radio, to write a five-part series: “In Crisis: Idaho’s fragmented mental health system.”
“Idaho’s mental health system is threadbare. It lacks resources — too few psychiatrists, too few options for Medicaid patients, too few 24-hour highly skilled treatment facilities for people with serious issues,” Dutton and Saunders wrote. “And, while Medicaid rolls swelled after the recession, Idaho didn’t increase its spending on mental health. The overall Department of Health and Welfare budget skyrocketed, while mental health got a smaller share. When Idahoans with mental illness go untreated and their disorders spin out of control, they end up in crisis care at an emergency room, a state hospital or a local jail.”
Szabo made a similar point, reporting that from 2009 to 2012, states cut $5 billion in mental health services and 4,500 (or 10 percent) of the nation’s public psychiatric hospital beds.
“States have been reducing hospital beds for decades, because of insurance pressures as well as a desire to provide more care outside institutions,” she wrote. “Tight budgets during the recession forced some of the most devastating cuts in recent memory,” Robert Glover, executive director of the National Association of State Mental Health Program Directors, told Szabo.
In Congress, Rep. Tim Murphy, R-Pa., a child psychologist, has introduced legislation to address some of these failings. Szabo quoted Murphy in her series: “We have replaced the hospital bed with the jail cell, the homeless shelter and the coffin. How is that compassionate?”
Last year, Jaclyn Cosgrove, a journalist who covers health, public policy and medicine for The Oklahoman, wrote a four-part series on mental health care in Oklahoma. Called “Gray Matters,” the series led Cosgrove to cover mental health more closely this year. As Brown, Dutton, Saunders and Szabo found, Cosgrove discovered the mental health care system failed to meet patients’ needs.
“It’s hard to understand why we lock people away in Oklahoma — and in other states as well. When I looked into the issue, federal data showed Oklahoma ranks second in the nation for adults with serious mental illness and second for adults with any mental illness. Data from Kaiser showed that in state funding per capita, we rank 46th,” she said. The federal statistics came from the Substance Abuse and Mental Health Services Administration and the state per capita spending data came from the Kaiser Family Foundation.
Meeting with individual patients made Cosgrove’s stories compelling, she said. Doing so led her to a reader who suggested an article about a man diagnosed with schizophrenia in 2010 who killed his mother last year. The story, “Did Oklahoma’s mental health system fail a man charged in his mother’s death?” ran in January. “It can be hard to get people to talk about mental illness on the record, but because I had written about it so much, people in the community trusted me,” she said.
After meeting with patients and other sources, she started a Facebook group for readers. Modeled on ProPublica’s Patient Harm Community, Cosgrove’s group has 322 members, including mental health patients, providers and advocates. Through the group she hears heartbreaking anecdotes from patients and family members. “That gives me a better narrative for my stories,” she said.
As Cosgrove learned, a series can lead to continuing coverage. That’s what happened with a four-part story last year by Meg Kissinger for the Milwaukee Journal Sentinel. Her series, “Chronic Crisis, a system that doesn’t heal,” showed that Milwaukee County’s mental health system focuses less on continual care and more on emergency treatment, causing patients to return again and again. One of every three patients treated in the emergency room of the county’s mental health system returned within 90 days, Kissinger reported. One woman was admitted 196 times in six years and police brought in another patient 10 times in a month.
For her work, Kissinger won a George Polk Award for medical reporting in 2013. The judges described her articles as being, “so revelatory, analytical and conclusive that they amount to a definitive study of a system that barely functions.” Her 2011 coverage of shortcomings in the state’s mental health system won first place in the health policy category of the Awards for Excellence in Health Care Journalism.
On Nov. 21, Kissinger wrote one of dozens of follow up articles, “Program to help mentally ill in home begins to show results.” This week, she’s followed the case of Scott Panetti, a Wisconsin native diagnosed with schizophrenia in 1978 and hospitalized 15 times over 14 years. In 1992, he killed his wife’s parents in Texas during a psychotic delusion. His execution by lethal injection was scheduled for Wednesday but a federal court issued a stay based on questions about his competency.
The Tulsa World has just launched a series, “Hitting Home,” that looks at mental health, how it can be intertwined with homelessness and how it affects our community. Stories published so far look at children with mental illness, the prevalence of mental illness in the state and how the business and social services community might address the problem. As AHCJ member Shannon Muchmore reports, one in five Oklahoma adults have a mental illness. In a video, managing editor Mike Strain and staff photographer Mike Simons discuss the series.
