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Profit motive and mental health care in California

Original source:

The Sacramento Bee
APRIL 12, 2016

California long ago moved severely mentally ill patients out of state hospitals, reserving the institutions for those who have committed crimes.

But with little public discussion, the state has privatized care for some of the troubled people who in an earlier day would have been institutionalized at Napa State Hospital or some other state hospital.

Although many mentally ill people wander the streets untreated, others live in nursing homes, and that can be dangerous for other residents, many of whom are physically frail or elderly, as shown in a report this month by The Sacramento Bee’s Marjie Lundstrom and Phillip Reese.

Nursing home operators have a financial incentive to fill beds, no matter the patients’ diagnosis or whether the staff and facilities are equipped to deal with addicts, parolees and those who are severely mentally ill.

Nursing home owners receive an average of $195 a day per patient from state Medi-Cal, and up to $800 a day under federal Medicare. But profit motive and proper care don’t readily mix.

Lundstrom and Reese reported that a 46-year-old patient with mental health issues attacked a 91-year-old resident at Chino Valley Health Care Center. The victim was rushed to a hospital but didn’t survive. At Bakersfield’s Corinthian Gardens Health Care Center, a resident told state inspectors her roommate, diagnosed with schizophrenia and bipolar disorder, threatened to “slice my throat open with a knife while I slept.”

Lundstrom and Reese detailed how Courtney Cargill slipped out of the South Pasadena Convalescent Hospital, doused herself with gasoline and lit herself on fire.

In 1999, The Los Angeles Times reported state officials could not say for sure how many mentally ill people were housed in California’s licensed nursing homes. Not much has changed.

The California Department of Health Care Services, which administers mental health programs, does not keep data on the number of residents who are diagnosed with mental illness. Nor does the Department of Public Health, which inspects nursing homes. It’s as if officials are willfully ignorant of the issue, until something terrible happens and they can no longer ignore it.

The Brown University School of Public Health collected data showing the rate of schizophrenia and bipolar disorder in California nursing homes increased by about 60 percent from 2000 to 2014, to 1 in 7 residents, fourth highest in the nation, The Bee reported.

If the state doesn’t know the size of the population, or in which nursing homes they are housed, it will never be able to set standards for their care, or hope to keep them and other residents safe. This issue is overdue for legislative oversight, unless, that is, policymakers would prefer to avoid reality.

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