Guy Reynolds, a previous Winston-Salem photographer has died. Reynolds was a friend of a friend of Linden Lodge. He recently beat cancer, he was a Pulitzer award recipient for his photography, and he worked for many years with The Dallas Morning News. Guy Reynolds also lived with Major Depression. In the end, no matter how much had been accomplished in his life, Reynolds still fell victim to an invisible illness. Our hope at Linden Lodge is for this amazing man’s life to live on through his beautiful photographs and to bring awareness to Mental Illness.
Major Depression in particular affects around 16 million adults in the US alone. Major Depression causes severe symptoms that affect everyday life. Personal hygiene, sleep, work productivity, and eating habits can all be affected by depression. Major Depressive Disorder is treatable. To learn more about Guy Reynolds, check out this article from artsandseek.org. To learn more about Major Depressive Disorder please visit the National Institute of Mental Health.
Wondrous are the ways of Washington. In a single day, the federal government officially reduced the number of people with schizophrenia in the United States from 2.8 million to 750,000. With a change of the National Institute of Mental Health website in 2017, two million people with schizophrenia simply disappeared.
The 2.8 million estimate, or 1.1% of the adult population, had been the official standard for the U.S. since the 1980s, when the last major prevalence survey was carried out. The figure was provided to Congress in 1993 and used for national estimates such as the cost of schizophrenia.
NIMH Director Joshua Gordon wrote in the Psychiatric Times that “the 1.1% figure is no longer scientifically defensible” in view of “the most recent findings.” These findings come from a 2001-03 National Comorbidity Survey, which included only those who lived at home and acknowledged symptoms of schizophrenia. It excluded those in hospitals, nursing homes, group homes, jails, prisons, homeless shelters and on the streets. Nor did it include the people with schizophrenia among the 29% who refused to participate in the survey.
In short, the 750,000 estimate, 0.3% of the adult population, was an absurd undercount, obvious to anyone with knowledge of the subject.
Why would a federal health agency want to make two million patients disappear? Welcome to Washington. Administrators spend a lot of time trying to make their agencies look good to the public and especially to Congress, which controls the purse strings. In 2006 Congress ordered the National Institutes of Health to make public how much they spend on each major disease. These figures, along with the number of people affected by each disease, allow anyone to determine quickly the NIH’s research expenditure per patient with schizophrenia, autism or any other disease, and compare them. It can be argued that the quality of the research portfolio is a better metric than expenditure per patient, but the latter is what most advocacy groups use.
In 2016 NIMH spent $254 million on schizophrenia research. With 2.8 million people affected, that was only $90.71 a patient. NIH expenditures for Alzheimer’s disease were $162.98 a patient ($929 million for 5.7 million people) and Parkinson’s disease commanded $173.12 a patient ($161 million for 930,000 patients as of 2020).
This imbalance created a problem for the NIMH. There were two ways to “solve” it: by spending more money on schizophrenia research or by reducing the number of people with schizophrenia.
Thus two million people with schizophrenia disappeared from the figures and voilà—expenditure per patient soared. Even though schizophrenia research funding fell in 2017 to $243 million, the NIMH can now claim to spend a mouth-dropping $324 per person. Call it a Washington victory for schizophrenia patients.
Dr. Torrey is associate director for research and Ms. Simmons is a research associate at the Stanley Medical Research Institute.
Hallelujah! This can have a major impact on our area, both locally and statewide, and on the population the Linden Lodge Foundation supports and serves. Please check out the news below and consider making the pledge to support more access to inpatient beds.
This week marked a milestone for our efforts to reduce the preventable tragedies caused by the lack of inpatient treatment and encourage #aBedInstead.
The United States now has fewer state psychiatric treatment beds per capita than any other time in our nation’s history. Without necessary beds, those in need of care experience delayed treatment, unnecessary crises, rampant criminalization and countless preventable tragedies. In 2016, the Treatment Advocacy Center launched our #aBedInstead campaign to bring light to this crisis and demand change.
On Tuesday, Secretary Azar of the U.S. Department of Health & Human Services announced important regulatory changes that will allow states to receive Medicaid reimbursements for mental health treatment in inpatient settings known as IMDs, or institutions of mental disease.
Since the 1960s, Medicaid IMD law has prohibited such payments for adult inpatient treatment, undermining existing medical facilities and exacerbating a national bed shortage crisis – effectively denying medically necessary care. This longstanding policy has disproportionately discriminated against adults with serious mental illness, many of whom are Medicaid beneficiaries, and many of whom have suffered terrible outcomes resulting from an inability to receive timely, necessary treatment.
Both this presidential administration and the one before it have granted state waivers to permit inpatient treatment for people with substance use disorders, but people with severe mental illness were consistently left out, discriminated against simply because they were adults with a mental illness. That is why our executive director, John Snook, who serves on the Interdepartmental Serious Mental Illness Coordinating Committee, joined his colleagues in urging the Centers for Medicare & Medicaid Services to address this disparity while strengthening quality and continuity of care to community services. Their call was both heard and heeded.
Secretary Azar’s recent announcement acknowledges the negative outcomes this policy has historically caused, and underscores the importance of both inpatient psychiatric care and connecting patients to robust community services to prevent the cycle of rehospitalization.
The new waiver guidelines set forth by the Centers for Medicaid & Medicaid Services create an opportunity for states to address their shortcomings in treatment delivery, by encouraging innovation that provides patients with access to a full continuum of care.
“Inpatient beds play an integral role in the treatment of serious mental illness that has been ignored for too long,” said Snook. “By making full use of this waiver process, states will have some recourse for mitigating the inexcusable discrimination of the IMD exclusion, and to provide necessary treatment for those most in need.”
Like most complicated regulatory reform, it will take time for meaningful change to take effect. States that decide to apply for these waivers will need to demonstrate their plans to bolster community services while integrating inpatient IMD care into their broader treatment system to better help people with serious mental illness. However, this new partnership between federal and state governments offers enormous potential to improve psychiatric care and to reign in the costs associated with neglecting those most in need.
We thank all those who dedicated their time, effort, and energy to make this happen, and we will continue to update you on as work to fix our broken mental health treatment system.