Congress must stop blocking mental health clinics from needed funding – New York Daily News

Newly elected Congressman Dan Goldman’s announcement about reintroducing the Michelle Alisa GO Act is welcome news. The act named for Michelle Gow, the young woman pushed to her death in front of a subway train by Marshall Simon, a homeless man with severe mental illness, would amend a decades-old federal rule at the root of our broken mental health system.

The Institute of Mental Illness or “IMD Rule” was enacted as part of the Social Security Act in 1965 and denied Medicaid to patients admitted to psychiatric facilities with more than 16 beds, including hospitals, nursing homes, and community or so-called group care. does. facilities. By limiting federal Medicaid dollars to smaller residential institutions, Congress rightly thought that service providers would never achieve “scale,” making it impossible for IMD providers to make a profit, let alone a responsible profit.

Instead, Congress hoped that by defunding community services and eliminating large asylums, poor people with severe mental illness would be served elsewhere, and they have been — in prisons, jails, and undertakers.

The need for more psychiatric beds whether inpatient or group care is an inconvenient fact that few would rather ignore, a luxury not possible for parents like Teresa and Dan Pasquini, sisters like Hilary de Vries or family members of Michelle Gou .

Like it or not, some people with serious mental illness will do better with access to congregate care residential facilities located close to family and loved ones, who are financially viable. Yet for many, this community-based option has been off the table for nearly 60 years because of the IMD rule. Without this option and others, including inpatient hospitalization and residential facilities where residents are not fully free to come and go, “continuity of care” is not achievable, at least not for everyone. .

There is no better evidence of this reality, and the need for a range of such facilities, than the fact that in the same time period, many of these options are available to those who cannot afford private pay residential and inpatient facilities. Can pick up This reality shows that IMDs above 16 beds are not inherently bad, we just don’t want to pay for good ones, at least not for poor ones. Instead, we continue to watch our jails and prisons fill with poor people with mental illness, especially black and brown people who end up in the criminal justice system after the mental health system fails them, their loved ones, and innocent victims. and their families.

Ironically, in the end, IMD fundamentally undermines the gold standard of our mental health care system: ensuring access to community-based mental health services as part of a comprehensive continuum of care. By drawing a rough line in the sand at 16 beds for all IMDs, Congress simplified both the problem and the solution, which needed to address the very real concerns associated with large, underserved snake-pit mental health asylums. Is.

As Goldman reintroduces legislation to amend the IMD rule, instead of seeking a wholesale repeal of the rule, the amendments should be crafted with greater precision. Otherwise, not only will a complete repeal of the IMD be dead on arrival due to its high cost, it will also raise real concerns about the government’s ability to unnecessarily regulate shelters on a very large scale and prevent some of the abuses of the past. .

Instead, instead of once again taking a crude, one-size-fits-all approach to Medicaid funding for mental health treatment, Congress should create different bed limits for different types of facilities. For example, members may find that a 36-bed group care facility would be both humane for clients and economically viable for service providers. Similarly, increasing the legal bed capacity for inpatient psychiatric hospitals to 100 or 150 would help New York City Public Health + Hospitals provide a high-quality, safe, therapeutic, and humane option for New Yorkers who need that level of care. may be capable.

Not only would this be a humane option for continuity of care for people living with serious mental illness and their families, but it would also improve public safety and save money by preventing people with serious mental illness from entering the criminal justice system earlier . Location.

It’s time for Congress to set it right. Be thoughtful but don’t delay anymore. Michelle Go and Marshall Simon deserved better, so did their fans.

Roberts is a part-time City Court Judge in Hudson, NY, where she presides over the Mental Health Court and is executive director of the Greenberger Center for Social and Criminal Justice.

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