STATE LIMITS OUR ABILITY TO PREVENT CRISES

Mental Patients' Drug Abuse May Go Untreated

A man is shot and killed by the Concord police in his family's home
after acting erratically. A woman is shot with a bean bag gun by the
police after threatening behavior. A parent writes to me asking for
help for her child who has a long history of mental health issues,
but I can offer only very limited services.

In each of these real cases, families and individuals are concerned
and frustrated by a lack of responsiveness in our mental health
system. Frankly, I share their concern. A growing number of people
who are uninsured or under-insured and have co-existing alcohol and
drug problems are not getting what they need from New Hampshire's
mental health system.

Why is this the case? First and foremost, it is about money.

At least 50 percent of individuals with severe mental health symptoms
have some substance abuse issue too. The good news is that mental
health centers can effectively serve people with mental health and
substance abuse disorders. But state regulations forbid mental health
centers from providing a full range of care if the person's behaviors
might be caused by substance abuse and not by a psychiatric diagnosis alone.

So instead of offering medication, psychotherapy, interventions to
improve behaviors, community support to help find a job, housing, and
healthy lifestyle options, we may only be able to offer a few
sessions of psychotherapy and refer the person to their doctor for
medication. These restrictions are about limiting the expenditure of
state funds and are not due to clinical considerations.

Unfortunately, left untreated or under-treated, people with
co-existing mental health and substance abuse issues often
deteriorate, and they may end up

in the criminal justice system or in the hospital at far greater cost
to taxpayers than the cost of mental health center services.

Other states have restrictions on expenditures for mental health care
too. Invariably, hospitals, prisons and the public pay the price for
intervening after things get worse. Sometimes an innocent bystander
is hurt and a special law is created, like New York's "Kendra's Law,"
to address the lack of resources in the mental health system.

Given the scope of this significant public health issue, it should
not take a tragedy for New Hampshire to put more resources into
mental health services. A modest investment in community mental
health will save money, save lives and make New Hampshire a state
where people can truly "Live Free" - free of mental illness, free of
substance abuse and free to enjoy a full life in their community.