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How caring for ‘least among us’ is matter of public safety
Te Arkansas Constitution explicitly provides that “the General Assembly shall provide by law for the support of the institutions for the treatment of the insane,” Ark. Const. 19 § 19. Te devout and the politicians express commitment to care for
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“the least among us.” But even for those with hearts not open to this moral argument, consider whether some of the many school attacks that have happened in the past couple of decades: San- dy Hook Connecticut; Aurora, Colorado; and Westside Middle School shootings, Craighead County, Arkansas, in 1998 could have been averted by crisis intervention or access to treatment? How we care for those with mental illness in Arkansas is not just a matter of public health but an important part of public safety. In the 1960s, 70s and 80s the number of state hospital beds for the mentally ill nationwide declined from 339 to 29 per 100,000 in 1988. Te number of beds at the State Hospital is limited to three 30-bed units for housing adults screened by the CMHC (Community Mental Health Centers). Te path for caring for the mentally ill in Arkansas has largely been delegated to the CMHC, the State Hospital, properly equipped hospitals and acute care and residential care units. However, we have enabling legislation, such as authorization for the Division of Mental Health to provide for intensive residential treatment for adults with long-term mental illness under Act 648 of 1987, but those services are generally lim- ited for paying customers. Arkansas is ranked 50th in the Report of America’s Health Care
System for Serious Mental Illness from the National Alliance of Mental Illness (“NAMI”). Arkansas dropped from a “D” to an “F” between 2006 and 2009 and the 2009 report finds urgent needs for evidenced based practices, crisis services and CIT (Crisis In- tervention Teams) and diversion. Likewise, the United States Dis- trict Court, Eastern District of Arkansas, Judge G. Tomas Eisele declared that our local and regional jails should not become our mental hospitals by default; and that it is up to the General As- sembly to address needs for services and mental health treatment facilities. See: Winters v. Ark. Dept. Health and Human Services, John Selig, et al. 491 F. 3d 933 (8th Cir. 2007). Most of our readers know local jails are past capacity from hous- ing state parole violators and state inmate back up in county jails comprise about 30 percent of local jail bed space statewide. How are the mentally ill and the severely mentally ill identified and cared for in our county jails? In communities throughout Arkan- sas? Te challenges for identifying and caring for both populations
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any of us have friends or family with mental ill- ness. Caring for the sick, the needy and the im- prisoned is a moral Christian directive from the teachings of the Bible (Matthew 25:40).
are explored below. In respect to the county jails, the Bu-
reau of Justice Statistics issued a special report in 2006 on Mental Health Prob- lems of Prisons and Jail Inmates that found the majority of state, federal and jail inmates had mental health problems and that up to 15 percent of inmates had severe mental illness. Te United States Supreme Court in Brown v. Plata, 131 S.Ct 1910 (2011), directed the State of California to reduce its prison population by 46,000 inmates due to the overcrowding of almost 100 percent and in- adequate medical and mental health care. Te State of Arkansas directs the county to hold their prisoners, yet enacts laws such as A.C.A. 12-27-114 which arbitrarily allows the state to avoid the costs of providing medical and behavioral care for state prisoners held in county jails awaiting transfer to state corrections until 30 days has lapsed. To add to challenges, federal dollars from Vet- eran’s benefits, Medicare or Medicaid cannot generally be spent on persons held following conviction or even those presumed in- nocent by the U.S. Constitution and awaiting trial, except that federal match may be used under Medicaid for medical care dur- ing an overnight stay in a medical facility. Rep. Micah Neal and Sen. Uvalde Lindsey sponsored legislation, now Act 1117 of 2014, which will allow application for Medicaid for inmates while in a local correctional facility. However, federal Medicaid dollars will only be accessible for overnight stays or upon release from incar- ceration. At some point the Private Option adopted by Arkansas in 2011 may enhance access to medical and behavioral care inside jails and in communities throughout Arkansas (particularly for patients with dual diagnosis). However, no one can say what the future holds. CMH are under contract to provide screening and behavioral
services to those in need in local jails, but under a system that ranks 50th nationally in the delivery of those services is disparate. Additionally, the state recently enacted cuts of $1.7 million as of January 1, 2014 and additional cuts of about $5 million as of July 1, 2015, for contracts with the CMHC. Te General Assembly wisley reduced the amount of proposed cuts. Te CMHC and DHS differ on the impact of the proposed cuts. CMHC says the cuts will be adverse to the delivery of the same services that NAMI reported were urgent needs in Arkansas (jail services, crisis services, CIT and diversion services, etc). DHS says the cuts are of monies currently being used for uncompensated care and the proposal is to shift will not adversely impact behavioral services. In any event it is imperative that CMHC mobile response teams (such as those
COUNTY LINES, WINTER 2014
Mark Whitmore AAC Chief Counsel
Research Corner
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