Groupwork Psychiatric Inpatient Unit

Mental health spending creating haves and have-nots

Seven years after voters approved a new tax to fund services for people with mental illness, California has slashed so much money from mental health departments that it now leads the nation in such cuts.

Counties have laid off psychiatrists, reduced hospital bed space and shut down mental health clinics.

And the $7.4 billion generated by the mental health tax?

Much of it has gone to a cottage industry of consultants earning up to $200 an hour, as well as a host of new programs that in many cases are only loosely linked to prevention, treatment and recovery.

The Bay Area News Group examined spending to date under the Mental Health Services Act of 2004, after reporting in May concerns expressed by the chairman and former chairwoman of a Santa Clara County watchdog group. They charged that local spending under the act has resulted in frivolous programs and enriched private contractors at the expense of people desperately in need of care.

The newspaper group found problems are evident statewide, despite years of warnings from a high-level whistle-blower and other mental health authorities.

"The state of California clearly did not comply with the law and they did not keep and honor the contract with the voters," said Rose King, co-author of the Mental Health Services Act, which appeared on the November 2004 ballot as Proposition 63. "It's a corruption of purpose, and it's a boondoggle for consultants and entrepreneurs at the expense of core services."

Designed to create new county programs and expand existing ones, the act veered off course after the state Department of Mental Health piled on burdensome and unnecessary guidelines, according to county directors who oversee the spending. Going beyond the language of Proposition 63, the funds were restricted so they could not be used to enhance state and county-funded services that were later gutted by the economic downturn. That created an odd predicament: County mental health budgets were devastated on one side of the ledger, while on the other they were flush with money for use only on new clients in new programs.

State mental health officials did not respond to repeated requests to explain the regulations. But in a 2007 letter to King, the state's former mental health director, Stephen Mayberg, explained that the department sought to first serve mentally ill people who were homeless and cycling through jails and emergency rooms -- essentially those who were outside the system.

Substance Misuse In Older People - - Addiction Treatment Strategies

The report, written by the Older People’s Substance Misuse Working Group of the Royal College of Psychiatrists, warns that not enough is being done to tackle substance misuse in our aging population – making them society’s “invisible addicts”.

The report pulls together evidence to highlight the extent of the problem:

- The number of older people in the UK population is increasing rapidly – between 2001 and 2031 there is predicted to be a 50% increase.

- A third of older people with alcohol use problems develop them in later life – often as a result of life changes such as retirement or bereavement, or feelings of boredom, loneliness and depression.

- Older people often show complex patterns and combinations of substance misuse e.g. excessive alcohol consumption as well as inappropriate use of prescribed and over the counter medications.

- Although illegal drug use is uncommon among over-65s at the moment, there has been a significant increase in the over-40s in recent years. The problem is likely to get worse as these people get older.

Professor Ilana Crome, Professor of Addiction Psychiatry and Chair of the Working Group, said: “The traditional view is that alcohol misuse is uncommon in older people, and that the misuse of drugs is very rare. However, this is simply not true. A lack of awareness means that GPs and other healthcare professionals often overlook or discount the signs when someone has a problem. We hope this report highlights the scale of the problem, and that the multiple medical and social needs of this group of people are not ignored any longer.”

The Working Group makes a series of key recommendations including:

- GPs screen every person over the age of 65 for substance misuse as part of a routine health check.

- The government issues separate guidance on alcohol consumption for older people. Current recommended ‘safe limits’ are based on work in younger adults. Since there are physiological and metabolic changes associated with aging, these limits are too high for older people. Evidence suggests the upper ‘safe limit’ for older men is 1.5 units per day or 11 units per week, and for women 1 unit per day or 7 units per week.

- Public health campaigns around alcohol and drug misuse are developed to specifically target at older people.

- All doctors, nurses, psychologists, social care workers and allied health professionals are given suitable training in substance use disorders in older people.

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