of reportThe report, based on a year-and-a-half-long investigation, concluded that people suffering from mental illness “are being forced into unnecessary admissions to care homes as a result of a series of systemic failures, typically by the state”.
The report said Missouri has long placed mentally ill adults in nursing homes at a higher rate than “all but a few states.”
As of March 2023, 3,289 The number of adults with mental illnesses who spent at least 100 days in a nursing home in Missouri, according to the report. This number does not include people with Alzheimer’s disease or dementia.
The majority do not fit the profile one might imagine.
Missourians with developmental disabilities languish in hospitals, prisons and shelters
About half are under age 65, and some are in their 20s. Most don’t need help with basic physical activities like eating, getting in bed, or going to the toilet.
And once adults with mental illness enter a nursing home, they often remain there, on average, for at least three years.
“We found that most adults with mental health problems live in care homes. “Missouri inmates are required to reside in these facilities, even for short stays,” the report said.
Most of them are in nursing homes against their will due to a series of “deliberate policy choices” in Missouri, the report said.
People sent to nursing homes often resist treatment and are in and out of psychiatric hospitals.
The main problem is that the state does not provide enough community-based mental health services and “inappropriately relies on guardianship” for people who refuse treatment. The appointed guardians often place the person in a nursing home.
One woman in her late 50s interviewed in the report, who had been placed in a nursing home by her guardians, was quoted as saying, “I have dreams of one day being free” – to live in the community, spend nights with her grandchildren and have “the freedom that someone won’t put me in a nursing home and leave me behind with no regard for my well-being, mental or physical.”
One mother was quoted as saying her son “had a life before they brought him there and now he has nothing.” He lives in a locked room at the facility.
These adults are primarily concentrated in dozens of facilities across the state, where in some cases more than 80% of residents have bipolar disorder or schizophrenia and which generally offer few mental health services beyond medication.
The Americans with Disabilities Act requires that states make reasonable modifications to allow adults with mental disabilities to live in settings that are as integrated into the community as possible. States cannot discriminate against people with disabilities through segregation practices.
The state must work with the Justice Department to come up with a plan to correct the violations identified in the report, or the department could sue the state.
The state agencies involved told The Independent they are currently reviewing the report: The Department of Mental Health oversees the state’s mental health services, the Department of Health and Senior Services oversees nursing homes, and the Department of Social Services administers Medicaid, which funds covered nursing home stays and community-based services.
“Vanished from sight, vanished from mind”
Many mentally ill adults in care homes are under court-ordered guardianship, according to the report.
The state has relied on guardianship for people who resist mental health treatment, but the Justice Department has determined it is a “pipe line to unnecessary institutionalization.”
One provider called Missouri’s guardianship system a “penal lock-in,” according to the report. [nursing facility]. “
Guardianship is supposed to be used in extreme cases when a person lacks the capacity to make basic decisions and less restrictive options don’t exist, but it has been applied more broadly in Missouri and is often used when mentally ill people aren’t receiving treatment, the report said.
“The combination of guardianship and nursing home placement creates the functional equivalent of involuntary and indefinite placement,” the report said.
Guardians are often public servants, county officials who are appointed when adult relatives are unavailable or unfit to serve. Many guardians have heavy caseloads and, due to limited resources and safety concerns, place their subjects in nursing homes, according to the report.
“Instead of diverting people with mental illness out of unnecessary care home placements, or moving people out of care homes who don’t need to be there, they are being lost from sight and forgotten,” the report said.
A man in his late 20s is a good candidate for intensive community-based mental health services. He works part-time in a fast food restaurant and Own an apartment or trailer in the Kansas City area.
“Instead, he lives in a locked care facility more than six hours away,” according to the report.
According to the report, the individual did not receive appropriate services, including permanent supportive housing. He lost his home and was hospitalized several times, in part to protect himself from the cold. Without access to necessary services, caseworkers recommended guardianship and a civil servant was appointed.
“Then the guardians placed him in three different care homes.”
The report urges Missouri to prioritize community-based services, including wraparound services that provide help with housing, treatment and other needs directly in people’s homes and communities.
“The fact that some of these changes may result in increased spending in the short term is“This renders them irrational,” the report states.
Being held in prison
Beyond the issues laid out in the Justice Department report, Missouri struggles with placing people with mental illness in another inappropriate environment: prison.
Missourians who are arrested, found incompetent to stand trial, and ordered to undergo mental health treatment spend an average of 11 months in jail before being transferred to a mental health facility.
There are currently 312 jail inmates awaiting transfer to a psychiatric hospital, according to data provided to The Independent last week by the Missouri Department of Mental Health.
In an email to The Independent last week, department spokeswoman Debra Walker said the numbers were continuing to rise because of a labour shortage.
“People who need mental health care or substance use treatment are unable to receive treatment in a timely manner due to a shortage of providers,” she said.
States have struggled for years to transfer people from prisons to psychiatric hospitals, in part due to a lack of hospital beds and a rise in referrals. Patients are supposed to be transferred to receive rehabilitative mental health services that would make them competent to stand trial, a process called competency restoration. Instead, they languish in prison, often in solitary confinement, without ever being charged with a crime.
Missouri passed a “jail-based competency restoration” bill this year that would provide treatment in prisons, which mental health officials said would reduce wait times.
Walker said hiring of staff has already begun and training will begin once the contract with the prison is “finalized.”
UPDATE: This story was updated at 7:36 a.m. with comment from the state that the Justice Department report is currently under review.
