Perhaps the worst outcome for the mentally ill is being cut off from support networks and placed in a position where they genuinely have nowhere to go. In some cities and states, the practice of “patient dumping” has become the answer for authorities struggling to manage burgeoning caseloads of social workers in mental health.
A History of Patient Dumping
The “patient dumping” phenomenon isn’t new. Reports of patients with serious illnesses and limited funds being shifted from private hospitals to public facilities started surfacing in New York in the late 1860s, following the introduction of ambulances. Hospitals weren’t prepared for the influx of patients from surrounding areas. And because in that era, the limitations of emergency care often meant these patients couldn’t be saved, their presence at a prestigious, private hospital often led to damning fatality statistics that drove away the well-heeled clientele hospital administrators were hoping to attract. The simplest solution for hospital staff was to send the patients elsewhere.
New York’s hospitals were again scandalized for dumping patients in the 1960s. Again, poor and moribund patients made up the majority of the people sent from private institutions to catch-all facilities such as Bellevue and King’s County hospital. In a New York Times article from December 12, 1966 the city’s health services administrator commented that, “…as long as you have one hospital able to pick and choose what it wants, and another which must take every case that it gets, you are going to be faced with the dumping problem.”
Why Mentally Ill Patients are Vulnerable
Over the last 50 years, beds in mental healthcare facilities have dwindled from around 600,000 to just 40,000. This is due to a host of policy changes, funding cuts, and even well-meaning civil rights campaigns for those with mental illnesses. The fact of the matter is: there are fewer places for someone seeking mental health care to go, which makes for less-than-ideal situations for mentally ill patients.
Insurance coverage for the mentally ill can be difficult to find and maintain. For some this means a gradual slide away from care and medications needed to maintain a stable lifestyle. This can cause job loss, then loss of insurance, and loss of housing. Data gathered by the Substance Abuse and Mental Health Services Administration in the mid-1990s estimated around a quarter of homeless people have a form of serious mental illness; by comparison mental illness affects around six percent of the “regular” population. This is where providing mental healthcare gets complicated, and expensive.
In areas where resources are stretched, facility administrators are taking the dramatic step of dumping mentally ill patients – but this time it’s the sheer volume of patient dumping that’s raising eyebrows. In recent months, Nevada’s Rawson-Neal mental health facility gained notoriety for bussing scores of patients to California. So many of these patients were sent to San Francisco that the city is suing the state of Nevada for $500,000, “Homeless, psychiatric patients are especially vulnerable to the kind of practices Nevada engaged in…” said San Francisco City Attorney Dennis Herrera. Estimates vary, but as many as 1,500 patients were “dumped” with nothing but a one-way bus ticket.
Ultimately, what we see happening in the headlines today is the latest evolution of an age-old trend where patients are excluded from care on the basis of their ability to pay and/or make a suitable recovery. Without a clear path to recovery or a great improvement in funding, resolutions for these patients will have to come through the legal system.