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CARROLL: State must step up to help the mentally ill

The Rapid City Journal - 2/21/2017

Everyone agrees our ability to care for the mentally ill is severely limited. I remember the first time I walked into Regional Behavior Health Center (West) to retrieve my daughter. The building is old. The design is old. It is clearly not meant for mental health care. It could be a movie set for "One Flew Over the Cuckoo's Nest." I felt sorry for the people who worked there and sorrier for the patients.

There's a reason employees in the facility "restrain" and "isolate" problem patients beyond reason. It costs too much money to build proper facilities, and it takes too many people per patient to do the job. Unlike sports medicine or orthopedic practice, where the return on investment is jaw-dropping, the remuneration to medical care providers for mentally ill patients is a flat loss.

It takes two to six or more people 24 hours a day to care for every serious mentally ill person, many times the cost of care for the merely sick or injured. Governments - local, state and federal-do not pay providers enough to make care worthwhile.

If there was any money in it, we'd be seeing the kind of investment in facilities Regional Health is building at Custer and in the palatial sports medicine complex. There's a sound financial reason Regional Health has not invested in improved mental health care.

Although we grant Regional Health huge tax breaks and monopolistic incentives to make massive profits, we have not made it mandatory for "nonprofits" to care for everyone - we allow them to pick and choose. They pick the profitable and avoid the expensive and difficult. Contrast this approach with Avera McKennan's successful program in Sioux Falls.

Second, our state programs are struggling to keep pace with modern notions of mental illness and standards of care. From drug abuse to autism, we simply don't meet the need anywhere in West River.

Rapid City Police Chief Karl Jegeris would like to see Yankton expanded to meet the need, but there is little money and less incentive on the part of a state government already wrestling with budget priorities. Even if we had the money, it's become almost impossible to hire qualified care-givers. Few people want to live in the isolation of the prairie where we built massive residential hospitals for the insane long ago. Psychiatrists on contract provide services from out of area. The locations give rural communities a piece of the government pie.

Even in Rapid City, providers like Behavior Management Systems struggle to find employees. The news that turnover at Yankton has slowed due to salary inducements is good. But it won't last. One employee told me last week there isn't enough money to keep her out there. Turnover will increase as standards of care increase and rural populations decline.

I agree that this problem does not belong to one entity or one community. It is, however, a duty of government to either establish an environment for success for mental health care providers or to take on the duty on our collective behalf. We must give ourselves statutory responsibility to maintain standards of care that don't disappoint the Joint Commission, at a minimum.

It's time to put our heads together and solve this crisis. Only a community-wide effort makes sense, and the Legislature will play a pivotal role. "Nonprofits" must do more with their huge profits and not by raising fees to patients and insurance companies. A legislative summer study group that includes people who provide care and people who need care should convene in time for the 2018 Legislature.