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Another Voice: Our behavior health infrastructure is broken

By Thomas P. McNulty

By the time you finish reading this, many families in America will be shocked, horrified and devastated at the loss of a loved one to some form of opioid concoction – lately, heroin and fentanyl.
People die every day because systems we rely on are ill prepared, incompetent and archaic to manage what they were built to do.

The behavioral health infrastructure has been broken for years and is a serious part of the current inability to respond. It’s the toughest pill to swallow but it is painfully apparent to those suffering. Behavioral health remains the bastard child of health care – hospital administrators say it takes up expensive floor and bed space. Insurers still avoid a fair reimbursement. Even now, they limit the number of mental health providers on their panel – parity laws are window dressing. Ask anyone who called to get help. A depressed and suicidal patient might wait eight to 12 weeks to see a psychiatrist. Insurance panels intentionally limit well-qualified therapists.

Our prison facilities now treat more of the mentally ill than our psychiatric hospitals. Many jails refuse to administer certain medications, claiming safety concerns while watching inmates go through the horrors of withdrawal even when the individual has a legitimate physician prescription.

Behavioral health education needs to be in K-12, especially with the amount of trauma children experience or witness. Recently, an IRBS study reported that about 1,400 high school students in Buffalo Public Schools attempted suicide. I co-chair the Mental, Emotional and Behavioral Committee at Buffalo Public Schools. How was that possible, we asked? We addressed it successfully.

When I was a therapist, I carried a caseload of teens. None wanted to be an addict. I worked with UBMD Addiction Medicine’s Dr. Rick Blondell, who says, “No one wants this life.” Help is broken at every point of entry: emergency rooms, hot lines, agency admissions, government oversight, private practices, law enforcement, managed care, parity legislation, many treatment agencies, Medicaid, primary care/behavioral health integration, health homes and even the morgue.

Fragmented health care systems caught up in creating the next best program have been missing the core humanity of behavioral illnesses, namely, people and their families are in pain and fear. Simple things like a human being on the other end of the phone, getting compassionate, but more importantly, helpful information they can use. How is someone dying from opioid abuse any less critical than the guy in the emergency room with chest pain?

Dedicated professionals, many my long-term friends, are doing herculean work. Recommended road maps to recovery are filled with broken pathways poorly structured to address this opioid crisis. So people will continue to die in the hopeless hallways jammed with addicts, the mentally ill, spouses, parents, friends and family members suffering in broken systems. How many died today?

Thomas P. McNulty is a consultant with 35-plus years in health care. He is founder of the not-for-profit Spotlight on Hope and president of his firm, Success Stories Inc.

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