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July 1, 2007
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Dear Mr. Edwards,

In response to your May editorial “Frustration,” I want to share how our community mental health center would have responded if your friend and “George” lived in our area. Our mental health center would have attempted to resolve the situation with George differently than from what you experienced:

  • Two professionals (teamed for safety reasons) from our Crisis Team would have met your friend at his apartment the day you called to get firsthand information.

  • The Crisis Team staff then would have made every attempt to get George to answer the door and engage him in a conversation to assess his mental status.

  • If needed and deemed safe to offer services, our Crisis Team members would visit George over the next several days.

  • Our staff would collaborate and coordinate a response with the local police department, which we have trained on recognizing signs of mental illness (the police can ensure the team's safety and assist if needed).

  • The Crisis Team could assess for and arrange a psychiatric hospital admission.

  • The Crisis Team would consult with the local district attorney's office to determine whether an involuntary admission to a hospital might be considered.

  • If necessary, the Crisis Team members would provide professional testimony in court for involuntary hospital admission.

In the process, our Crisis Team would have dedicated anywhere from 3 hours (if we simply met with your friend and called the police) to 20 or more hours (if we did all of the above) to this case. Because George was not seeking treatment, the grand total of reimbursement for our intervention would have been $0.00 (even if he has medical insurance, which he probably does not)! This type of crisis intervention is not reimbursable. So who is responsible to pay for George's care? This is where the breakdown in the delivery system occurs—gross underfunding that forces mental health centers across the country to make decisions related to what services they provide.

We would have provided this outreach and care to George because our mental health center is committed to doing the right thing for persons with mental illness. We strive to offset this unreimbursed care with other services we provide. However, the goodness of our hearts does not pay the bills. We face escalating expenses related to salaries and benefits, including the rising costs of health insurance for our staff, training and continuing education, and other operating costs.

In the postscript to your editorial you mention the need to transform the mental health system. I believe this is what it is going to take to ensure that George and others like him get the help they need for their personal benefit and for the overall health and well-being of our communities.

Tonja Speer, Director, Comprehensive Outpatient Services, Wyandot Center for Community Behavioral Healthcare, Wyandotte County/Kansas City, Kansas