(00:00:00) Community-based treatment is treatment in the community that is where people live where their families are right in their own communities the provision for a variety of treatments that people who experience mental illness need mental illness is very complex. So it is more than just hospitalization or institutionalization though some people who suffered an acute experience May at any one time need that kind of treatment but people that suffer chronic mental illness need to have many other needs taken care of educational vocational social living skills. These I think are best done in the community rather than miles away are out in Retreat setting (00:00:45) when you talk about community-based treatment are you talking about? Having a sort of a halfway house or a place where people who may have been hospitalized or institutionalized for sometime may live or are you talking about people who are living in homes back with their families or does it run the full (00:01:04) gamut? I think we talked about a Continuum of services different people have different needs for what they need in the community. I would certainly expect that many people would go back with their families, but these persons they they had a six months hospitalization may need Rehabilitation so they could live I'd like to see them living in their homes if that's possible back with their families, but having then either vocational experience some sort of retraining education day activity, so they would be able to go back and forth and feel part of the community and still get Services. I do not call of these things treatment but Services provided for this population in need (00:01:47) now you were involved in a national study. Chew of the whole concept of Community Based treatment few years back. Where has that whole concept comment and how well or badly? Is it going these days? (00:02:03) Well President Carter when he one of the first acts he did was to create a commission to study the needs of the mentally ill in this country at the instigation of his wife and we came back to him to reaffirm that community-based treatment was the way to go the Community Mental Health movement is 20 years old now and there has been a verbal commitment but not a monetary commitment to this process from the federal state or local level, but I would say there has been a Groundswell and the past two years not only is a result of the president's commission, but that certainly was an impetus to push this You certainly have to look at what happened with drugs as one way of maintaining our lessening symptoms. So the need to keep people locked up for their lives really lessened as we began to find chemicals, then the excuse for keeping, you know, keeping people institutions lessened, but at the same time these people had spent a long time in institutions need rehabilitative services. This is where the community broke down. We did not realize this in time or just didn't want to deal with that. We thought well these people can just, you know, leave the hospital and go and live in the community again. Well, in fact that is not true that wouldn't work for any of us who had spent been in a very dependent relationship for any period of time. So we are now acknowledging these needs (00:03:38) did the committee that you sat on at the president's request make any specific suggestions for funding of Various kinds of community-based care or were they General statements of (00:03:51) support. Now, we made very specific recommendations to for every state to move towards the closure of their mental state hospitals or Mental Hospitals in the idea being to use those hospitals for another purpose because we met reaffirmed the need for Community Based Services. We did make specific recommendations on funding patterns. That would have to be set up in order to accomplish this there is a bill in Committee in Congress right now, which is trying to come up with a community mental health system systems ax which will deal with some of these funding needs but it is not just a matter of federal funding. It is a matter of community attitude. I believe we do need money. We need it from every level of government. But until the community realizes that these individuals are part of their Community. I think we'll have a difficult. Time bringing this off (00:04:49) Community attitude brings me to ask the question of how do you answer criticism of community-based care particularly in light of instances or incidents as the one that allegedly at least till the fire wasn't alleged definitely occurred took the life of one elderly resident of a Minneapolis nursing home a few weeks ago and the person who allegedly set that fire was someone who had been released from hospital within the last year or so for mental illness and was placed in the community that when people read about a fire like that and they hear that somebody who was out of a hospital only a short time and may have started that fire. How do you answer those kinds of criticism that that indeed people like that should be kept locked up. (00:05:34) Well, I do agree with you. It's a very complex issue. There are probably no guarantees that any of us will not behave in a manner that causes harm to other but that does not Use the issue. I think we have Alternatives we can take someone's behavior and say, you know, we can only tell future behavior on past behavior and keep them locked away. We do not do this in our penal system and I certainly don't think we ought to do it with people who experience mental illness. We do believe if there is services or programs or supervision then some of the kind of risk factor will be less than that. We ran into that situation last week on the other hand as we move people to the community and place them in Board and Care or nursing homes. There are not provided the services are the supervision that is needed to care for these individuals. That is the way the system is at the moment people recognizing this as public sector is recognizing this and there are Diaz, you know coming forward to how to provide those Services the there is Sure to get people out of the institutions. I agree. There is pressure on the social workers. Then to place them there is pressure on the nursing homes and Board and Care Homes to take these people if information does not follow with the patient, you must recognize that there's confidentiality and unless the patient signs off then information cannot be given so it there are no simple answers though. If if someone would say to me what about this, you know this kind of act, how can we make sure it can't happen again? I can't say anything to that but I can say that there are 12,000 people with a diagnosis of mental illness in this state that live in Board and Care Homes and nursing homes. And I never see a headline 12,000 individuals today who suffer from mental illness have no way created an incident or risk the lives of other people. So I think that's a very important fact risk is with us all the time and I would also like to say It we must believe that people can improve their functioning. Otherwise, we just turn our state hospitals are psychiatric hospitals into more of a jail or a penal situation the the individuals that work with these people and state hospitals do believe they can make some progress. So it there's no simple answer but in just injustice to human beings and looking at people's human rights, we must give them the opportunity and if we know there is a problem. We must create better supervision as they're trying to get well, (00:08:23) I'd like to go back to the degrees of care or variety of services that we touched on a little bit ago. I was talking to another reporter here Greg Baron and Greg just a few weeks ago finished a documentary of sorts on mental illness particularly involuntary commitment and he said the one of the things that he discovered in his work on that program was that there aren't many Alternatives as a matter of fact, he said there really is there really are only to a person who is charged to be mentally ill or who is found to be mentally ill can either be committed to a hospital or If the family is willing and able to try and add that person as best they can and that person remains in there. They're setting in their home, but that there aren't as he as far as he knew anyway, and he places in between for a person to go for some time to to get some treatment to gather themselves together, but yet avoid being locked up literally that's the way you see it too. Is it (00:09:28) absolutely I what we do in our own community and I went from Hennepin County. We do not have residential treatment centers that someone could voluntarily or even in a commitment be committed to as an option as against what would be the most restrictive we think in terms of in the law states that someone must be treated in the least restrictive setting and I think we would consider the state institutions as being the most most restrictive setting I would like to Either hope people would voluntarily do an outpatient treatment plan. If they could we talk about a need for pre petition screening And if every individual who a petition was brought against could go through a screening process to see if there were Alternatives available in the community and if they were discovered not to be that a statement could be made this person could use a different kind of treatment but since it doesn't exist, it would make a statement to the community. So we'd end up with less fewer people having that most restrictive treatment, but right answer your question would (00:10:38) right now in Hennepin County, there isn't anything like you mentioned you call it a residential treatment center. (00:10:46) No, I would say there is nothing there is a new place that's going to open up the next few weeks. It's Wellspring therapeutic communities and it will be a long-term Treatment Center. (00:10:59) What if I visited a residential treatment center of the kind? We're talking about what might I find there that I wouldn't find say it a state institution a state hospital. (00:11:10) Well, this is an this particular Treatment Center will use a holistic approach. It will start be in three phases. It will start out with rather intensive therapy in a very heavy peer support group based on we're talking about 25 individuals will be living in this residence with staff. They will have a very very Democratic Society where they'll set up the rules of the house. So to speak the they will be taught about diet and nutrition they will be if some of them will be on medication and hope those it'll have to stay on medication will be taught and expected to take responsibility for taking their own medication say someone's a depressed person is it stays on lithium? We that kind of thing to develop responsibility and Independence. After this first phase of rather intensive treatment, there will be a move out into the community to take vocational training to go back to school to get into voluntary volunteer positions each step being to further the independence of this individual with the goal that after a year to two years. These individuals will be independent in the community (00:12:26) and they would at that point then it (00:12:28) was sold out but some of those individuals may need support throughout their lives, but their can't there are Community Services self-help groups linking them up with those kind of services to we all need networks in order to support us and we take a lot of ours for granted for these individuals who are broken from families many come from the rural areas areas. They don't know people that to help them create and what we call normal setting. I think when we talk about the institutionalization and I don't like to use that word, but for many people that is what expresses closing or lessening of people in state hospitals the whole funding system needs to be changed one major problem as I see it. Is it cost the county $10 a month to put an individual in the state hospital and if it cost Only $10 a month for that. Why would they ever put them in something that would cost $30 a day? However, the state hospital costs around 55 dollars a day. So it's but the county only pays $10. I would like to see that funding change that would take legislative action that is not a county problem at the state problem. If people who were considered to be chronically mentally ill it wouldn't would experience a long-term hospitalization. I think when they are discharged the funding should follow them into the community (00:14:01) how so how would that happen? (00:14:03) Well, you could even set up a specified period of time someone had four months a in the state hospital at say fifty five dollars a day and and you had an expectation that they would need further but maybe less intense treatment in the community. You could say we will give them forty dollars a day to live and find treatment and hook up with Services. I mean, I'm just using that. You're 40. I think we have good evidence that Community Services as far as a residential treatment center are less costly and certainly compared to a hospital which the would cost about a hundred and fifty a day and I think insurance is an issue. We have to talk about here. If you're in a hospital, you'll probably insurance will probably cover you for a period of time for mental illness. If you were to go into a residential treatment center insurance will not cover that this is not true say with chemical dependency. We do have free standing chemical dependency treatment centers. So I would say the mentally retarded and the chemically dependent have very good continuing funding sources mental people experience mental illness do not have that same assured continued funding resource.