It is hugely ironic that deinstitutionalization from state psychiatric hospitals and decarceration from city and county jails—major objectives long sought by the behavioral health community—have turned into significant problems in the COVID-19 era.
For many decades, our community has argued strongly and loudly that most persons with behavioral health conditions served in the state psychiatric hospitals would fare better and recover more quickly if served in community settings. For the past decade, we have made exactly the same argument about the large number of those with behavioral health conditions incarcerated in city and county jails. COVID-19 has turned these quests into a new problem.
As we have learned more about clusters of COVID-19 cases in nursing homes, it has become quite obvious that the state psychiatric hospitals and the jails also could serve as hotbeds for the virus, potentially leading to large clusters of cases and a significant number of deaths. This realization led the managers of these facilities to take two actions: first, close the front door to new entrants and, second, open the back door so that larger numbers of residents could be released. Almost needless to say, these actions were taken very quickly and with very little thought about the immediate or longer-term consequences in the community.
The combined effect of these two actions is a rapid increase the numbers of persons with serious behavioral illnesses in our communities. Unfortunately, because of the speed of these management actions and the dramatic changes in the operation of community behavioral healthcare programs during the same COVID-19 period, our community programs are woefully unprepared to meet the extensive needs of these people.
Clearly, several important services must be addressed to protect their lives and wellbeing. These include:
- Housing services. This is an urgent need. In the current national emergency, Federal Emergency Management Agency (FEMA) housing could be made available. Why has this not happened? A similar question could be asked about housing from the U.S. Department of Housing and Urban Development (HUD).
- Care coordination. This service is needed to help these people negotiate the complexity of health and social services in our communities, especially at a time when these services are changing in response to COVID-19.
- Health services. Many of these people have chronic health conditions that require continuing medical attention. Such services should be linked to our virtual behavioral health services.
- Behavioral health services. These services, including peer support, are essential, especially at this time of mass trauma and discontinuity.
What actions can we take? First, we need to begin advocacy at the national level today. This will help to assure that both authority and resources are provided to the federal agencies, including SAMHSA and HRSA, so that our counties and communities can develop the capacity to organize and respond effectively to this emerging problem. Second, we need to work at the county level to help our counties and communities organize a response to this problem that is appropriate.
The need is urgent.