It's crazy how we don't we take mental health more seriously, by John McGauley

It’s just crazy, this way we fail people who are mentally ill, which, in many cases, is ourselves or those we love.

The latest failure in this long line of failures is between the state of Vermont and Brattleboro Retreat. Put simply, the state has denied the place additional money, and the Retreat’s board is considering, among other options, closing the place. I can’t imagine that, the Brattleboro Retreat, 185 years old and one of the largest and finest mental facilities in the country, shutting its doors!

This Brattleboro Retreat story follows the decision by Cheshire Medical Center to close its mental health unit in Keene a couple of years ago. Then there was the story in The Sentinel a week ago that agencies that treat mentally ill people in the Monadnock Region are slowly dying, asphyxiated by lack of money.

If you’re mentally ill in the Monadnock Region or over in Vermont, good luck, because that’s the only thing left that might help you.

Oh, experts will say it’s a real complicated problem, with all sorts of arcane reasons for the way it is. We need a task force to understand it.

No, you don’t. It’s all about where the real money is in medicine, and it ain’t in treating people with mental illness.

If the Brattleboro Retreat wanted to get out of its financial hole, it should revamp an entire floor and provide assembly-line colonoscopies, and another floor for replacing hips and knees in people who are in their 90s or 200 pounds overweight. Throw in some “imaging” and dermatology offices, and they’d be rolling in dough.

There isn’t any money in schizophrenics.

One of the reasons the overpaid Dartmouth-Hitchcock swells who run things at Cheshire Medical cited for closing the hospital’s mental health unit was they couldn’t find a psychiatrist who would take a job in Keene. That’s true.

Here’s why it’s so hard to hire a psychiatrist anywhere — there aren’t any because there’s not enough money in it. Why would you do a residency in psychiatry if down the hallway, the guys and gals who are becoming bone doctors will be making three times what you will?

Regardless of all the rhetoric about helping mentally ill people, most still regard the afflictions of the mind as something strange, or weird, or some sort of failure of willpower. You don’t think I’m kidding? What’s your reaction to news about a neighbor or friend who has cancer, as opposed to news that they’re hearing voices? They’re both illnesses. Let’s say that a friend slips on the ice and hits their head. That’s serious. But let’s say that friend was found at Target, mumbling to himself and roaming the aisles, covered in feces? That’s serious, too, but your reaction is going to be very different.

Also, the legislative lobbyists putting pressure on lawmakers to increase state funds and Medicare and Medicaid reimbursements are no match for those with the “medical” industry — the drug firms, doctors’ groups, hospitals, etc.

Private insurance companies pretty much don’t even want to know your name if your particular affliction is a mental illness. Don’t think that’s true? Wait until you or someone in your family develops depression or hallucinations. All insurance claims are processed through specific “coding” numbers, and when they find out it’s a mental illness, you’re coded with that number that rockets you down a chute that goes to nowhere. Sorry, we don’t reimburse for that particular thing, you’re told. Or you get a very limited number of visits.

OK, let’s say some guy is found by the police down and out on a street in Keene, and EMTs are called. He’s suffering from a heart attack or possible stroke.

At the emergency room, he’s checked out and a helicopter is ordered that flies him up to Lebanon. He’s rushed into surgery and stents are implanted. Nothing is spared, he’s given the same expensive and sophisticated treatment there as the wealthiest person in Keene would undergo.

Say, though, that the Keene cops are called to a guy howling at the moon on West Street, running into traffic and trying to punch out any pedestrians he can find.

You know what happens to him? He’s thrown in a special place at the emergency room, sedated, a security guard placed outside, and he’ll wait for days or weeks there until a bed opens at the tiny state mental hospital we have in Concord. Sorry, bud, no helicopter for you.

And mental illness often isn’t the guy howling at the moon, but you and me and members of our extended family. It’s depression and anxiety and PTSD, autism, impulse control disorders, substance abuse, personality disorders, paranoia, debilitating phobias, eating disorders, psychotic episodes. And that’s just the start of the list.

Is this ever going to change? Not until treating mental illness starts to pay as well as a set of new hips.

John McGauley, an author and local radio talk-show host, writes from Keene. He can be reached at

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