"Greyhound therapy' for the mentally ill

Last February a 48-year-old schizophrenic man named James Flavy Coy Brown, who had (as it turned out) long been homeless before arriving at Rawson-Neal Psychiatric Hospital in Las Vegas, was found wandering, suicidal and confused, in downtown Sacramento, where I live. He was taken to the emergency room of the University of California-Davis Medical Center (the main source for indigent medical care in Sacramento County), where he remained for three days until a shelter bed could be found for him.

As a subsequent investigation revealed Rawson-Neal had, over the last five years, bused about 1,500 of its patients all over the country. About a third of those, destined for California, were given one-way tickets, a small amount of medication, and a bottled nutrition drink.

This practice has become so widespread that it even has a name in mental health circles: Greyhound therapy.

Ask for the receptionist

Truth to tell, mental health services in the U.S. are in a shambles. Anyone who says differently is a dreamer or a fool, or doesn't want to spend money on caring for the afflicted.

A Sacramento social agency on whose board I sit was recently visited by another Rawson-Neal voyager bearing a note instructing him to ask for our receptionist by name. As it turned out, a few days earlier our receptionist had answered a phone call requesting her name, and she had provided it.

It seems that the ingenuity of mental health specialists in saving money— if not in caring for patients— knows no bounds.

"'Whoops, I'm sorry'

Many people seemed surprised at revelations of this gross disrespect of the needs of severely mentally ill people. Yet since America's large mental hospitals were deinstitutionalized in the 1960s without the promised community level support, care for the seriously ill has been strictly hit-and-miss, as you might expect of a system where patients can't be institutionalized without their consent.

Since 2008 the recession has exacerbated the problem. Many budgets have been sliced resulting in fewer programs, smaller programs, shorter term counseling and staffing by less trained (and therefore cheaper) staff. In addition, the increasing tendency for many years has been to heavily medicate people rather than utilizing more costly "talk therapy."

At the same time, the recession has accelerated the long-term pattern by which rural areas, suburbs and smaller cities ship their chronic (and most expensive to care for) mental health patients to larger cities. If the shippers get called out for this dumping, they tend to do a "Whoops, I'm sorry" and blame an administrative glitch of some sort for a lack of notice.

Take it from one who works in the field: It's no glitch. It's conscious policy.

Psychologist's confession

In the wake of its massive busing of patients over a number of years, Rawson-Neal's accreditation is in jeopardy, lawsuits have been filed and Rawson-Neal's procedures for sending patients elsewhere have been changed. (For example, they must now be accompanied by a staff member.)

But "Greyhound therapy" is likely to persist. It's not just that delivering patients across state lines can save states significant amounts of money. As a psychologist from a sending institution told me in confidence some years ago, "Most of the people we bus to [larger regional city] get better care than we would have been in a position to give them." As long as we grossly underfund mental health services, the temptation to utilize some form of Greyhound therapy seems inevitable.

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A follow-up note: As of Tuesday, August 19, San Francisco City Attorney Dennis Herrera has sent a letter to Nevada's attorney general threatening a class action lawsuit unless Nevada reimburses California cities for the care of those dumped by Rawson-Neal via Greyhound in the last few years.