Tragedy and Balancing of Public Interests

This is just sad.

In January, a group of teenage girls showed up at the state Capitol, begging just about any official who would listen not to end a state-sponsored drug and alcohol treatment program.

The long-term residential treatment program, in which young people lived with other recovering addicts in group homes, was being phased out in favor of mostly outpatient therapy that would allow state dollars to stretch further.

You can’t treat addictions that way, the girls said. Someone will be hurt, they pleaded.

The program shut down a few months later. As a result, an 18-year-old alcoholic named Barbara Wells was sent home several months shy of completing the program at a group home called Katharos in Griffin.

Less than three months later, she was dead.

Her mother, Diane Lankford, says Wells got drunk and choked to death on her own vomit at the home of a 30-year-old man. Police charged him with providing alcohol to someone underage, but they are waiting on toxicology results to officially list a cause of death.

I grew up in Jackson, LA, before departing for ten years in Dubai, UAE. Jackson is the Milledgeville of Louisiana, if you will; the home of the state’s Mental Hospital. In fact, I grew up in a nice antebellum home just a few blocks from the hospital’s property.

In the late 70’s, there was a movement to send the mentally ill out into society and care for them outside of institutions. It was allegedly more humane and saved money. The two and the lives of the mentally ill both deteriorated.

I am absolutely not an expert by any means. But in both my personal experience and in hearing so many stories from so many others, I think the state really needs to reassess whether the cost savings of out patient treatment is enough to outweigh the greater benefits of in-patient or residential care treatment.

19 comments

  1. memberg says:

    Almost certainly the girl didn’t have a father at home to guide her in her teen years. Another casualty of the welfare system.

  2. Nicki says:

    I am not an expert, either, except in that I have some experience in the state management of substance abusers. Residential treatment is absolutely necessary for a small, but intractable segment of the population, as well as those who cannot exclude the substance to which they are addicted long enough to concentrate on therapy. For some people it is the only thing that works. And if compassion isn’t compelling, then economics should be: this relatively small portion of the population is very expensive to handle poorly and repeatedly. It’s true that the treatment itself is cheaper. But you have to treat them repeatedly and they cost a small fortune in policing, hospital stays, legal costs, etc.

  3. bird says:

    Good post Erick.

    Many of the homeless that my Church works with are mentally ill. Granted some of the mentally ill will not accept mental health assistance no matter how great the help, many will, and our system is just not adequate for most of these folks. Because poor mentally ill individuals cannot provide these services for themselves, this is a legitimate end for government, and it is one where we are failing.

    It is a problem that disproportionately affects the poor. Many well-to-do families can afford long-term treatment at private facilities for their children affected by drug or alcohol addiction or other mental illness, and many of those that receive treatment come out happy productive members of society. However, many people do not have this alternative.

    This is not a matter of laziness or personal responsibility. I don’t see homeless individuals ‘having fun’ and living on the streets. It is a physically and emotionally degrading existence. The root of homelessness is most often mental illness. If I were a lazy man, I could figure out a much easier existence than living on the street. The poor mentally ill cannot simply work harder, and their families cannot afford to get them the treatment that they need.

    Private charities cannot solve this problem. As a member of one of the wealthier churches in Atlanta that funnels most of their contributions to community services, I have seen first hand that private charities simply do not have the resources to provide the care that these individuals require. Almost all private charities will tell you the exact same thing.

    This is the responsibility of our government, and we are failing.

  4. Rogue109 says:

    No, Bird, “we” are not failing. The State’s annual budget is in excess of 20 billion dollars…almost three billion more than Florida’s annual budget. “We” are taxed to the hilt and are paying enough. “We” haven’t failed them and maybe if “we” would be allowed to keep more of our own money, “we” could give more to the private charities which no doubt would give a better outcome for these poor people, as you point out.

  5. Icarus says:

    “The State’s annual budget is in excess of 20 billion dollars…almost three billion more than Florida’s annual budget. ”

    Rogue109,

    According to http://www.stateofflorida.com‘s quickfacts, their 2005-2006 budget was $64.7 BN.

  6. Rogue109 says:

    That’s what I get for reading “Florida Today,” then. Sheesh (grin).

    Okay…go re-read my other post but imagine that that number is not there.

  7. Icarus says:

    I don’t disagree that we’re overtaxed, but I was shocked to read that our budget was larger than Florida. I feel a little better knowing that a state with twice our population is spending three times our budget.

  8. Rogue109 says:

    No doubt, you got me on that one. But I don’t feel good at all about the budgets of EITHER Florida or Georgia! Too much, too large, too punitive.

  9. Nicki says:

    Here’s the thing, though — we don’t have a choice with regard to these costs. We either treat people properly or we deal with the costs of them untreated. It’s not like we just get out of paying — we effectively transfer the costs to a different sector.

  10. Rogue109 says:

    No, Nicki, we actually do have a choice with regard to these costs…we can not pay them.

    Make no mistake, though: I’m not saying these people should not be treated. What I’m saying is that I believe the private charities are in a better position to achieve cost savings with a superior treatment regimen for which citizens can voluntarily contribute their savings towards, if they so choose.

    In supplying social goods, charities have several advantages over the state. First, being voluntary, donations distort incentives less than taxes. Second, being focused, many donors monitor performance of charities, rewarding good performance and punishing bad performance. Third, the state’s majoritarian politics fails to supply the mix of social goods required by a diverse population as evidenced by the point of Erick’s original post. See: Weisbrod, Burton. 1988. The Nonprofit Economy. Cambridge: Harvard University Press.

    We are not merely “transferring” payments; we are obtaining a better benefit from payments while simultaneously not compelling participation from all taxpayers and allowing individuals to determine which programs THEY want their money to go towards.

    It’s freedom of choice with ones money and it’s a groovy concept. Peace out!

  11. bird says:

    Wishful thinking Rogue, but your argument holds no water. Since Reagan cut taxes and reduced mental health care services, the mentally ill have stayed in our streets. Private charities have not picked up the slack.

    The problem is just too big. And I will assert my previous statement. Ask charities if they want the government services to go away in exchange for a tax break that will “probably” increase their contributions. It is an easy answer, these charities can’t even supplement the government services properly, and they will be the first to tell you.

    I would like to think we can do without the government, but I would also like to think everyone will just get along and we won’t need the police, army, etc. It just ain’t reality. Your experiment will hurt real people.

    I hate to presume motives, but I have a strong suspicion that many people advancing your argument care more about keeping their own money than helping those less off. Call me crazy . . .

  12. Rogue, there should be a simple way to test your hypothesis. Compare the various states, look for states that spend fewer state dollars on mental health and have a lower overall tax burden and compare them to states that spend more and tax more.

    In the first category there will be less money from the government and more money for charity (since the taxes are lower) and in the latter there should be less money for charity (gov’t takes more) and higher gov’t spending in mental health.

    If you can measure mental health in these states in a uniform way, the category 1 states should have better stats than category 2. My gut tells me you would not be able to clear your theory this way, I just don’t think Mississippi is some boon for mental health compared to Vermont or New Jersey.

    In actuality I think you’ll find that mental health care is lacking across the board, and blaming government involvement as opposed to non governmental charity involvement is probably not the answer here.

  13. Rogue109 says:

    Bird:

    “I would like to think we can do without the government, but I would also like to think everyone will just get along and we won’t need the police, army, etc. It just ain’t reality. Your experiment will hurt real people.”

    Yes, and the State of Georgia isn’t hurting people with their move? And what is the answer…higher taxes? And who said anything about doing away with government? Charities can’t supplement government services because the monies that could go towards them are taken away without option. (Of course, chrisishardcore makes a point about that below…)

    I did like your dig at Reagan! Could you point to me in the Federal Constitution where taken care of alcohol addicted people is a responsibility of that level of government to collect taxes for their treatment? Let me guess: the Commerce Clause?

    chrisishardcore: Hey, that’s an excellent idea. Like you (I’m guessing), I don’t have the time to run the numbers. It would be interesting, though, and might make me change my mind if the disparity in tax rates was large enough. I do think that blaming government involvement is appropriate, though, as it has wholly failed. Isn’t that what we are talking about here with Erick’s post?

    Bottom line: I think these people do need help and it is clear the government option isn’t working. At the very least, we need to try the private option more often.

  14. Donkey Kong says:

    Rogue,

    In concept, you’re right. The problem is that it is difficult to cut taxes sufficiently to have the effect of substantially increasing charitable donations. But there is some evidence of the free market system working.

    Case in point: many liberals are decrying the need for additional funding in public education. Well, the Bill and Melinda Gates Foundation spends huge sums of money to provide technological training to students, things that technically, the school could provide if the government provided additional funding. Their impact on children’s education in urban areas is substantial. However, if the top marginal tax rate was still at the pre-Reagan levels (70 something percent) instead of the post Reagan level (20 something percent, I think), Gates’ money to contribute to charitable organizations would be cut in HALF. Why half? The top marginal tax rate is 50% less. That means Gates can keep 50% more of his income, and has more $$ to give away. These tax cuts, in a fairly clear-cut manner, gave people like Gates the capacity to fulfill a societal need. Plus, private efforts like this are much more efficient and effective than governmental programs.

    However, Rogue, in the next 10+ years, the mentally ill will suffer until the need becomes large enough for charitable efforts to satsify it. And we need to determine if we are willing to let that happen.

  15. HeartofGa says:

    We need a continuum of care for the mentally ill. That continuum includes both inpatient and outpatient options. We are currently providing much of the “care” for the mentally ill (including addicts) in jail-the most expensive and least effective solution. That just doesn’t make any sense.

    By the way, the need for a continuum of care also applies to children and youth. Residential treatment, group homes and foster care are all options that need to be available for children who are in the care of the State.

  16. Doug Deal says:

    Chris, the problem with that method is that the federal government takes such a large percentage of income (About 30% when SSI and medicare is included) that the puny 0-8 percent taken by states is just statistical noise. The effect of differing incomes, sales taxes and local custom would far outweigh the small change in tax burden.

    In any event, if the federal government stopped funding and mandating everything, there could be 50 different approaches to problems, and states could learn from each other, instead of all 50 states being locked into the program selected by Congress.

  17. Donkey Kong says:

    As an aside, what’s up with this: I am in Chicago working for the week. One week. A little over 50 hours. And I have to file an Illinois tax return. What in the world???? Do they want my fifty cents that badly? They probably spend more in bureaucracy and paperwork to charge me for taxes than they actually receive. Psychos.

  18. Jmac says:

    Rogue, I just want to add a comment regarding your stance that if folks had more disposable money they’d give more to assist private charities. That’s not true, and I say that as someone who has numerous family members working in the accounting field.

    The majority of clients they have who earn in excess of $250,000 are considerably less charitable than those who make less, and the majority of folks across the board give little to nothing. What makes a person want to give is a desire to affect change or support a worthy organization. It’s a matter of one’s heart, not one’s pocketbook.

    From their take, as well as my experiences working with fundraising for a few non-profits, the folks who give generously currently are the only ones you could count reliably to give more with a ‘lower tax burden.’

    Again, it’s more a character trait than a pocketbook issue.

  19. Nicki says:

    No, Nicki, we actually do have a choice with regard to these costs…we can not pay them.

    Wrong. The groups onto which the costs are transferred ultimately are the hospitals, the police, and the prisons. We do have the option to not fund mental health services, or to pass that responsibility off to voluntary associations of citizens. But we don’t have the ability to refuse emergency care or allow crime to run rampant.

    There was a really great article in the New Yorker a while back which centered on Reno’s efforts to help its homeless. It found that the cost of not addressing its most egregious offenders — nearly all of whom were intractably mentally ill or seriously addicted — was staggering. A million dollars for one guy over the course of a few years, for example, in wasted government services such as those mentioned above. It’s actually cheaper to invest more on the front end.

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