SCOTT DETROW, HOST:
America's already strained mental health care system is facing federal cuts with the recent passage of the Trump administration spending bill, leaving mental health workers nervous about the ripple effects for people living with severe illness. The podcast "Lost Patients" explores the difficulties of obtaining treatment in Washington state, and it focuses on people who experience psychosis firsthand, as well as their families. It's produced by The Seattle Times and KUOW Public Radio. I'm joined now by Esmy Jimenez, one of the three journalists who produced the podcast. Thanks for coming on.
ESMY JIMENEZ: Thanks for having me.
DETROW: This is such a difficult topic for families to talk about. What did the people who took part in this series share with you? And what did - like, really, what do they want you to know?
JIMENEZ: Yeah, so I talked with Heidi Aurand. She's a mom based in Portland, Oregon. Her son, Adam, was diagnosed with schizophrenia many years ago, and he also struggled with addiction. Heidi and her daughter, Bethany, reached out to me because they had such a hard time getting Adam help in Seattle and the surrounding cities. And they ran into so many hurdles. And one of the things they told me was just how hard this was because Adam was a really special part of the family. Here's what Bethany and his mom, Heidi, had to say about him.
(SOUNDBITE OF PODCAST, "LOST PATIENTS")
BETHANY ANDERSON: He could pick up something, and he could learn how to fix it or learn how to play it or learn how to train it or whatever. And he had the patience of a saint.
HEIDI AURAND: Adam could train a dog without treats, without harsh words. He just was one with the dog. And he didn't even say, come. He just made a noise, and the dog was right to his side.
DETROW: I mean, that's rough. What - tell us what happened as they looked for treatment for him.
JIMENEZ: It was remarkably challenging. Adam ended up being an example of a phenomena that I witnessed in my reporting over the years, and that's that people with severe mental illness would end up kind of churning through emergency rooms, jails and sometimes even the street without really getting any long-term help. In Adam's case, he specifically did end up in the hospital because of an overdose, but there was other times that I saw in his paperwork that he was just needing and looking for food and shelter, and the hospital would then stabilize him. But then they would also have to discharge him after 24 hours, 48 hours. And then he would eventually just cycle back into psychosis or addiction or both.
And then when he got involved with law enforcement for minor offenses, police would also detain him but only for a short time. And specifically, here in Seattle there were so many people in the jail system who were needing mental health treatment that officials ended up triaging. So sometimes people with misdemeanors were released. And so with Adam, after years of this cycle, he actually ended up in prison. And his family, at the time, thought, OK, well, maybe now he's in one place, and maybe now he'll finally get help. But he didn't actually seem to get better. Instead, his sister saw how sick Adam really was. Here she is again.
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ANDERSON: We're sitting at this table, and his behavior was erratic. And he was, like, side whispering to himself. I had to get up and go smoke a cigarette. And as I'm walking out, I had to walk past guards. I'm crying 'cause I'm trying to get myself together. The guard says, what's wrong? And I said, that's not my brother. There's something wrong. What do you mean that's not your brother? That's not my brother. There's something wrong with him.
DETROW: Various degrees of mental health challenges are really widespread, and yet it seems like the way of addressing this is so broken. As you've done this series, as you've zoomed out on this, like, what have you found about what shaped this current mental health system that we all live in?
JIMENEZ: Honestly, the thing that I try to remind folks, and I try to remember as well, is that the psychiatric system we see today is really inherited from policy decisions that were made back in the '60s and '70s. That's when many states closed down these big, state-run psychiatric hospitals, and those really - they used to be the backbone of the mental health system. In Washington state, for example, Northern State Hospital was shut down, and that's how we lost a number of psychiatric beds.
And the idea at that time was to move patients into smaller, community-based systems instead of the big, giant hospitals. But the thing is, a lot of those smaller treatment centers just never materialized. And at the time, there were also concerns about the quality of care the patients were getting. For a time, that included hydrotherapy. That's these really cold and hot baths, where people are restrained in them. Later, as many people know, that also included lobotomies. It was also just much easier to involuntarily commit people. And all of this led to a patient rights movement to deinstitutionalize the mental health system and really focus more on the civil rights of patients.
DETROW: Let's talk about where all this meets where we are right now. Big cuts are coming to Medicaid based on the bill signed into law - a trillion fewer dollars over the next 10 years, so that's going to shake out in a lot of different ways. But big picture, what is your sense of what this funding change means for the mental health system and for people like Adam?
JIMENEZ: Yeah, so I reached out to some state officials, and they shared that currently there's about 500,000 people in Washington state alone who are on Medicaid, and they're receiving some kind of behavioral health service. So that includes both treatment for their mental illness or substance use disorders. And officials are really worried about these people, especially in rural areas and especially knowing that more cuts are likely coming or already going to be attacking other parts of the system. They said the ripple effects will be quite dire. They think fewer people will get medical care, and people with untreated mental illness may also cycle for longer before they're able to actually get help.
And one thing that I want to just state is the mental health system in the state and, frankly, in large parts of the country, it's never really been sufficiently funded. Psychiatric hospitals and community-based clinics infamously deal with these workforce shortages already, precisely because of the money issues. They already just face so many other challenges. So this blow is really just the latest one that staff have to deal with.
DETROW: You're paying a lot of attention to this. What are the specific repercussions you're going to be keeping an eye on?
JIMENEZ: I think I'm interested in seeing how many people are still able to get care, how this affects potentially the jails or prison systems as well, homelessness counts. All of this, I think, is really important to keep an eye on just because they're so interconnected, unfortunately.
DETROW: That's Esmy Jimenez, one of the journalists behind "Lost Patients." It's a podcast that explores the mental health system and how it overlaps with homelessness and substance use on the West Coast. Thank you so much.
JIMENEZ: Thank you for having me.
DETROW: And you can listen to "Lost Patients" wherever you get your podcasts.
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