Minnesota

I retired a few years ago as a hospital administrator in a nationally top rated west coast hospital. Located in a well to do suburb of Seattle, we weren't generally getting homeless and indigent patients prone to substance abuse and other complicating factors of behavioral health problems. But we did get many folks just as the story describes, a family member or foster care person that had issues the family responsible simply could not deal with effectively at home consistently. They tried. But they got worn down. Something goes wrong one day , the person under care hurts themselves or others, gets off their meds or whatever and the closest Emergency Department gets involved. It was not unusual to be boarding up to a dozen of these patients at any one time and some for over a month or more until a proper behavioral health bed could be found. We had one patient that it took over six months to place.

Psychiatrists who would deal with uninsured or Medicare/Medicaid patients were almost non existent and it could takes days to even get one in to consult and come up with a treatment and placement plan. And while we could stabilize and protect them, it was at the cost of precious hospital beds frequently needed for much sicker patients. It was not unusual in the winter flu and pneumonia season that we would, as well all the hospitals in the region, be out of beds. Getting a dozen beds back, over the 8 or so major local hospitals meant helping another 100+ critically ill (usually elderly) patients a day. And we were this overwhelmed frequently from January into April. People died for lack of beds and appropriate care and medical staff gets overwhelmed and demoralized. And that was before Covid!

There are not enough psychiatrists or behavioral health facility beds. The vast majority that exist are for profit and only take cash or rare high end insurance that covers mental health. The states long ago divested themselves of being responsible for public mental health as it was thought home treatment was the way to go rather than institutionalizing people for what was likely to be life. Most of the state hospitals were closed or repurposed. No support was really given to make home treatment workable, no matter how much more humane it was. The staes just took the savings for other uses.
And now in a country where over 60% of people can't cover a $1,000 emergency expense, substance abuse of all types is rampant and complexities of contemporary life push people to a mental brink more and more, there is no real workable system to help the patients, families and communities affected. Pretty sad for one of the richest and supposedly caring countries on the planet.