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Ellen Belcher is the Dayton Daily News opinion pages editor. She writes about state government, education, the environment, higher education and all things Dayton.
Martin Gottlieb is an editorial writer and columnist for the Dayton Daily News opinion pages. He focuses on the political process itself and does such national issues as war, the economy, taxes and Social Security, as well as a hodge-podge of local and state issues.
Scott Elliott is an editorial writer and columnist for the Dayton Daily News opinion pages. He writes about education, city and suburban issues, politics, business, workforce and consumer issues.Home > Blogs > A Matter of Opinion > Archives > 2009 > November > 12
Thursday, November 12, 2009
Editorial: Mentally ill not getting care they need
Vulnerable, sometimes dangerous, people are not being treated well — morally or medically — partly because of a fight between Montgomery County’s mental health agency and local hospitals.
The failure to come together could get someone — a mentally ill patient, a family member, a doctor or nurse or some unsuspecting soul on the street — hurt.
Last year Twin Valley Behavioral Healthcare was closed by Gov. Ted. Strickland. It was the Dayton area’s state psychiatric hospital, the place where acutely disturbed people were treated sometimes for long periods.
Since Twin Valley closed, patients generally are sent to a similar facility in Cincinnati. Local hospitals complain, though, that they can’t get the Alcohol, Drug Addiction and Mental Health Services Board to sign off on this intense treatment.
If a mentally ill patient is taken to a hospital emergency room by police or a family member and needs to be admitted, local hospitals are equipped to keep these individuals for short stays. Their facilities aren’t built or staffed, however, to allow people to remain for a week and more.
But hospitals have to get county mental health officials to agree that a person needs to be in a state facility — and they have a financial incentive to resist.
So long as a patient is in a hospital, the mental health board doesn’t have to pay for the care. Either the patient pays (which is rare) or the hospital eats the cost and hopes to collect from the county’s uncompensated health care fund.
Because of cuts in the state budget, the local mental health board has taken a $7 million hit, representing 30 percent of the money it was previously receiving from the state.
That loss, of course, has mental health officials scrutinizing every placement to a state facility.
(Montgomery County used to get funding for having an average of 31 patients per day in a state facility; that’s been cut to 20.)
Even as mental health officials can’t send every patient who needs intensive care to Cincinnati, they’re plowing ahead to create a new facility called Morningstar that would take patients for short periods.
The hospitals are throwing up their hands, saying they are able to treat those individuals; it’s the longer-term treatment — for the most complicated and most violent patients — that they can’t provide.
Of course, the state has had a big hand in creating this mess by closing Twin Valley. But, nonetheless, Columbus officials have to be fed up with the bickering. They’re aware that things are not working well here for patients and their families.
The hospitals that are complaining have a financial stake in getting a certain outcome. They are not unbiased victims.
But Montgomery County’s mental health board, under Joe Szoke, has abdicated. When Twin Valley closed, the agency could have been all over the sorts of problems that easily could have been predicted — this being just one.
Montgomery County’s mental health agency can’t let this chaos continue. Its funders at the state and at the county need to tell it just that.
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Martin Gottlieb: Can Leitzell avoid being Carter?
Let’s compare Gary Leitzell with Jimmy Carter. No offense intended. To either.
It’s just that certain similarities present themselves.
When Carter was elected, a fellow Georgian who had worked for him all along said that if Cyrus Vance became secretary of state, he, the Georgian, would eat his hat, or words to that effect.
Vance was a Washington insider and was one of the first names to come up for the job. But Carter had run as an outsider, an alternative to a Washington establishment that had given us Watergate and Vietnam.
But Vance got the job. And no hats were eaten.
Carter knew that campaigning is one thing and governing is another. He was going to need some local expertise to help him.
But the story is misleading. Carter never really worked out relations with Washington. The instinct about the Washington establishment that animated his aide in the discussion of Vance represented something in Carter, too. And it never went away. Carter did bring a lot of Georgians in with him: chief of staff, press secretary, political adviser, attorney general, budget director.
In that context, he pretty much had to appoint a couple of Vances just to keep the peace. It didn’t quite work.
His presidency was not successful and was not renewed.
The Leitzell connection? Welll, Carter had been a relatively obscure, one-term governor before launching a presidential bid against much better known people and against long odds.
If you win a race like that, the tendency must be powerful to stick with what worked, to trust your own instincts and your own people, to look upon the establishment as the people you beat, the people the public rejected.
Leitzell, too, came out of no place on his own instincts and with his own friends to get elected mayor of Dayton.
He’s got to feel pretty good about what got him here.
Thing is, though, there’s a lot of luck in campaign outcomes. And luck tends to run out.
Anyway, governing will be a very different undertaking. It will be less about winning than about working things out. He’s only one vote on a five-member commission.
He’ll need support from a commission that is otherwise all Democratic. To get it, he’ll need support from outside: from the general public, the business community and others on a case-to-case basis.
Alternatively, of course, he could just go to war against the commission majority. He could aim toward election of like-minded commissioners in two or four years.
But it’s a dicey, dangerous path. And little in his 2009 campaign suggests the necessity of that course.
Little even suggests what being “like-minded” would consist of.
Leitzell is fortunate about one thing: His campaign didn’t lock him into ideological stances or promises that rule out cooperation. That’s the upside of a campaign that was mainly just about being the alternative.
When Mike Turner defeated a Democratic incumbent in 1993 to become mayor, he was pretty much committed to a house cleaning at City Hall. That made things a lot tenser than they need to be now.
Still, tensions there will be. After all, more elections will be coming up, and people do have their ambitions.
Another thing that could work out nicely for Leitzell is the independent label. It makes him freer than most to reach out in several directions and expect sincere help. He should be able to talk with Rep. Mike Turner and Paul Leonard. Former city managers could be helpful, too, including Rashad Young and Jim Dinneen. Though gone from Dayton, they both know the personalities and issues he’ll confront.
Important among the things he might learn from them is whom to ignore. Every city has some very insistent people seeking the mayor’s ear, people who are fueled by misinformation and misunderstanding. Listening to them will send a public official down multiple dead-end paths.
Leitzell doesn’t have to abandon his own nature to become some cookie-cutter, establishment version of what a mayor should be. He just has to recognize his strengths — neighborhood affairs especially — and weaknesses.
In some realms, he is a fairly blank slate, as was, no offense, Jimmy Carter.
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Editorial: Homeless sex offenders can be tracked
An unsettling attack in Dayton by a homeless sexual predator has raised a serious question:
Is there a better way to track and monitor people convicted of major sex offenses, but who don’t have a permanent addresses?
Montgomery County has the chance to blaze a trail in the right direction by experimenting with electronic monitoring as a solution.
The sheriff has been promised support from state Rep. Clayton Luckie, D-Dayton, and Sen. Jon Husted, R-Kettering.
James Cundiff, 42, labeled a sexual predator after serving 18 years in prison for robbing, raping and assaulting a girl when he was 17, was arrested last month for allegedly robbing and stabbing a nurse in a parking lot near Miami Valley Hospital. He had been living under a railroad bridge near Patterson Boulevard.
During the past 15 years, state and federal laws related to sex offenders have gotten increasingly tougher, with both good and bad results. New Jersey’s 1994 Megan’s Law first began requiring sex offenders in that state to report where they live and notify neighbors. Similar laws have spread to all 50 states.
These laws have the positive effect of raising awareness about the need for extra vigilance, especially for those with children who are in close proximity to someone with a history of serious sex offenses.
But in some places, the rules for sex offenders are suffocating and unreasonable. Limits that block sex offenders from getting too close to schools, child care centers, churches and other places where kids may congregate have made it difficult for them to find work or places to live.
Ohio’s law is sensible. It restricts all sex offenders from living within 1,000 feet of a school, requires them to register their address with the state and stipulates notification of those living nearby.
But there is a loophole. When sex offenders declare themselves homeless, they are more difficult to track and notification of neighbors becomes harder.
Homeless sex offenders do have to register and describe a general area where they spend most of their time. In Montgomery County, about 12 of the most serious sex offenders — those considered to be sexual predators — are listed as homeless.
One thought is to require electronic monitoring only for this class of offenders who declare themselves homeless. It seems like a sensible approach.
There are different types of electronic monitors, but in most cases, they allow the wearer’s location to be tracked in real time by satellite.
Some systems allow officers to see when an offender enters a restricted area (getting too close, say, to a school), and some of the bracelets will actually emit an alarm, drawing attention to the offender.
Any system will require dedicated officers keeping tabs on these individuals. That could be costly, but Sen. Husted said he believes grant funding can be found. That would give the county an opportunity to try out the system. If it proves effective, Sen. Husted said lawmakers could look at incorporating this approach into state law.
Electronic monitoring will not prevent all crimes by sexual predators. But it would be an aggressive attempt to fill a gap in efforts to make sure offenders aren’t where they shouldn’t be.
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