I recently retired from my career as a psychiatrist. During the past 40 years, I primarily worked in inpatient psychiatric facilities and psychiatric emergency services. I have worked primarily with patients with severe and persistent mental illnesses.
Just before I started my training, the movement in the country was for “deinstitutionalization,” the reduction of state hospitals in hopes that with the advent of newer medications, patients could be returned to their home communities and receive outpatient care. The idea had merit, but the money needed to provide the wrap-around services for these patients was never adequately funded. It is not surprising that the front page in today’s (December 13, 2021) Denver Post spells out, in detail, how community mental health providers are in truly short supply and salaries have not been competitive with other work available.
I have worked with different systems of mental health care. Mostly, I treated patients who required inpatient hospitalization in addition to working in private hospitals at the Colorado Mental Health Institute at Fort Logan (CMHIFL) from 1984 to 1988 as an attending psychiatrist on an admission ward. Patients received great multidisciplinary care, and at that time, there was no pressure for rapid discharge and return to outpatient care. 11 years later, I returned to CMHIFL as the medical director. The hospital had shrunk in size. Managed care outpatient systems were putting greater emphasis on brief hospital stays and turnaround of beds for patients.
One of my best experiences as a psychiatrist was serving as Medical Director of an Assertive Community Treatment team. This team received rich funding primarily from a class action suit referred to as the Ruth Goebel case. Ruth suffered from mental illness and eventually froze to death in an alley in Denver. The class-action suit identified 1,600 homeless individuals with mental illness who were not receiving adequate mental health services. The case was filed against the State of Colorado, City of Denver, Denver Health, and Hospitals. The resultant funds from the lawsuit set up many levels of supportive care for the identified homeless and mentally ill persons.
The goal was to maintain these individuals outside of a hospital. My assertive community treatment team (ACT) was a project of the University of Colorado and the Mental Health Center of Denver. The University supported me to provide half of my time to the ACT team. Our total number of clients was 100, and I had a staff of ten case managers, two nurses, a psychologist team leader, and a receptionist. The case managers each had ten clients. Their focus was to maintain our clients in housing, see them make it to appointments, and assist with obtaining medications and other supportive services. We were known as the University High Intensity Treatment Team or HIT team for short. I believe our funding was just below $600,000 per year for this level of care. This experience reinforced my beliefs in the importance of providing continuity of care with a long-term focus for the recovery of persons with severe and persistent mental illnesses.
“This experience reinforced my beliefs in the importance of providing continuity of care with a long-term focus for the recovery of persons with severe and persistent mental illnesses.”
It was natural for me to gravitate towards being on the board of Karis Community because of the similar focus of using a therapeutic living community for growth and recovery. Several of the patients I treated in the hospital were able to obtain placement at Karis and go on to significant recovery and independence.
The uniqueness of Karis is the ability to have a place to live, for up to two years, with other persons working on their recovery and growth towards further independence. This environment is unique. The residents have input into who joins the Community, take turns preparing meals, participate in support groups provided by Karis’ clinical staff, and are expected to spend a minimum of 20 hours at school, work, or doing volunteer work.
Mark Trubowitz, Board Member