Leana S. Wen is Baltimore’s commissioner of health.
The world has heard about Freddie Gray. I want to tell you about another young man whose life ended too soon.
He was my patient in the emergency room at a D.C. hospital. He was 19 years old and had been shot five times in the chest and abdomen.
I knew him because it wasn’t the first time he’d come to our ER. Two weeks earlier, he was there after a heroin overdose. Three weeks before that, he sustained a knife wound and a broken jaw in a fight. Multiple records noted his hospitalizations for suicide attempts and repeated run-ins with the law.
Baltimore’s riots are last week’s news, but the underlying problems have not gone away. Violence, poverty and health disparities have many inputs. In Baltimore, the District and many other places across the country, these are closely tied to substance use and mental health problems, and to historical policies of mass arrest and incarceration.
Consider these statistics. Among Baltimore’s population of 622,000, more than 73,000 arrests are made every year. The most common reason for arrest is a drug offense. Eight out of 10 people behind bars use illegal substances; four out of 10 have a diagnosed mental illness. Nearly 7,000 juveniles are arrested every year, and 25 percent of all those in jail are younger than 25. While African Americans make up 62 percent of the population in Baltimore, they constitute 95 percent of juveniles arrested.
While limited addiction and mental health treatments are provided in jail, and Baltimore’s drug courts successfully divert hundreds from incarceration each year, many people fail to connect with medical and social resources once they are freed. People seeking assistance often visit ERs; more than half of frequent ER utilizers have mental illnesses, substance addictions or both. This can be further complicated by homelessness and an inability to find employment.
These are Baltimore’s problems, but they are not unique to Baltimore. To solve the deep-rooted problems of cities around the country, we must target residents who are most at risk and most in need and provide quality, trauma-informed care. I propose the following three interventions:
First, we need dedicated teams of professionals to assist every individual released from a detention center or jail. This multidisciplinary team would address acute psychiatric needs and ensure that there is follow-up with primary care and mental health providers. It would also guide people to key social services, such as job training, legal assistance and neighborhood reintegration programs.
Second, we need a 24-hour treatment center that specifically serves those with mental illnesses and addictions. Patients could walk in or be brought in by families, police or emergency medical services personnel. This center could provide counseling and addiction treatment, as well as help people solve housing and other needs. A “no wrong door” policy would ensure that nobody is turned away.
Third, we need to address the huge unmet need of mental health care for our youth. Through telemedicine, we can have mental health providers accessible to every one of the 85,000 students across 188 schools in the city. These services are needed not only for our children but also for their parents. We need to expand home-visiting programs so that all at-risk mothers receive home-visiting and case-management services.
Critics may ask whether these interventions are realistic, but all three are based on evidence and successful demonstration. Baltimore Crisis Response offers limited case-management teams, including to former inmates, and has reduced ER visits by 24 percent. San Antonio has a mental health treatment center that has saved the city $10 million a year. Several rural and suburban jurisdictions have started telemedicine in schools, and initial reports are promising. Home-visiting for at-risk mothers has reduced child abuse and improved children’s educational outcomes.
Others may argue that the interventions target only a small segment of the population, but there are sound reasons for focusing on this group. These individuals are the most costly in terms of societal resources and lost productivity. They are often disruptive to their neighborhoods as they circulate through the revolving door of hopelessness, crime and incarceration. Finally, many successful community interventions target those most at risk, including case management for high ER utilizers and violence interruption in high-crime areas.
The root causes of Baltimore’s unrest have plagued our city for decades and will not be resolved overnight. Many other investments are necessary, including in schools, housing and job opportunities. However, the critical underlying problems are mental health and substance use as it relates to the criminal justice system and to our youth. Other reforms will not be successful unless these core issues are resolved.
My patient died that day in the ER. Like Freddie Gray, he never really had a chance to live. For his sake, and for Gray’s and so many others’, let’s heed Baltimore’s call to action — in Baltimore and across the country. Let’s align our national urgency with targeted funding and the willpower for change. Let’s focus on the real causes of violence, poverty and health disparities to heal Baltimore and transform it into a successful and positive model for others to follow.