The IMD Exclusion is an illogical, unscientific, and discriminatory government policy that is premised on a gross fallacy of something called “mental diseases”.

The IMD Exclusion should have been repealed decades ago. In 1996 Dr. E. Fuller Torrey, in a Senate hearing, told Congress that serious “mental illnesses” were brain disorders, just like Parkinson’s and Alzheimer’s Disease and that they should be covered under Medicaid with no restriction accordingly. This grotesque policy came about as a product of misguided and false beliefs stemming from the splitting off of psychiatry from neurology in the late 19th century, the emergence of psychosocial and public service psychiatry, the bizarre Mental Hygiene Movement, and the nascent Consumer Movements.

The IMD exclusion is found in section 1905(a)(B) of the Social Security Act, which prohibits “payments with respect to care or services for any individual who has not attained 65 years of age and who is a patient in an institution for mental diseases” except for “inpatient psychiatric hospital services for individuals under age 21.” The law goes on to define “institutions for mental diseases” as any “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services.” 

The adverse consequences of this policy cannot be overstated. It is one driver of homelessness, unjust incarceration and familial crisis for parents struggling with the horror of trying to care for a child at home with serious cerebral illness like so-called schizophrenia (Jacobi Flemming Nasse Syndromes – JFNS in the NASNIcares’ lexicon).

While our legislators congratulate themselves on passage of the Safer Communities Act, which is said to be a gun bill wrapped in “mental health”, the IMD Exclusion remains in place. Our legislators don’t know the difference between ‘Mental Health’ and serious Cerebral Disorders and are profoundly ignorant about the fundamental nature of these brain function disorders and their neurobehavioral symptoms so the paradox of passing this bill while the IMD Exclusion remains law probably never even crossed their minds.

Intrafamilial tragedies have resulted when parents have tried desperately to get a loved one admitted to inpatient care when in neurologic crisis (so-called psychosis) but have been rebuffed by the system. This is a system that solicits – demands violence, in the form of irrational dangerousness standards for involuntary admission. The analogy to the dangerousness standard would be a patient experiencing chest pains who is denied evaluation and treatment until they can report having had a full-blown heart attack. Misguided and spectrum-disordered advocacy have written these laws.

Right now, there are many thousands of people either languishing in emergency rooms (known as psychiatric boarding), out on the streets fending for themselves, living (dangerously) in the family home, or in jail and desperately ill because they can’t get a bed. At the same time, the Department of Justice Civil Rights Division is persecuting states for holding patients with so-called mental illnesses too long in inpatient settings or housing them in nursing homes or other congregate care settings that are not “community-based” enough to satisfy the deranged ideological beliefs of Consumer Movement and Disability Rights advocates. So-called psychosis (another legacy term of strange psychoanalytical ideas), which is a potentially dangerous neurological detachment from reality, is treated as a mental health issue when it should be treated as a medical emergency.

The general public has been miseducated to believe that an “insane” person cannot think up and carry out a goal-directed plan – terminology used by a prosecutor recently in a high-profile case of a mass shooting, but that is absolutely false. A person who is neurologically detached from reality and anosognosic about their brain impairment is MORE, not less likely to carry out a ‘goal-directed’ plan. They have lost or do not have awareness of their impairment – even if their actions suggest to the untrained eye “knowing right from wrong”. They do not have the capacity to audit their thoughts and behaviors. This is evidenced by the fact that people that carry out these acts of violence declare their plans to others or post frank statements on social media with no appreciation for the risk that these declarations present to themselves. This is not what run-of-the-mill criminals, or evil people, or just bad kids do. It is abnormal and bizarre behavior typical of serious brain function disorders (some of which are treatable with pharmaceuticals and some of which are not) but most people do not perceive it this way because these brain disorders are not something that people understand.

Excerpting from an article in Forbes:

“Reports across the country are bubbling up about the closing of psychiatric beds, according to officials in New York, Illinois, Massachusetts, Texas, and here in Washington, D.C. In some cases, patients are being discharged even though many still showed signs of psychosis and mania”

Mania and so-called psychosis are not Mental Health problems (as described in the article), they are serious neurological symptoms that can have catastrophic consequences if untreated and the afflicted person is not closely monitored and case managed. If that person gains access to a deadly weapon, it can result in tragedy. Where in America are major hospitals closing down general medical beds? There should be no such thing as a “psychiatric bed” for people afflicted with grave neurological disorders like bipolar, so-called schizophrenia (syndromes), neurogenic “depression”, and other serious brain function disorders. These medical conditions require medical beds.

The anti-stigma and disability rights brigades, as they are known among this writer’s advocacy network go on frenzied media offensives at any suggestion of a connection between so-called mental illness (a ridiculous term that they are too insight challenged to recognize as problematic) and violence, but this writer doesn’t care what they think. Neuroscience doesn’t care what they believe either. The media needs to start tuning them out, along with the psychosocial (vs biological) psychiatrists that chime in with them. Their perspectives are not healthy and do not need to be respected or given deference to. This is a matter of life and death.