We have failed the mentally ill of this country. In trying to save government money, we have watched them become subject to increasing job loss, homelessness, imprisonment, emergency room treatment, substance abuse, or vulnerable to violence. How did this happen and what is being done?

The Institutes for Mental Disease (IMD) exclusion began in 1965 as part of the Social Security Amendments Act of 1965, which created Medicaid and Medicare. Here are the basics of the exclusion:

The IMD exclusion prohibits the use of federal monies through Medicaid for any care (including non-mental health services) provided to patients from 21 to 65 years old, in mental health or substance abuse residential treatment facilities with more than 16 beds. A facility is determined to be an IMD based on its ‘overall character,’ or the totality of whether the facility is a licensed psychiatric facility, is under the state’s mental health authority’s jurisdiction, specializes in providing psychiatric care or treatment (based on the proportion of staff trained in psychiatric care), or whether more than 50 percent of patients are admitted to the facility for mental health care.