Antipsychotics Access Options Outside of Incarceration

Peter Salgo, MD: If somebody is incarcerated and they’re getting these injections, your taxes are paying for them?

Judge Steven Leifman: Absolutely.

Peter Salgo, MD: Once out of prison they’re subject to third-party payers or Medicaid/Medicare.

Judge Steven Leifman: Or state funds.

Peter Salgo, MD: Do most payers cover this once they’re discharged?

Judge Steven Leifman: The long-lasting injectable?

Peter Salgo, MD: Yes.

Richard Jackson, MD: Individual states and counties are all different—that’s why the long-acting injectables, when they leave, provide leeway, which is needed since many patients who were on Medicaid or Medicare now need to reestablish their payment system. You need a team to help them through each step—it takes a village.

Mauricio Tohen, MD, DPH, MBA: Getting back to the previous point of the first- and second-generation injectables: the second-generationals have advantages for patients with mood and bipolar disorders, some of which are not covered by various insurance companies. It’s a problem.

Peter Salgo, MD: Just another moving part.

Mauricio Tohen, MD, DPH, MBA: Speaking to a point Steven made earlier—the overlap between the homelessness and mental illness and medicine now needs to be patient-based. That means you go where the patient is, since many patients are homeless. There’s been places like San Antonio where the physicians actually go out into the homeless shelters and provide medication.

Judge Steven Leifman: In Miami we go to the street, prescribe and distribute medication. It’s wonderful because a lot of people who are homeless with mental illness are overstimulated. It’s not that they don’t want housing—they don’t want to be in a loud housing situation. We’ll treat them on the street, watch their symptoms reduce, and then gently try to arrange an integration into our system.

Transcript edited for clarity.