4 Big Ways We Can Change Mental Health Care in America

American Flag PuzzleWhen President Obama addressed the nation in his January 2015 State of the Union speech, he made only two vague references to mental health, despite it being an issue that impacts millions of Americans either directly or indirectly. There was no mention of increasing funding for mental health programs, no urging of Congress to explore ways to treat mental health more compassionately, and no message to communities encouraging them to find creative solutions to complex problems. Instead, mental health as an issue was largely ignored, as it often is.

Each year, an estimated 590,000 Americans, who would be receiving mental health care in a better system, fall through the cracks. Without proper resources and support systems, these people are at high risk for ending up in the country’s jails, prisons, homeless shelters, on city streets, and, too often, in the morgue. Even if we vote or choose to ignore the problem through reduced funding, decentralized resources, and archaic treatment, it’s an issue that won’t resolve itself. Although we’ve come a long way since the 18th century, the mental health system in America today is seriously flawed and in desperate need of attention.

 

From Mental Institutions to Prisons

If you talk to someone about how mental health care was performed in the past, he or she might scoff at the poor “treatment” some people received at mental institutions that were often indistinguishable from prisons. However, that same person might be surprised to learn that the largest single-facility provider of mental health services in the United States today is not a mental health facility, hospital, or community center at all. It is, in fact, the Cook County Jail in Chicago.

In 2012, more than 350,000 people with mental health conditions were living in jails and prisons, whereas only about 35,000 people were treated in state-funded impatient psychiatric institutions. According to the 2012 National Survey on Drug Use and Health, almost 40% of adults diagnosed with schizophrenia or bipolar issues remained untreated in the previous year, and as many as 60% of adults diagnosed with a mental health concern went without any treatment. Of those who do manage to receive treatment, few get the level of care they need; the system nationwide is massively underfunded. Texas, for example, spends just $40 per capita on mental health care but in 2012 led all states in the number of prisoners in its jurisdiction. The historic relocation of many of those experiencing serious mental health issues from hospitals to streets to prisons, however, isn’t good fiscal policy, and it’s downright shameful from a human rights perspective, especially because it allows society to facilitate an “out of sight, out of mind” attitude toward the issue.

A majority of mental health experts agree that that the current system is in shambles, but, as was evident in the most recent State of the Union address, few significant efforts have been made to improve it. Now that you’ve read about some of the problems, let’s talk solutions. Here are four suggestions we believe would go a long way toward fixing the mental health care system:

1. Increase Mental Health Care Funding

Mental health concerns are estimated to cost the United States more than $444 billion each year. However, only about a third of those estimated costs actually go toward treatment. The majority the $444 billion is spent in the form of disability payments and lost productivity. The real cost to society as a whole is significantly higher, as this total doesn’t include the cost of incarceration or lost earnings for caregivers.

Despite the high cost to the country, mental health budgets are usually among the first to be cut in times of economic hardship. From 2009 to 2012, states cut $5 billion worth of mental health care services and the nation eliminated more than 4,500 public psychiatric hospital beds. Because of poor policy moves like this, in a crisis many people who experience serious mental health issues wind up in emergency rooms because there is no place else for them to go. When all other services have been cut, an emergency room is one of the few places where they won’t be turned away.

The reality is that by increasing rather than cutting mental health care budgets, the country would ultimately save billions. With increased budgets, people would have more access to care and be less likely to end up in emergency rooms, jails and prisons, homeless shelters, on the streets, or worse. Furthermore, many who need treatment and actually receive it will likely recover completely or be able to control symptoms enough to contribute to the economy by returning to work or by volunteering their time or services. This is not only good for the person who needs treatment, but also for their families, neighbors, and communities.

2. Provide Better Care and Services in Jails and Prisons

While this isn’t the ultimate answer, it’s sometimes best to heed the advice of Theodore Roosevelt: “Do what you can, with what you have, where you are.” As previously stated, there are approximately 10 times more people with mental health issues incarcerated than there are being treated in state-funded hospitals. What is perhaps saddest about this statistic is that as states have cut funding for mental health services, they have increased funding for jails and prisons.

Many prisons have few, if any, mental health treatment options. Too often, prisoners don’t get the medication they need and they’re unlikely to receive therapy or any other type of meaningful support. Since prison beds appear to be replacing the beds in psychiatric units, trained mental health professionals should be employed in the penitentiaries, not just for brief evaluations but for continued care and support. Inmates should be given equal access to quality mental health care in order to give them a fair shot at making a recovery and reintegrating into society, which many studies have shown would lower recidivism and thus the burden on taxpayers. Until better alternatives come about, prison time should be used as an opportunity for healing and transformation.

3. Create More Community Centers and Inpatient Facilities

When the Community Mental Health Act was passed in 1963, officials proposed a national network of community-based mental health facilities to provide a point of access where people could quickly receive all forms of mental health care in the same place. This legislation led to the closing of several large, state-funded mental hospitals across the country, as it was thought these new community centers could drastically reduce treatment times and return people to society rather than keep them locked up in institutions. This was the last piece of legislation President Kennedy signed just weeks before his assassination, and while it ushered in a newfound optimism toward mental health care, its vision was never fully realized.

Regrettably, most of the necessary support for the proposed community mental health facilities was never provided, resulting in less than half of these centers being constructed and many people getting lost in the transition from state facilities to community-based facilities. Though much has changed in society since 1963, the vision of a comprehensive mental health care system is still an important one.

In addition to outpatient services, individuals experiencing mental health conditions deserve access to adequate inpatient care, supported housing, family therapy, and addiction services, as well as supported employment programs. These types of facilities are not only fiscally responsible, they localize treatment and make it easier for people to connect with the resources they need to improve their quality of life.

4. Provide Compassionate Care and Support

On the surface it appears lofty and idealistic, but this is perhaps the most important change we can make to improve mental health care. Many psychologists have attributed poor mental health outcomes in America to overmedication and lack of validation for the individual’s experience.

John Weir Perry was a Jungian-oriented psychiatrist with more than 40 years of clinical experience working with individuals experiencing psychosis and/or schizophrenia. He believed that the best way to care for an individual experiencing these conditions was to support the conditions themselves rather than trying to suppress or reverse them in any way. Through his clinical practice, he found that when a person’s experience was validated and supported in a positive way, even many of his most challenging patients would become reality-oriented within as little as two to six days. The integration phase that followed took about six to eight weeks on average. Perry found that 85% of the people he treated at Diabasis—an alternative crisis center he created—improved without any medication and continued to improve after leaving his facility.

This isn’t to argue against medication, as it can be a crucial factor in many peoples’ stabilization and recovery. The problem is, with a lack of funding for other options, many people seeking mental health treatment are sent home with bottles of rainbow-colored pills to treat their symptoms and are left with little or no therapeutic support to accompany them.

Providing compassionate, nonthreatening, and nonpathologizing care should be at the forefront of reform efforts.

We’re All Responsible for Mental Health Care

Even if all these suggestions were immediately implemented, there would still be many holes to fill to make the current system successful and equitable for those in need of treatment. These are just a few steps forward for policymakers and a system that is long overdue for a transformation.

Through the people we elect, the programs we lobby for funding, and the day-to-day interactions we have with people who inhabit this world with us, we’re all responsible for mental health care. Our greatest hope, and what will ultimately inspire more change, is that more people choose to become involved this year and every subsequent one.

References:

  1. Appelbaum, Paul S. (2014). How to rebuild America’s mental health system in 5 big steps. The Guardian. Retrieved from http://www.theguardian.com/commentisfree/2014/may/29/-sp-fix-america-mental-health-system-ideas
  2. Dansky, Kara (2014). A Mental Health Crisis Shouldn’t End in a Jail Cell. The Nation. Retrieved from http://www.thenation.com/article/181924/mental-health-crisis-shouldnt-end-jail-cell
  3. Kliff, Sarah (2012). Seven Facts about America’s Mental Health Care System. The Washington Post. Retrieved from http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/
  4. Szabo, Liz (2014). The Costs of Not Caring: Nowhere to go. The financial and human toll for neglecting the mentally ill. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/
  5. Whitaker, Robert (2010). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books.
  6. Williams, Paris (2012). Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis. Sky’s edge Publishing.

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  • barry

    barry

    January 27th, 2015 at 10:26 AM

    Don’t you think that much of the apathy about mental health care comes about because this is not something that everyone is affected by, or at least they don’t think that they are touched by it. I think that those of us who have struggled with mental health issues or concerns or who have watched friends and family members with their own issues, this is something that we think about and that we care about. But if you have never personally been touched by it then it is hard to consider just how much you really should pay attention to the growing need that is currently there in the mental health care field. We need more people to sit up and pay attention because just like with physical health problems these are not things that will go away on their own.

  • Everett

    Everett

    January 27th, 2015 at 11:24 AM

    Increasing the $$$ is great but then where does that come from? What gets cut to make that a possibility?

  • John

    John

    January 27th, 2015 at 12:24 PM

    We seem to have a never-ending supply of money to bomb people Everett. Maybe we can re-appropriate a few bucks from that fund to, you know, help people.

  • Everett

    Everett

    January 27th, 2015 at 2:35 PM

    Hey John, what’s up with that kind of reply man? I think you and I both know that there are some bad choices that are made and no one said that I didn’t agree with you on where the money might be best cut to fund some mental health programs. But I think that if you look at things realistically and not from our own point of view, you will see that there are probably far fewer people who think that it would be a great idea to fund mental health care over the military or whatever. I am not saying that I disagree with you, but I do think that you have to realize that this might not necessarily be a top priority for many in charge right now.

  • John

    John

    January 27th, 2015 at 5:11 PM

    Sorry Everett, didn’t mean to sound so outwardly cynical toward your specific comment, just cynical toward the system and its choices in general. I have a feeling that most people don’t know where their money actually goes in federal expenditures, nor do they probably care. They just grumble, pay their taxes, and flip on the television and hope that someone fixes all the problems. I believe that if more people were aware that we spend many times more on bombs, tanks, and bullets than most of our enemies and allies combined, we’d be able to find a few bucks to get people the type of care they need and keep them from shooting up schools, malls, workplaces, theaters, etc. The first step in solving a problem is recognizing you have one. I’m just glad there’s at least two of us that recognize the problem :)

  • Jazz

    Jazz

    January 27th, 2015 at 8:44 PM

    I’m from Southeast Asia and as you might be aware,the situation in Asian countries with regard to mental health is pretty bad..it is not given any priority and the state of things with regard to mental health is often deplorable..I thought the situation in America was much better but this article has been a real eye opener!

    When the President of the world’s strongest country does not address this topic with all these sad statistics existing, in his address to the nation,then something’s definitely not right and those in power seriously have their priorities misplaced..I’m not condemning the Prez or Amerixa itself but we as people need to do more for mental health as a community..The west often shows the way for best practices and if America does not in the sphere of mental health then the outlook for other countries seems a bit too dark if you ask me.

  • Everett

    Everett

    January 28th, 2015 at 3:44 AM

    Absolutely John. We collectively have to be willing to do more than just moan and grumble about things when they aren’t to our liking. We have to be willing to take a stand, and sometimes that may be uncomfortable but we have to do it. This may be a great starting point.

  • eden

    eden

    January 28th, 2015 at 11:02 AM

    I am guessing that the reason that it wasn’t mentioned is because for so many this is something that they still would rather shove under the rug and pretend like it doesn’t exist.

    Why, I don’t understand.

    It is not taboo to say that you have cancer, but someone looks at you like you are more pitiful if you admit that you suffer from depression or any other mental illness! They are all equally important but in the eyes of the general public, this doesn’t seem to be so.

  • Jay

    Jay

    January 28th, 2015 at 2:14 PM

    Sadly, caring for those with mental health illnesses has never been much of a priority in this country and I do not see that attitude changing anytime soon

  • melody

    melody

    January 29th, 2015 at 3:42 AM

    I can really get behind improving services across the board EXCEPT when it comes to those in jail. Why should they have better care while they are serving time than most of us do who have never broken the law? I know that there has to at least be minimum standards that have to be met, but don’t you think that there are times when it seems a little unbalanced, that the criminals are getting far more money than the rest of us are?

  • Donald

    Donald

    January 29th, 2015 at 10:33 AM

    There has got to be some way to make care much more affordable and accessible to those who really need it. I think that there is probably excellent care available for many who have insurance or who have the means to self pay, but what about the rest of the population who could never meet their deductible, much less pay out of pocket? It is incomprehensible to me that there are people who need care, and could benefit from just a few visits and yet they are still left to spiral because of the greed and the inaccessibility that they are confronted with. Until we make it more affordable then there is not much else we can do.

  • phil

    phil

    January 30th, 2015 at 10:13 AM

    If we make it a priority then the insurance companies would have to make this a priority for care as well

  • Florence

    Florence

    January 30th, 2015 at 3:48 PM

    I think this is a typical disease mongering article with the usual Big Pharma/Psychiatry/”Mental Health” promotion to push more bogus voted in DSM (the bible of psychiatry) stigmas that have no scientific, medical or other validity per Dr. Thomas Insel, Head of the National Institute for Mental Health. Dr. Insel has only finally acknowledged this truth because the DSM 5 debacle became so embarrassing due to the worst medicalization of normal human behaviors ever. Otherwise, we kept hearing the lies that the latest fad fraud bipolar and psychiatry’s bogus schizophrenia stigma debunked by Dr. Mary Boyle and countless others were/are real brain diseases due to inherited bad genes or the horrible eugenics claims, chemical imbalances in the brain and many other out and out LIES to brainwash the public. This was/is because psychiatry sold out to Big Pharma in the 1980’s because Freudian analysis was waning. Sadly, psychologists and social workers jumped on this lucrative but deadly bandwagon that has harmed and betrayed so many so called “patients.” Even main stream psychiatrists like Dr. Allen Frances, editor of DSM IV, admitted the bogus bipolar and ADHD epidemics he helped create and the absurdity of stigmatizing grieving over the death of a loved one or “binge eating” as mental disorders.

    So, sure, if you include caffeine, arithmetic and other absurd, voted in “disorders” everyone is “mentally ill.”

    And using the claim that the “mentally ill” are in prison instead of psych wards, though there is little difference with the forced treatment agenda with the lethal, brain damaging neuroleptics like that of Fuller Torrey and his cohorts, is a false claim based on studies since those who end up in jail or psych wards have different problems and profiles.

    Anyway, this is just a typical mental health/Big Pharma promotion or ad campaign, which I think is very, very harmful though I think some articles on this web site can be helpful.

  • Irma Desiderio, M.S.

    Irma Desiderio, M.S.

    January 30th, 2015 at 9:39 PM

    I agree that mental health care has seen budget cuts over the last few years. Areas of recognition are inpatient care, substance abuse and mental illness. Also, due to these budget cuts, students pursuing degrees in mental health cannot seem to find appropriate internships at the Masters level, which seems to create a shortage of qualified candidates for these positions after obtaining a degree and licensing. Most facilities only create internships at the doctorate level, which creates frustrations for those students who wish to enter into Mental Health and Social Work fields. I have a Masters in Gerontology, which doesn’t seem to receive the appropriate recognition in the behavioral science fields. Social Work degrees are becoming the main focus when seeking employment; however, many other mental health specialties are also qualified to fill the same positions (but are not considered). As a gerontologist, I have noticed the aging population is not acknowledged for their need of mental health services; yet, this population needs it the most, due to their ongoing chronic issues and losses. It frustrates me to think that society may have the mentality that the elderly are going to die soon, so their emotional and mental needs are not a priority or considered important. I hope I am wrong in this assumption. If a chronic drug addict is entitled to help, so is an elderly person who has a vast history of contributions and accomplishments to society! Funding is critical in helping all populations and I agree that more centers are needed. If our society would reconsider the fact that a psychiatrist must run a center/facility as a mandate, and allow extremely competent clinicians with other degrees, then maybe we might be able to provide less costly centers to help those in need that are not necessarily mentally ill, but are in need of a more “solution focused” model. This would lighten the burden of those centers that help clients with more pressing mental health issues. What we must realize is that there is no cookie cutter answer when it comes to mental health issues, and centers should be designed to help the specialized needs of those that otherwise do not fit into the mainly focused areas of “mental illness”, “substance abuse” and “inpatient” therapies.

  • Dahlia

    Dahlia

    January 31st, 2015 at 8:28 AM

    It has to become a group mentality that this is important and that this is something that needs to be recognized as such. You cam’t have it that it is important to one small group when there are so many more louder and larger voices out there.

  • Elizabeth

    Elizabeth

    January 31st, 2015 at 10:52 PM

    Melody~ We need better care in the jail system because that is currently where most of our mentally ill are ending up. Instead of getting the care they should be to keep them from ending up in jail, they are, in fact, ending up in jail rather than treatment facilities. Without our mentally ill prisoners getting help, they’ll be released to go back to what they were doing before that landed them in there. It’s a vicious cycle and for those who suffer from mental illness or have parents or children who are mentally ill, it’s one of the biggest fears you have next to death, that your loved one will end up in jail rather than in a psychiatric treatment facility.

  • Kayla

    Kayla

    February 1st, 2015 at 6:59 PM

    Colorado started a new program this year, which I work for. It is called the community crisis connection and consists of a hotline, mobile crisis, walk in centers, and overnight units that are similar to hospitals. The goal is to stabilize mental health crisis in a short amount of time and connect people to ongoing outpatient services. I’m excited to see how this model works and maybe it will be implemented across the country. Even so, there are many people in crisis, say homicidal or being violent toward their family, etc, that sometimes can’t be helped with mental health services. Sometimes, it is purely behavioral, lack of empathy, etc, and the most appropriate intervention is the legal system. More often than not, I’d say that could be traced back to a societal problem, poor parenting and/or an ongoing lack of resources. While I agree with the premise of offering good mental health services to people in jail to fully rehabilitate them, I understand why they’re not there. In Colorado, the prisons are run by corporations and in rural areas. I’m not willing to sacrifice my quality of life by living out in the sticks to meet a community need unless I’m being paid significantly to make that sacrifice. I also know few clinicians that want to work for these for profit corporations that have an investment in keeping the prison population high. I’d also rather work with people interested in changing. Denver is oversturated with therapists. People will pay 100s for bad habits, jeans, air Jordan’s, but often don’t want to make that investment in self.

  • melody

    melody

    February 3rd, 2015 at 3:47 AM

    I don’t care- it just seems so unfair that those who are in prison usually end up with a better standard of care then those of us who obey the law. If they are truly mentally ill won’t the court system see to it that they are placed in a facility that is better equipped to handle their needs instead of lumping them in with the general prison population?

  • John

    John

    February 5th, 2015 at 11:59 AM

    Melody, other than initial cost, which could be addressed if the average Joe or Jane had any real context for the amount of taxpayer dollars we spend on defense and the mostly for-profit prison system in America, I fail to see the downside of mentally rehabilitating prisoners. More jobs for mental healthcare professionals and less criminals re-entering the prison system at the cost of taxpayer dollars. Seems like a win-win for the American economy. If we measure a nation by the way it treats its “worst” citizens, how do you think we stack up right now? We basically just created a recycling system for criminal behavior. Enter into it for reasons or behaviors sometimes out of your control, get locked in a cage with a bunch of criminals and receive little or no treatment during your stay, and then get out with no real rehabilitation but quite a few criminal contacts. It’s no wonder we imprison something like 25% of the world’s prisoners in the “land of the free.” Also, I totally agree the court system should place mentally ill people in facilities for treatment rather than gen pop in the jails and prisons. The problem, as the article points out, is that we shut down most of the facilities we built for that purpose and gave the people in them nowhere or few other places to go.

  • Michelle

    Michelle

    February 6th, 2015 at 8:55 PM

    Unfortunately this is all too true in today’s world. The attention that the mental health system needs to gather funding to better serve programs across the nation is not being given. Even the thought of bringing up a such topic is still hard for communities to handle.

  • shaggy

    shaggy

    February 4th, 2019 at 5:45 AM

    mental health care made me use .0000001% of my power to create, don’t diss me homie

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