Monday, February 4, 2013
"WE THE PEOPLE Cry Out For Better Mental Healthcare"
A fascinating insight in to the world of MH in the USA by Gerald Bouthner "WE THE PEOPLE Cry Out For Better Mental Healthcare" The state of mental healthcare in America is a hot topic again recently. The truth of the matter is in the U.S. at various times and even in recent history the same has been true. Even in recent decades cries for change have rung out to our leaders. As a result of these cries for changes in our mental healthcare system, attempts have been made and some changes have occurred. These attempts and changes although helpful in some ways have fell way short of being a solution. Although it has been shown that mental illness is a treatable condition, still less than half of Americans with a mental illness are receiving treatment. When treated with drug therapy and psychotherapy upwards of 70 percent of people with mental illness experience a significant improvement in symptoms and quality of life. Yet still, according to the National Alliance on Mental Illness (NAMI) such a significant amount of people with mental illnesses in the U.S. go untreated that the annual economic cost of untreated mental illness in this country is over 100 billion dollars. According to a 2007 report released by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) there were still many gaps in the U.S. mental healthcare system. One gap that was pointed out in this report was that there was a critical shortage of individuals trained to meet the mental health needs of children and youth, and their families. In this report the federal government projected the need for 12,624 child and adolescent psychiatrists by 2020, which far exceeded the projected supply that would be available which would be 8,312 as was highlighted in the report. This report also noted that of the projected total of adolescent psychiatrists that would be available, relatively few of those were located in rural and low-income areas. SAMHSA Full Report Problems within the U.S. mental healthcare system have existed for a very long time. Some changes have been made in attempts to address them, but clearly more needs to be done. Governmental attempts at improving mental health care in the U.S. In 1955 Then Senator John F. Kennedy sponsored a bill which passed unanimously that same year in congress called the Mental Health Study Act. This bill called for a truly comprehensive review of the nations mental health system. Sounds very familiar to the cries being made now. In 1963 just prior to his death then President John F. Kennedy signed into law the Mental Retardation Facilities and Community Mental Health Centers Construction Act (CMHCA) of 1963. This act called for the replacement of the flailing mental institutions with mental health community centers. In the 1970's amendments to the CMHCA act were passed to further improve the countries efforts to replace traditional public mental hospitals with community mental health centers. This movement started by John F. Kennedy along with the help of the National Institute of Mental Health was so effective in this regard that the number of patients in mental hospitals had now declined by 62 percent. However noble the efforts and intentions were for improving mental healthcare for Americans by deinstitutionalization , major issues arose during this transition. The funds withdrawn from state mental institutions were suppose to follow all patients and be infused into the community based mental health centers. But no proper coordination or authority was established to ensure this happened and it didn't. As a result, many of this countries mentally ill citizens were left to suffer without any real comprehensive treatment. Little more than basic custodial care was being provided leaving the severely mentally ill without any true rehabilitative care. Because of the lack of comprehensive care many of those in our nation that were suffering with severe mental illness either ended up in jail, were left homeless, or had to live in unregulated substandard housing. In the 1980's very little changes for the good for the mentally ill in this country. As deinstitutionalization continues, so do the same problems. By this point it is estimated that as many as one-third of the homeless people in the U.S. are believed to be seriously mentally ill. Lack of comprehensive treatment for the severely mental ill resulted in increasing episodes of disorderly conduct and violence and a growing number of imprisonments. One jail official in Ohio stated when interviewed in the 80's about the influx of mentally ill prisoners "Deinstitutionalization doesn't work. We just switched places. Instead of being in hospitals the people are in jail. The whole system is topsy-turvy and the last person served is the mentally ill person". Read more here. In the 1990’s some improvements are made with the passing of the Americans with Disabilities Act which provides protections for people with any disability mental or physical. In 1991 The Public Health Service Act is passed enacting requirements for state comprehensive mental health service plans. Yet these attempts still fell short of a full improvement. In the 90's NAMI releases a report about the state of the nations mental health care. In this report NAMI highlights that 8 crises still existed. There are more than twice the amount of people with schizophrenia and manic depressive psychosis living in public shelters or in the streets than there are in public mental hospitals. There were more people with schizophrenia or manic depressive disorder in jail than in public mental hospitals. Increasing violent episodes by seriously mentally ill persons were a consequence of not receiving adequate treatment. Mental health professionals have abandoned the public sector and patients with serious mental illnesses. Most community health centers have been abysmal failures. Funding of public services for individuals with serious mental illness was chaotic. An undetermined portion of public funds for services for people with mental illness is literally being stolen. Guidelines for serving people with mental illnesses are often made at both the federal and state level by administrators who have had no experience in the field. The complete report by NAMI. Here in the 2000's, President George W. Bush in recognition of the inequality of health care for the mentally ill created the New Freedom Commission on Mental Health. This commission in short was to identify policies that could be utilized by Federal, State and local governments to improve the coordination of treatments and services for adults with serious mental illnesses and children with serious emotional disturbances. You can view the executive summary of suggestions and results found by the commission here: Final Report The Vision Statement of the President's final report: "We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports - essentials for living, working, learning, and participating fully in the community". Quite a profound vision statement indeed! We are all hoping that these profound words will be followed very soon with further necessary actions to move closer towards realizing as much of that goal as we can. In 2008 the U.S. took another step in the right direction when Congress passed the Mental Health Parity and Addiction Act with the Emergency Economic Stabilization Act of 208. This eliminated the higher deductibles that were often in place for mental health care and restrictions of treatment. Federal law mandated that all states and group health plans were to comply by 2010. This leads us to today. Another comprehensive review of the nations mental health system is in order. We the people are crying out a new call to action to fix a mental health system that is still clearly in a state of crisis. In 2009 NAMI released their latest overall grade of the U.S. mental healthcare system and gave the nation a dismal D. Full report Today, because of insufficient treatment or none at all, many people still languish in the suffering inflicted upon them by their mental illnesses. Today many of our mentally ill citizens still unfairly populate our streets in homelessness and have been shuttled into our prison systems. Today many people with mental illnesses still remain untreated. As much as 30% of homeless people have a combination of mental illness and addiction disorder. Over 90% of those who commit suicide have a mental disorder. Adults with serious mental illnesses die as much as 25 years sooner than the average American. Over 20% of prisoners in both state prisons and jails have mental illnesses. As many as 70% of our youth's in juvenile justice systems have mental disorders. Mental illness is the leading cause of disability in the world. From fiscal years 2009-2012 States cut a total of 1.6 billion dollars from their mental health budgets. (NAMI) Some of the mentally ill in this country can be helped significantly and will be able to function successfully after receiving services from a community based mental healthcare center. However other's will need additional intensive care and social support in order to be able to function successfully in the community. Still other's with the most severe and chronic mental illnesses will need constant assistance and supervision. Those with chronic mental illness without such treatment will just continue to populate our prison's and our streets in homelessness. This is a very comprehensive problem that needs to be addressed with very comprehensive solutions. What can be done? On December 20th, 2012 NAMI wrote our President offering to work along with the White House in fixing our mental healthcare system. In this letter they outlined suggestions that if properly implemented and utilized will steer our Country in the right direction. Here is the gist of those six suggestions.You can also read the complete letter here. Improve early identification and intervention in mental health care. Too often, what in hindsight are clear signs of the need for mental health care are not identified until after a crisis happens. It is well documented that timely mental health treatment can prevent crises and foster recovery. Routine mental health screening should become part of standard practice so mental health conditions are identified early when they can most effectively be treated. Provide training to school personnel, law enforcement, families and members of the community on how to identify and respond to youth and adults experiencing mental health crises. Too often, those in a position to help do not know what to do when a child or adult manifests the early signs and symptoms of mental illness. Implement school based mental health services and supports. Drop-out rates among students classified as Emotionally Disturbed (ED) under the Individuals with Disabilities Education Act (IDEA) are alarmingly high, over 50 percent. We are clearly not addressing the needs of students struggling with mental health conditions in many of our nation’s schools. Increase the qualified mental health workforce. Throughout the nation, there are critical shortages in the availability of qualified mental health professionals. In many communities, children and adults are placed on long waiting lists to access mental health services. Fully implement key provisions of the Affordable Care Act, including mental health and addictions parity requirements. Passage of the Affordable Care Act (ACA) was a seminal achievement in improving health and mental health care in this country. Protect federal funding of Medicaid. Youth and adults with mental illnesses are among the largest, most important class of Medicaid beneficiaries. Forty-eight percent of all public mental health services in America are funded through Medicaid. Reductions in federal funding of Medicaid would have a devastating impact on people with mental illnesses. If our nation is to rightly fix its broken mental health system and provide adequate and equal healthcare for its mentally ill citizens, implementing the above suggestions made by NAMI is crucial. These six points alone if implemented and carried out properly would improve the care of the mentally ill in this country significantly. Note: On January 16th, 2013 President Obama in addressing the nation's plans for protecting its communities from gun violence, also called for mental health first aid training for teachers and staff to help them recognize mental health disorders in our young people. This new initiative called Project Aware also calls for the training of more than 5000 additional mental health professionals to serve students and young adults. Project Aware details. I sincerely hope that our country responds swiftly to all the additional suggestions made for improving a mental healthcare system that has failed to provide adequate help for those suffering from mental illness. Over the course of this nations history various attempts have been made to improve the nation's mental healthcare system. All such previous attempts have fallen short of doing so. Many of our mentally ill citizens have suffered at the hands of an inadequate mental healthcare system. It is time to put an end to this sad history of unnecessary suffering. After all this is a Country which is a government of the people, by the people, for the people that shall not perish from the earth. We the people want equal health care treatment for our mentally ill. Guest Blogger ~ Author: Gerald Bouthner Mental health advocate Published Mental Health Article Writer Mental Health Blogger: The Challenges of Mental Illness Social Contact Information: Twitter Google+ Facebook