The New York Times
Across the country, hundreds of thousands of Americans with serious mental illnesses, such as schizophrenia and bipolar disorder, have been relegated to lives of profound instability. Instead of therapists to help them manage their illnesses or doctors to oversee their drug regimens or evidence-based treatment for their substance use disorders, they roam homeless shelters and jails and jails who have become the largest mental health providers in the country. Or they make their homes in the streets. They are victims of a mental health system that is not designed to meet their needs and of a society that has been largely indifferent to their plight.
Community mental health clinics serve the vast majority of Americans with serious mental illnesses. These patients tend to be low-income, disabled and dependent on Medicaid, whose reimbursement rates are so abysmal that advocates say clinics receive only 60 to 70 cents of every dollar spent on care.
In many ways, the criminal justice system has become the only reprieve: since court-ordered patients have priority, filing charges against loved ones is a common way to seek psychiatric care in a crisis. More than 40% of inmates nationwide have been diagnosed with mental disorders.
In 1963, in the last bill he signed into law, President John F. Kennedy laid out his vision for an “entirely new approach and emphasis to the care of the mentally ill.” It was to close the country’s public psychiatric hospitals – which had become dens of neglect and abuse – and replace them with a nationwide network of community mental health centres. The centers would support and treat institutionalized elders so that they could live freely with as much dignity as possible.
Lawmakers and health officials executed the first half of this vision with alacrity. The number of people housed in major psychiatric hospitals fell by 95% between the 1950s and the 1990s. But nearly 60 years after Kennedy’s bill took effect, there are still no community mental health system in America.
It is possible to start building one now.
What stands out from this story now is not how badly it all went, but how close those responsible got it right. The model presented in the Kennedy bill would allow people in psychiatric distress to remain anchored in their community. And one-stop clinics would help families in crisis avoid the hopeless gamble of seeking treatment from courts and judges.
Congress could course-correct now by drafting a new bill that brings together the best of those past attempts and builds on them. None of this will come cheap. By most estimates, it would cost several billion dollars to fund and fully realize the original vision of community mental health today. But those costs would be partly offset by what police departments, prisons and hospitals could save.
It is in our power to break the cycle of neglect and abuse now and change the way the most vulnerable among us live for generations to come.
