Show Me The Money
All in the Family
Treating mental illness requires resources
Published on January 8, 2014 by Rachel Pruchno, Ph.D. in All in the Family
But before we can institute change, we need to understand how we got here.
The bottom line is that mental health care never has been funded sufficiently.
A look back at history—at the attempts of Dorothea Dix, Clifford Beers, and John Kennedy to enrich the lives of people with mental illness—is instructive. Together their efforts tell the story of what’s gone wrong in our approach to providing care for people with mental illness.
A series of detailed state investigations beginning in Massachusetts in the 1840’s led by Dorothea Dix examined how people with mental illness were treated. She found that towns contracted with local individuals to provide care for people with mental illnesses who could not care for themselves and who lacked family or friends to help them. Unregulated and underfunded, abuse was widespread. People were chained, naked, beaten with rods, and lashed into obedience.1
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Following a suicide attempt, Clifford Beers, a graduate of Yale, was hospitalized at both the Hartford Retreat and the Connecticut Hospital for the Insane. In 1907, disillusioned by his experiences at these institutions, he wrote A Mind That Found Itself. Beers accepted his diagnosis of manic depression, but was critical of the psychiatrists who had treated him. Their use of punitive measures, including straitjackets and seclusion and their lax system of supervision of brutal, untrained attendants angered him.
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Resources in the community are woefully inadequate. People with mental illness have no place to go for treatment. And so they live on our streets and sometimes in our prisons.
Another great article by Psychology Today http://www.psychologytoday.com/blog/all-in-the-family/201401/show-me-the-money
President Kennedy signed the Community Mental Health Act in 1963 with the vision that by establishing a nationwide system of community based mental health centers the population of mentally ill individuals languishing in large state hospitals, sometime for years, could be dramatically reduced. This Act had been preceded by the manufacture of Thorazine, the first effective antipsychotic medicine, and two years later Medicaid was created. These three things did produce a substantial reduction in the patient populations in the state psychiatric hospitals. Unfortunately, the funds necessary to provide adequate treatment at a local level never fully materialized, and the money available for the care and treatment of the chronically mentally ill has diminished over time. The result? We now have a large population of mentally ill individuals who are inadequately treated and often end up homeless. The discovery of newer and more effective neuroleptic medicines (antipsychotics) enabled rapid stabilization of psychotic patients, which shortened the amount of time these individuals spend in the local inpatient unit. However, it also means discharge before social workers can arrange for a stable residence and plug the patient into the needed outpatient psychological services. This has produced the “revolving door patient,” a term that describes the cyclical pattern of partial stabilization, discharge, deterioration, and eventually another involuntary hospitalization for partial stabilization.
When I began my training the concept of community psychiatry and psychology was prevalent, as was the idea that psychologists and psychiatrists were responsible for the mental hygiene of the communities where they lived and worked. Sadly, this is now consider a quaint, but terribly antiquated idea, largely because the health care delivery system and the way providers (that’s right, doctors are now “providers” rather than doctors) are reimbursed actively discourages this concept.
The upshot of this failure to implement and maintain the vision of President Kennedy is an increase in the number of mentally ill individuals receiving inadequate or no treatment. Limited funding means limited services, which means seriously ill people often winding up homeless and sick. What happens to them? Many end up in jail, basically because there is no place for them to go and they become a “community nuisance.” The sad reality is that today jails and prisons have become the largest suppliers of mental health services in many communities.
So, in the 51 years since Kennedy signed the Community Mental Health Act we have gone from warehousing the mentally ill in state hospitals to warehousing them in jails and prisons. Now quite what JFK had in mind.
Hi Stephen
Thank You for your comment, You packed quite a bit in there….I think I should post your comment and respond to the post.
In the end, we agree that this was not what JFK meant by Community Mental Health. People with mental health are dying from treatable conditions while following doctors orders. The are vulnerable because of their disabilities that also make them targets.
Transparency and outcome metrics provide everyone with useful data to keep environments engaged, healthy and productive. Positive work environments and a healthy society are as vital to mental health as health insurance and good healthy lifestyle (something I should work on)
Our government was designed to accomplish nothing, so I guess we are doing as expected. ….always different perspectives, eh. 🙂