We need to do mental health better, especially in crisis care. Not just in America, but around the world.
At its simplest, the problem can be stated as that our knowledge and practices of mental health has advanced greatly since the mental health care systems were put in place that we are using today, and not enough has been done to properly update the standard of care.
Think about this.
If you don’t suffer from mental health issues, you probably know someone who does. As of 2007, about 11% of adults in the United States – approximately one in nine – experienced psychological distress that was serious enough that it caused serious functional problems. Someone you know and love – maybe even yourself – is suffering, perhaps in silence. In the UK (for example), only one in four of the population with mental health problems will receive any treatment at all. The reasons why are varied. Social stigma, lack of resources, affordability, lack of education, lack of coverage and lack of modern and comprehensive mental health policies all contribute to a mental health crisis in every country around the world.
Police forces everywhere are struggling with the challenge of dealing with detaining people with psychiatric issues. Too often people who need immediate crisis intervention simply land in the “drunk tank” until they are no longer a threat to themselves or others, simply because police don’t have the resources to appropriately handle the situation. This has led to such bizarre situations as the Cook County Jail in Illinois is now America’s largest single provider of mental health care.
In no way do I fault those who are working as mental health experts and care providers in the system. They do excellent work, they work incredibly hard, and are incredibly dedicated to their delivery of care. They are heroes – often unsung, and there are far too few of them.
The American system of care was largely put in place in the John F. Kennedy days, at a time when mental health professionals were struggling for recognition of Post Traumatic Stress Disorder as a real disorder with a diagnosis and course of treatment, and not just the dismissive “Shell Shock” for which the prescription was maintaining a “stiff upper lip”.
The last major development of America’s mental health care system was in the 1960s with a global move toward deinstitutionalization. Hospitals dedicated to mental health care were shut down, and the number of available acute-care beds went from hundreds of thousands to just hundreds almost overnight. This helped to reinforce a kind of bias within the health care system so that when medical care services and programs are faced with funding cutbacks, psychiatric care is often the first and deepest cut, and the cuts often affect the most critical and most expensive needs of psychiatric care – long-term care beds.
The World Health Organization has described a system outline for the optimal mix of services for mental health. It’s a simple pyramid, where most of the resources get allotted to the “outpatient care” scenario, and the rest of the structure of the pyramid allows for a proper focus at the peak – the long-term care of chronic patients. This program, however, is only high-level planning of a mental health care system. Something to get a country started in the right direction. It’s not a comprehensive plan.
What is the answer? …Hell if I know, but what I do know is that the system we have just simply isn’t working for the majority of people who require mental health care. Something has to change, and it will require a fundamental cultural shift in the way we consider and prioritize mental illness before we get there. Cultural change is possible. People are now making that crucial link between mental health and violent crime, and people are also understanding that there’s a critical connection between mental health and physical health.
The stigma associated with mental health care is something we can all individually commit to change. We don’t stigmatize someone who goes to see their doctor for a curious rash, but anyone who dares mention that they’ve just come from their psychiatrist’s office almost certainly faces stigmatization for no good reason. We need to eliminate this delineation that we’ve created between mental health and medical health. We need to understand that mental and medical health care often are inseparable as complementary practices.
One of the best articles I’ve read about the state of mental health care in the United States is one just recently published by a Republican, Rep. Tim Murphy of Pennsylvania. Not only is Murphy a Congressman, he is also a clinical psychologist and very experienced in cases of post-traumatic stress disorder and traumatic brain injury. He is very familiar with the system and how it’s broken. In his article, Murphy lays out some cold facts, such as rates of homelessness and incarceration are growing over the last 20 years, and annually 38,000 people commit suicide with untreated or improperly treated mental illnesses. Murphy has tabled legislation in Illinois to remove some of the immediate and obvious barriers to providing better health care. Murphy sees that constant misinterpretation of HIPAA legislation, designed to protect the privacy of patients, is actually preventing those who can and should be involved in a patient’s care – that being the family or a caregiver – from actually doing so. Murphy’s legislation empowers parents, family and caregivers to take a more active role in mental health care of a loved one. His legislation also seeks to increase the number of professionals available for care, and it will also integrate mental health with the rest of the health care system. And finally, Murphy’s legislation also proposes expanding research into mental health so that our understanding of the human brain continues to advance and improve.
I think those are damned fine places to start.