The New York Times
Across the country hundreds of thousands of Americans with serious mental illnesses, such as schizophrenia and bipolar disorder, have been consigned to lives of profound instability. Instead of therapists to help them manage their illnesses or doctors to oversee their medication regimens or evidence-based treatment for their substance use disorders, they cycle through homeless shelters and the jails and prisons that have become the nation’s largest mental health providers. Or they make their homes on the streets. They are victims of a mental health system that is not designed to meet their needs — and of a society that has proved mostly indifferent to their plight.
Community-based mental health clinics serve the vast majority of Americans with serious mental illnesses. These patients tend to be low-income, to be disabled and to rely on Medicaid, whose reimbursement rates are so abysmal that advocates say clinics receive just 60 to 70 cents on every dollar spent on care.
In many ways, the criminal justice system has become the only reprieve: Because court-ordered patients are granted priority, pressing charges against loved ones is a common way to get them psychiatric attention in a crisis. More than 40% of the nation’s inmates 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 “a wholly new emphasis and approach to care for the mentally ill.” It involved closing the nation’s state psychiatric hospitals — which had become dens of neglect and abuse — and replacing them with a national network of community mental health centers. The centers would support and treat the formerly institutionalized so that they could live freely with as much dignity as possible.
Lawmakers and health officials executed the first half of that vision with alacrity. The number of people housed in large psychiatric hospitals fell by 95 percent between the 1950s and the 1990s. But nearly 60 years after Kennedy’s bill became law, there is still no community mental health system in America.
It is possible to start building one now.
What stands out about this history now is not how disastrously wrong it all went but how close officials came to getting it right. The model laid out in the Kennedy bill would enable people in psychiatric distress to remain anchored in their communities. And single-point-of-access clinics would help families in crisis avoid the desperate gambit of seeking care through courts and judges.
Congress could correct course now by writing a new bill that pulls the best of these past attempts together and builds on them. None of this will be cheap. By most estimates, it would cost several billion dollars to fully fund and carry out the original community mental health vision today. But those costs would be partly offset by what police departments, jails and hospitals could save.
It’s within our power to break the cycle of neglect and mistreatment now, and to change the way that the most vulnerable among us live for generations to come.
