50 Years Later, Mental Health Care in America Still Hard to Come By

Next week marks the 50th anniversary of President John F. Kennedy signing historic legislation known as the Community Mental Health Act (back when the name of legislature plainly reflected what was in it). It was the country’s boldest attempt to bring mental health care into the modern era by moving people out of inpatient psychiatric hospitals, and put them back in the community where they belong, making mental health care affordable and readily available to all Americans.

And due to the federal government slashing funding for mental health care in the 1980s, the legislation was wildly successful in emptying out state psychiatric hospitals of old. The problem is, they had nowhere to go, because the government never bothered to come anywhere close to funding community mental health centers to make them an equivalent replacement.

John F. Kennedy’s vision here was bold but sadly unrealized. Fifty years later, our biggest providers of mental health care in the U.S.A. are not hospitals or community mental health centers at all… but prisons.

While Kennedy is widely credited for the legislation, it was actually the culmination of years’ worth of work beginning back in 1955 during President Eisenhower’s administration. That administration’s Joint Commission on Mental Illness and Health published its groundbreaking report in 1961, Action for Mental Health: Final Report of the Joint Commission on Mental Illness and Health. This was the foundation for the legislation which became the Community Mental Health Act of 1963.

The Associated Press has the story:

Kennedy said when he signed the bill that the legislation to build 1,500 centers would mean the population of those living in state mental hospitals — at that time more than 500,000 people — could be cut in half. In a special message to Congress earlier that year, he said the idea was to successfully and quickly treat patients in their own communities and then return them to “a useful place in society.” […]

In 1963, the average stay in a state institution for someone with schizophrenia was 11 years. But only half of the proposed centers were ever built, and those were never fully funded. [emphasis added][…]

Meanwhile, about 90 percent of beds have been cut at state hospitals, according to Paul Appelbaum, a Columbia University psychiatry professor and expert in how the law affects the practice of medicine. In many cases, several mental health experts said, that has left nowhere for the sickest people to turn, so they end up homeless, abusing substances or in prison. The three largest mental health providers in the nation today are jails: Cook County in Illinois, Los Angeles County and Rikers Island in New York.

Former U.S. Rep. Patrick Kennedy, the president’s nephew, is gathering mental health advocates in Boston this week for the Kennedy Forum. The forum will mark the 50th anniversary of the Community Mental Health Act legislation (PDF), and meeting participants will also develop an agenda for improving mental health care in America.

While the original legislation provided startup funds to get the community mental health centers up and running in the states, it had little money for ongoing operations of those centers. The thought was they would eventually become financially self-sufficient — a fatal misstep. During the Reagan years, the remaining funding was given to states as block grants, which they could use in any manner they saw fit. The federal government, in effect, got out of the mental health care business.

Which would’ve been great, if states had held themselves to the same standards that the Carter Commission on mental health reform identified in 1978. Some did, but many others saw the opportunity to provide the minimal care necessary, since nobody is doing much lobbying on behalf of the poor and middle-class.

This map shows how much funding has decreased for mental health services state-by-state from 2009 to 2012 — just three years. ((Why is that during a recession, we inevitably cut services to those most in need?))

State psychiatric hospitals were begun in the 1800s partially in order to answer the question of how to best help people with mental health needs — people who otherwise were clogging up the local prisons with petty crimes.

Fast-forward nearly 200 years later, and we’re faced with much the same situation — as though we’ve learned nothing in two centuries. Society appears content with warehousing those with serious mental illness in prisons now, rather than providing them treatment in either their local community (as an outpatient) or in a psychiatric hospital.

I think John F. Kennedy would be sadly disappointed if he saw what became of his vision 50 years later.

Read the full article at USA Today: Kennedy’s vision for mental health never realized