Mental health in the US: New ideas on care emerge
Mass shootings by mentally unstable people have focused attention on the inadequacies of the US mental health care system, in which less than half of the seriously ill can get treatment.
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Just a day after the Newtown shooting, blogger Liza Long published an article about her own experience with a mentally ill son that quickly went viral. Titled "I am Adam Lanza's mother," the blog was an impassioned plea for more discussion of mental illness and more options and support for those who struggle with it.Skip to next paragraph
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The Newtown shooting has started a national conversation about tougher mandatory commitment laws, tighter gun-control laws for people with mental illness, and the need for more funds. Some opponents of gun control seized on mental health care reform as a better way to respond to Newtown than stricter gun-control laws.
Advocates for better mental health care tend to see all the attention as a mixed blessing.
"On the one hand, they recognize the mental-health system needs all the attention they can muster," says Paul Appelbaum, director of the division of law, ethics, and psychiatry at Columbia University in New York. "On the other hand, the link to violence as a means to persuading people to provide more adequate levels of funding is misleading and likely to further stigmatize people with mental illness."
An overwhelmed system
Most agree that the current system is not adequate. A litany of statistics illustrates its shortcomings. Only 4 in 10 people with a serious mental illness have access to any treatment. The number of institutional public beds available for the mentally ill is 5 percent of what it was 50 years ago. Since 2009, about $4.35 billion in state funding has been cut from the mental health care system. Some 20 percent of people in prison have a serious mental illness. More than a quarter of adults living in homeless shelters have a serious mental illness.
No one, of course, is suggesting a return to the system of 50 years ago, when many people were involuntarily locked up in psychiatric wards for years. When such hospitals were closed in the 1960s and '70s, a community treatment system offering high-quality treatment in a less restrictive setting was supposed to take its place.
"The problem is that those resources never materialized in a way to compensate for the closure of the hospitals," says Liza Gold, a clinical professor of psychiatry at Georgetown University's School of Medicine.
While it's difficult to pin down exact costs, due to fragmented funding sources and varying quality of treatment, good community-based programs cost significantly more than warehousing the mentally ill in big psychiatric hospitals, says Frank Ochberg, a clinical professor of psychiatry at Michigan State University and a former associate director of the National Institute of Mental Health.
"Living in a community ... is more expensive," Dr. Ochberg says, though he also emphasizes that the psychiatric hospitals had negative effects on patients and employees, and needed to be shut down.
These days, the system isn't up to the task of dealing with the people experiencing a major mental-health crisis, and very few public programs offer support or preventive care before someone gets to that point. Family members, like Ms. Long, the blogger, talk of feeling scared and very alone when it comes to getting help for a loved one who they believe is on a downward trajectory – especially when the person doesn't recognize his or her own illness and refuses any help.