Mental Health Budget Cutters on the Wrong Side of Reality

How do we help political leaders understand that the actions they take can have a profound, long-term effect on the mental health of our population?



copyright Mental Health America, 2011

David Shern, CEO of Mental Health America and one of the nation’s leading mental health advocates, has an answer.  Arguing that “the next century of mental health in the U.S. needs to be fundamentally different” from the last one, he makes the case for a new “vision for mental health now within our grasp.”

Speaking at an April 13th seminar sponsored by the Mental Health Association of Palm Beach County, FL, Dr. Shern offered a glimpse into a policy future that could reverse the epidemic of mental illness in America. 

“The United States has the highest rate of mental illness in the world,” he began, as he laid out the present state of mental health in the United States.

·         One in four of us have diagnosable mental illnesses each year.  Half of us will have diagnosable mental illness in our lives.

·         By 2002, serious mental illness cost us $193.2 billion in lost earnings per year, an amount greater than the annual revenue of every Fortune 500 company except one.

·         The mean age of onset of mental illness in America is 14, but treatment for mental illness is typically delayed for up to ten years.

·         Chronic disease, or disability, accounts for 70% of death.  Diabetes accounts for 3% of disability, arthritis 4%, cancers 12%, cardiovascular disease 15%, and mental illness over 20%.

Dr. Shern believes that we have accepted this current state of affairs for far too long.

Serious mental illness robs people of 25 years of life, but as he pointed out, “these are not death sentences.”  With proper diagnosis, care, and rehabilitation, even 50% of people with schizophrenia can largely or fully recover.

Dr. Shern says that there is a lot we can do about mental illness.  He believes that a 21^st century mental health system should focus on both prevention and treatment. 

Mental illness prevention strategies should be modeled on the hugely successful 20^th century public health program. 

He cited compelling evidence from a 2009 IOM report that addressing environmental factors, including child abuse and assault, neighborhood and family violence, and substance-abusing caregivers, can prevent mental illness.  He used as an example a long-term Seattle-based study, which found that at-risk children whose parents received training had a 38% reduction in mental illnesses 15 years later.

To illuminate the point some more, he presented data showing that when immigrants arrive in America, they have the lower rates of mental illness of their former nations.  After several years in this country, they experience mental illness at the higher rate of the rest of our population. 

His treatment strategies are modeled on inclusion and integration. 

In his talk, he advocated for a reversal of the 20^th century practice of segregating mental health care from other health care.  He promoted collaborative care models, in which primary care and mental health professionals practice side by side.  It’s a good investment, which one insurance company found saved $2 for every dollar spent.    

He sees hope in both the Mental Health Parity Act and the Affordable Care Act, which provide for better treatment coverage and more prevention dollars for mental health.  But he observed that it took more than a decade for Congress to pass the Mental Health Parity Act, despite strong public support for it.

He derives inspiration about the future from Dr. Julius Richmond, former Surgeon General, who said that societal change requires three elements – science, the ability to implement, and political will. 

We have the science to identify the best methods for preventing and treating mental illness, he said, and the ability to implement them.

But what of our political will?

Around the country, political leaders are making people with mental illness budget scapegoats.  In a recent blog, I wrote how states are pushing huge cuts to mental health. The same day Dr. Shern gave his talk, the U.S. House voted to repeal the ACA prevention dollars he referenced. 

It is as if they believe people with mental illness are responsible for unbalanced budgets. In the face of overwhelming evidence to the contrary, they act as if nothing they do for, or to, people with mental illness will make a difference.

If they listened to Dr. Shern, they would know that they were on the wrong side of reality.  Mental illness prevention and treatment programs are working and should be expanded. 

If legislators are not careful, a new mental health catastrophe may be just around the corner from the cuts they make. 

This is an important message for every American.  And every American, Dr. Shern concludes, must play a role in creating the political will we need to change our mental health trajectory for the better.

For more information, contact Mental Health America at www.nmha.org, the Mental Health Association of Palm Beach County (www.mhapbc.org) or your local Mental Health America affiliate.  You can also get information about mental health and mental health advocacy through NAMI (www.nami.org) or your NAMI affiliate. 

For information about this blog, or to subscribe to the Our Health Policy Matters weekly email, contact gionfriddopaul@gmail.com.