Exactly a half century ago, in October, 1963, President John
F. Kennedy signed the Community Mental Health Centers Act into law. It affected two very different classes of
people - people with mental illness and people with developmental disabilities.
In many ways, it was a civil rights act, promising to
replace large, segregated institutions with integrated, community-based
services.
It made a huge difference for people with developmental
disabilities.
But for people with
mental illnesses, its promise is unfulfilled and the dream sometimes feels like
it is dying.
When President Kennedy signed the Mental
Retardation Facilities and Community Mental Health Centers Construction Act
on October 31st, he did so with optimism. The law specified that the new community
mental health centers would offer four services – prevention, diagnosis,
treatment, and rehabilitation or recovery – to people with mental illness. And the result would be that all people, no
matter what their disability, would live freely and comfortably in their home
communities.
Had he lived to today – into his late 90s – President Kennedy
would be appalled at what became of this vision.
He would have witnessed in 1981 the replacement of direct federal
funding for community mental health services with an
inadequately-funded mental health block grant to the states. And he would have seen the result. Chronic homelessness grew, and jails and prisons
became the new warehouses for adults with mental illness. Here is a statistic that would have stunned
President Kennedy – women in
prison today are twice as likely to have serious mental illnesses as are men.
President Kennedy would also be dismayed that his vision for
community-based special education for children with emotional disturbances
became so clouded, and with such tragic consequences. The Act provided for demonstration grants to improve
special education services. He never could
have imagined that fifty years later, only 389,000 children
would be receiving special education services because of emotional disturbances. And if one in five school-aged children
actually has a mental disorder, then this means that we are identifying only one
in every 28 for special education services.
And, notwithstanding the promise of the Affordable Care Act,
President Kennedy would also be far from satisfied with some recent federal foot-dragging. In 2008, the Mental Health Parity and
Addiction Equity Act passed with the help of his brother and nephew. It guaranteed equitable insurance coverage
for mental health and health conditions.
But it has taken five years for a final rule to implement that law (a
rule now promised within days or weeks).
And at the same time funding for SAMHSA – through which federal block
grant dollars flow – has declined.
He would have seen
states do no better.
I was in the Connecticut State Legislature when we received
our first block grants in the early 1980s.
There was zero interest in using state funds to continue building the
community mental health center program.
That was long ago. So
let’s look at today.
In the five years between 2008 and 2013, states cut $4.6
billion from mental health services, often citing an unwillingness to burden
state taxpayers with these services.
But even when states were offered a free ride, many still refused
to authorize additional spending on mental health services. This year, twenty-two
states refused to expand their Medicaid programs, even though the federal
government agreed to pay 100 percent of the cost for three years and told
states that they could contract the programs again as the federal share went
down. No surprise – many of the 5
million left behind will be people with mental illnesses.
If we wanted to realize
the vision of President Kennedy, it would not be hard.
We could offer all children mental health screening as part
of well-child exams, and admit more children with mental illnesses to special
education services.
We could provide insurance coverage to more people with
mental illness, and appropriate more funding to community mental health
services.
And we could opt not to send adults with mental illness to
prison, at least until we have guaranteed them access to care and worked with
them to develop a meaningful recovery plan that might help them avoid hospitalizations,
homelessness, and imprisonment in the future.
If we did these five things, we could give vigor to the
dream and honor the promise President Kennedy made when he signed the Community
Mental Health Centers Act into law:
“It was said in an earlier age that the mind of a man is a
far country which can neither be approached nor explored. But today… it will be possible for a nation
as rich in human and material resources as ours to make the remote regions of
the mind accessible. [People with mental
illness]… need no longer be alien to our affections nor beyond the help of our
communities.”
Paul Gionfriddo via email: gionfriddopaul@gmail.com. Twitter: @pgionfriddo. Facebook: www.facebook.com/paul.gionfriddo. LinkedIn: www.linkedin.com/in/paulgionfriddo/
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