Mental Health Solutions Need Coverage,Too

Posted on October 2, 2013

On Sunday, September 29, 60 Minutes aired a segment entitled “Untreated Mental Illness an Imminent Danger?” reported by Steve Kroft. The connection between mental illness and violence is a complex and fraught issue, not easily covered in 13 ½ minutes of primetime television, but the story did aptly describe failures in the mental health system.

Inadequate mental healthcare is responsible for untold human suffering – not only for the sensational mass shootings that prompted the segment, but for homelessness, incarceration, suicide, and countless lives of wasted potential. States are quick to cut their community mental health budgets, abandoning people who are living with serious mental illness to the Medicaid system – a medical plan that is woefully unable to meet their needs. Rather than the integrated psychiatric, medical, and social support that is proven to lead to better outcomes, many people are left to the revolving door of the justice, corrections, and hospital systems. Society pays the price, in real economic costs and in inestimable human costs.

The problem is easy to formulate, but what about the solution? In the present dialogue, it is easy to lose sight of the fact that there are responses in place to the mental health crisis that are working. Sunday’s segment neglected any mention of this, yet in almost 40 states there exist community mental health centers that help people with serious mental illness live productive, fulfilling lives. These centers often struggle for survival in the face of limited support and funding, but they are successfully addressing the problem. People’s concern and understanding of what is possible should be informed by that.

Everyone who weighs in on this issue agrees that ultimately we must expand mental health support services for people living with schizophrenia. My experience as the president and executive director of Fountain House, a world-renowned community mental health program, has taught me that these support services must have a few key features:

Early intervention
50% of psychiatric illnesses manifest by the age of 14 and 75% manifest by the age of 24. Diagnosing and treating these disorders earlier means less time lost to the downward spiral of illness and the slow climb back to recovery.

Location
Isolation is one of the single largest problems facing people living with serious mental illness today. Even someone who is in mental health treatment may dutifully take their medications, see their providers for a few hours a month, and have little else to fill their life. Frequently these conditions disrupt people’s lives – causing them to lose jobs, drop out of school, and alienate those around them. Discrimination, misunderstanding, and self-stigma only exacerbate that.

Centers in the community – physical locations where people congregate – can help those living with mental illness reconstruct their social networks and build the support that encourages them to move forward with their lives. 

Proactive outreach
People living with serious mental illness are frequently difficult to engage, and mental health recovery is seldom straight line. Any number of things may deter people from seeking or connecting with available help – anxiety, medication changes, and lethargy, to name a few. A persistent outreach effort by a person or team aimed at building a genuine relationship with the recovering person is crucial.

Since 1948, Fountain House has been confronting the social challenges of mental illness and developing a response that includes these vital features. Fountain House serves New York City from its Hell’s Kitchen location, but the inherent humanity, social inclusivity, personal empowerment, and innovation of this approach has inspired its replication around the world and has earned federal recognition in the US as an evidence-based practice. It is the gold standard for community mental health programs, and it is the model for more than 200 programs in 38 states and another 100 programs internationally that successfully address the social impact of mental illness and support people to build meaningful lives in their communities.

Untreated mental illness is an imminent danger, but as the 60 Minutes report rightly stated, very little of that danger is due to tragedies like the Navy Yard shooting. It is much easier to avert our eyes from the smaller daily tragedies of mentally ill individuals and their loved ones struggling to make their way in an inhospitable world with little or no help. But that help does exist. As a society, we must decide whether we will prioritize making it available to everyone who needs it.

Kenneth J. Dudek
President, Fountain House

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