The Community Mental Health Act was meant to develop and fund programs so that people with the most serious mental illnesses – schizophrenia, bipolar disorder, major depression - could live successfully in the community. Somehow this effort is failing the group that was intended to be its priority, and prisons have become the de facto mental hospitals of the new century.
The reasons for this failure are complex. I do think that people involved with community mental health bear some responsibility. It is evident that we have not developed a network of places of support sufficient to help the group who needs us the most. There is a disconnect between the needs of the neediest and the funding and services available.
State governments clearly bear some significant responsibility for the problem since they reaped the funds from the closing of state mental hospitals but did not allocate them to community care. Instead they accelerated their use of Medicaid funding, a medical insurance system that lacks an efficient funding stream for the community support programs that are so vital for this group to live productively and successfully. Ironically, now state governments are caught in an ever-expanding Medicaid mill.
In order to truly fulfill the promise of the Community Mental Health Act, we must develop more places for people with the most serious mental illnesses, and states must step up to pay for the community supports that Medicaid is not designed to provide.
Kenneth J. Dudek
President, Fountain House