A homeless man holds a sign asking for money at the entrance of a subway station in New York on October 9, 2015.
photo:
Mark Lenihan / The Associated Press
President Biden has just signed into a gun law that seeks to increase funding for preventive outpatient treatment for mental illness. This is an important step toward solving America’s mental-health crisis, but only part of what is needed. Happily, there may be help if Republicans withdraw Congress in November.
From homelessness to crime to rising suicide rates, a variety of problems in America today are linked to mental illnesses. But Democrats, journalists and social activists often focus on other possible causes, such as racism, economic inequality or police abuse. Ask a Democrat about solving homelessness and the standard response is a call for more housing. But housing alone does little to help those who are in psychological distress. It sometimes makes matters worse if people are more isolated.
More outpatient counseling and medication is a better solution than many have been told by these politicians. But for severe mental illness — untreated and acute psychosis — this may not be enough. Some require long-term residential care with trained physicians.
Unfortunately, the inpatient resources needed for these patients have been taken away. “We exacerbated the institutions’ problematic situation in the 1960s that we created a huge shortage of funded psychiatric beds,” said Thomas Insel, former director of the National Institute of Mental Health. The 1965 law that established Medicaid included a provision called the Institutional Mental Disease Exclusion, which restricts most Medicaid payments to state psychiatric hospitals. The US now has only 5% of psychiatric beds as compared to six decades ago.
As hospitals reduce beds, patients must move to community care facilities, but community care facilities often cannot provide medication and provide little more than housing. These facilities usually lack professional medical and mental attention, and patients with acute psychosis are asked to leave before they have recovered enough to attend therapy and take responsibility for taking medication.
Instead these patients end up locked up in the streets, hospital emergency rooms and prisons. The nonprofit Treatment Advocacy Center estimates that more than three times as many mental cases remain in US prisons than in state hospitals. Many judges would not consider compulsory treatment for severely disturbed individuals because psychiatric hospital beds are too few. Prison care generally provides little support for the mentally ill and is unlikely to prevent recurrence.
This neglect may come to an end. If Republicans take Congress, Washington Representative Cathy McMorris Rodgers could lead a key committee to tackle direct mental illness legislation. Mrs. Rodgers has been instrumental in drawing attention to the IMD exclusion, the effects of which she sees in her hometown of Spokane.
Reps. French Hill (R., Ark.) and Andy Barr (R., Q.) and Sen. Tim Scott (SC) is preparing legislation to allow housing funds to be used, in part, for mental-health services and medication. -Addiction treatment. They intend to pursue their proposals if the GOP takes over Congress in November. The Democrats would be wise to join, but have so far been resistant.
As House Republicans refine their commitments, they should focus on improving mental health. The poll may not show much concern among voters about untreated mental illness, but it is at the center of many of their top concerns.
Mr. Chapman is the President of the Discovery Institute. He participates in the institute’s program FixHomelessness.org. He served as the director of the US Census Bureau, 1981–83.
Wonder Land: Joe Biden prefers to talk about racism and guns rather than face the real problem. Images: AFP / Getty Images / Reuters / Shutterstock Composite: Mark Kelly
opinion | Republicans Could Lead to Mental Health Treatment
A homeless man holds a sign asking for money at the entrance of a subway station in New York on October 9, 2015.
photo:
Mark Lenihan / The Associated Press
President Biden has just signed into a gun law that seeks to increase funding for preventive outpatient treatment for mental illness. This is an important step toward solving America’s mental-health crisis, but only part of what is needed. Happily, there may be help if Republicans withdraw Congress in November.
From homelessness to crime to rising suicide rates, a variety of problems in America today are linked to mental illnesses. But Democrats, journalists and social activists often focus on other possible causes, such as racism, economic inequality or police abuse. Ask a Democrat about solving homelessness and the standard response is a call for more housing. But housing alone does little to help those who are in psychological distress. It sometimes makes matters worse if people are more isolated.
More outpatient counseling and medication is a better solution than many have been told by these politicians. But for severe mental illness — untreated and acute psychosis — this may not be enough. Some require long-term residential care with trained physicians.
Unfortunately, the inpatient resources needed for these patients have been taken away. “We exacerbated the institutions’ problematic situation in the 1960s that we created a huge shortage of funded psychiatric beds,” said Thomas Insel, former director of the National Institute of Mental Health. The 1965 law that established Medicaid included a provision called the Institutional Mental Disease Exclusion, which restricts most Medicaid payments to state psychiatric hospitals. The US now has only 5% of psychiatric beds as compared to six decades ago.
As hospitals reduce beds, patients must move to community care facilities, but community care facilities often cannot provide medication and provide little more than housing. These facilities usually lack professional medical and mental attention, and patients with acute psychosis are asked to leave before they have recovered enough to attend therapy and take responsibility for taking medication.
Instead these patients end up locked up in the streets, hospital emergency rooms and prisons. The nonprofit Treatment Advocacy Center estimates that more than three times as many mental cases remain in US prisons than in state hospitals. Many judges would not consider compulsory treatment for severely disturbed individuals because psychiatric hospital beds are too few. Prison care generally provides little support for the mentally ill and is unlikely to prevent recurrence.
This neglect may come to an end. If Republicans take Congress, Washington Representative Cathy McMorris Rodgers could lead a key committee to tackle direct mental illness legislation. Mrs. Rodgers has been instrumental in drawing attention to the IMD exclusion, the effects of which she sees in her hometown of Spokane.
Reps. French Hill (R., Ark.) and Andy Barr (R., Q.) and Sen. Tim Scott (SC) is preparing legislation to allow housing funds to be used, in part, for mental-health services and medication. -Addiction treatment. They intend to pursue their proposals if the GOP takes over Congress in November. The Democrats would be wise to join, but have so far been resistant.
As House Republicans refine their commitments, they should focus on improving mental health. The poll may not show much concern among voters about untreated mental illness, but it is at the center of many of their top concerns.
Mr. Chapman is the President of the Discovery Institute. He participates in the institute’s program FixHomelessness.org. He served as the director of the US Census Bureau, 1981–83.
Wonder Land: Joe Biden prefers to talk about racism and guns rather than face the real problem. Images: AFP / Getty Images / Reuters / Shutterstock Composite: Mark Kelly
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