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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

60 Minutes Highlights Need for Excellence in Mental Health Act

September 30, 2013 | Excellence in Mental Health Act | Comments
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First, let’s be clear — there is no “mental health system” serving people with serious mental illnesses in this country just as there is no single “healthcare system.” Mental health services are available in every community just like general medical services. For people with serious mental illnesses, these services are primarily funded with state Medicaid dollars and delivered by not-for-profit organizations or by state and county employees.

Every state has a unique Medicaid program — offering, for the most part, similar services to people with serious mental illnesses but with enough variation in what the services are called, how much is paid for the covered services, and who is eligible to receive the services to confuse most consumers and families and many of the most sophisticated Medicaid experts. Additionally these services are in a constant state of redesign often labeled as “healthcare reform.”

Unfortunately, it has taken a series of mass shootings by individuals with mental illness for the nation to start talking about services for people with serious mental illnesses and to question the extent to which needed services are available. While I desperately wish we were having this conversation under other circumstances, I am glad that we are finally having a real conversation about the financing and delivery of mental health services.

The latest chapter in that conversation came last night with a lengthy piece by Steve Kroft on 60 Minutes.  The premise of his story is that many of the recent mass shootings may have been preventable, if only for a more robust mental health “system” for those with serious mental illnesses.  The 60 Minutes piece raises many important issues — and some controversial ones — but one that particularly struck me as I watched was made by Tom Dart, the Cook County Sheriff.

Using language we’ve worked hard to banish, Sheriff Dart said last night, “Jails and prisons are the new insane asylums. That’s what we are.” He then went on to describe people with mental illnesses in his jail and the crimes for which they were incarcerated. Sheriff Dart explained that they were arrested for burglary – needing to buy food – and for trespassing – needing a place to stay. Stop and think about that. His jail is not full of people ready to commit mass murder but rather filled with people that need food and shelter.

So the issue is how do we ensure that people in need — ill, confused, and frightened by serious mental illness — and their families know where to get help?  And how do we ensure that the help will include treatments paid for by Medicaid as well as access to food and shelter? And how do we design – state by state – and adequately pay for service packages that expect and allow us to stay in contact 24/7 with people with serious mental illnesses and their families?

It took decades of bad decisions to get us to this point. And I know that we are not going to fix the problem overnight.  But I also know that we can, and must, do better. While the situation is dire, there are signs of change on the horizon.

Congress is considering legislation, The Excellence in Mental Health Act, which would restore a steady funding stream for community behavioral health centers. The bipartisan bill would also ensure that community behavioral health centers cover a broad range of mental health services, including 24-hour crisis care, increased integration of physical and behavioral health needs, and expanded support for families of people with mental health issues.

I believe with all my heart that, if enacted, the Excellence Act will make life better for millions of Americans. It is not a quick fix – much more needs to be done.  But it is an essential first step.  The National Council is working hard to build support for the Excellence Act and I urge everyone to join us.  Call, write or email your member of Congress and tell them that the time has come to reinvest in community mental health services. We can and must do more to care for the millions of Americans with mental health needs. To maintain the status quo is nothing short of a national tragedy.