America's Mental Health Crisis
By Sharon S. Joag
Mental Health has been a topic of discussion in the United States since
the population started to grow, and communities started to form, in the 1800’s.
From the time of Dorothea Dix in the late 1800’s, who was one of the foremost
champions of mental health asylums in the United States, until today, there has
been an ever changing need for mental health care in the United States. Through
Dix’s efforts, by 1854, she helped to establish mental asylums in 9 different
states (Blau, 2014, pp.251).
In 1945, the NIMH (National Institute of Mental Health) was authorized by President
Harry S. Truman, who signed it into law, called the National Mental Health Act.
In 1949, the NIMH finally opened its doors (https://www.nimh.nih.gov/about). However,
in the 1960’s, 70’s and 80’s, “states closed hundreds of psychiatric hospitals
but offered very little in its place” (Bobrow, 2022). Many people started to shuffle
between emergency rooms, homeless shelters, jails, and prisons; and this is true
even today (Bobrow, 2022).
Thomas Insel, a neuroscientist and a psychiatrist was the director of
NIMH (National Institute of Mental Health) from 2002-2015. In his article in
the Wall Street Journal, he gives a hopeful, yet constructive criticism about
the health care system that exists in America as it relates to Mental Health.
He says that there is much research in human behavior and the brain, however,
that research is not translated into actual implementation of the findings. The
gap in what researchers know, and what is actually done to help the public at
large, is called the “implementation gap”(Bobrow, 2022).
Dr. Insel traveled the world after his tenure at the NIMH, and he did
research on various health care models in other countries. He compiled his research
in a book that he recently published, called “Healing”. In his book he details
a new approach to mental healthcare in patients with mental illness. He
believes that creating a structural support for patients, which includes social
support (involving families and case management), in additional to medical
support (medications), is the key to helping patients to be able to function optimally
in society, and to be able to overcome their mental illness. This view was
touted by Dorothea Dix in the 1800’s when she was an advocate for having
smaller mental health facilities in various communities to help people with
mental illness (Gollaher, 1995). Dr. Insel also believes in a more encompassing mental
health therapy; a step further than Dix. He says that it is important to “(find
a) connection, sanctuary, and meaning (which is) not defined or delimited by
mental illness”. Dr. Insel talks about offering housing, job training, and
opportunities for patients to join the social world and create social
connections.
It is interesting to note that in over 100 years, there has been so much change
in the research arm associated with mental health care; Insel talked about how
he oversaw $20 billion in grants for research in human behavior as it relates
to the brain (Bobrow, 2022). However the translation into tangible aid for the
mentally handicapped has been slow.
One of the major problems in mental health care in general are the lack
of official standards or protocols for treatments, and doctors are not held
accountable if the treatments garner minimal to no results. “Doctors get paid
when patients are in treatment, and not if they get better” (Bobrow, 2022). In
contrast to mental health care, doctors who treat other physical issues, such
as Orthopedists, or Primary Care physicians, get paid based on a model that is
based on whether the patient gets better. If the patient does not get better or
if the treatment does not garner a good result, patients can and do sue (the
reason for malpractice). However, if a mental health patient sues, there are
virtually no repercussions for doctors, since they are not held accountable for
the results of their therapy.
Many mental health providers also cluster in wealthy urban areas and often only
accept cash payments as they do not take insurance (Bobrow, 2022).
This article is a red flag, and a call to action. We as social workers
need to find ways to help to affect change in policies affected the mentally ill.
There should be more local community programs that are functioning, with the help
of the state or federal government. These programs should have various branches
in place to offer assistance when needed. Social workers should be hired to understand
each individual problem, and schedule appointments with the correct medical
professional, or institute programs to help socialize patients. Doctors should
be required to volunteer a few hours a week at these clinics to help the
mentally ill. Utilizing technology might also be an online option for doctors
and patients to get required treatments, as Dr. Insel has started doing more
recently. He co-founded an organization called “Humanest” with his daughter,
Lara Gregorio, who is a licensed social worker. Their company utilizes
technology by offering online group intervention (Bobrow, 2022).
References:
1.
Blau,
J. & Abramovitz, M. (2014). The Dynamics of Social Welfare Policy. 3rd,
237-263, Oxford University Press.
2.
Bobrow, E. (2022,
February 11). Psychiatrist Thomas Insel Looks for a Cure to America’s Mental
Health Crisis. The Wall Street Journal. https://www.wsj.com/articles/psychiatrist-thomas-insel-looks-for-a-cure-to-americas-mental-health-crisis-11644600489?st=teehdmjgcb8216z&reflink=desktopwebshare_permalink
3.
Gollaher, D.
(1995). Voice for the mad: The life of Dorothea Dix, 163-182. New
York, NY: Free Press.
4.
National Institute of
Mental Health (NIMH) https://www.nimh.nih.gov/health
