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. 3^rd, 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