Mental-health care in America has seen a lot of improvements in recent decades.
There is a stronger focus on the biology of mental illness, which has contributed to a reduction of stigma. The causes and treatments for most major mental illnesses are better understood. People get better care, and more resources.
Yet most families affected by mental illness will agree that the country still has a long way to go in providing good mental health care, and paying for this care. And now states and communities across the country are faced with dwindling revenues – and are looking at major budget cuts.
This was a major concern Thursday night as more than 100 people working in the field of mental health gathered at WHYY on June 18th, to screen the latest installment in the Fred Friendly Seminar series, "Minds on the Edge".
The hour-long TV program brings together a panel of experts ranging from psychiatrists and psychologists to judges, lawyers, parents, and treatment providers. Through role-playing and round-table discussions, the panelists explore how mental health issues affect individuals, families and communities.
For example, the program addresses the helplessness families feel when they are trying to commit a loved one who is experiencing a mental break-down:
While role-playing a scenario involving a person in acute psychiatric distress, Pete Earley, journalist, author, and father of a bi-polar son, says what distressed parents are likely to hear from an emergency room physician turning them away:
Earley: The law is very specific. Unless this person poses a danger to themselves or others, I may not require them to stay in the hospital. So you know, good luck and good-bye.
University of Pennsylvania bio-ethicist Arthur Caplan summed up one of the major complaints about America’s mental health system : “You have got a system of health care that isn’t particularly attentive to mental illness. It likes physical illness.”
The screening was followed by an exercise in civic engagement around the topics raised by the program. Participants were broken up into focus groups, and talked about some of the most pressing topics in mental health care in the region. Stigma around mental illness, fragmented services, the disparities between mental and physical health, the burden on caregivers were all topics on the minds of participants'. But all of the evening's discussions were guided by one big theme - budget cuts.
Pennsylvania's secretary of public welfare, Estelle Richman, has to submit $100 million in new budget cuts for her department. Governor Rendell ordered these cuts this week as part of an additional $500 million he wants slashed from the budget for the fiscal year starting in July.
Richman: People with mental retardation, people with autism, people with mental illness, will feel some pain as I try to go through, and the governor said with a scalpel, I am actually going to use a laser which is even more defining, so we can try to preserve the system as much as we can, but...$100 million is a lot of money.
Richman says in addition to cutting services and containing costs, Pennsylvania has to increase revenues in order to close the budget gap.
Richman's deputy for behavioral health, Joan Erney, says this will mean significant reductions in the office of mental health and substance abuse services. She is worried that the cuts would affect some of the agency's most successful programs:
Erney: Peer work, people working with each other, who can work and be with a person who is struggling with their mental illness and trying to recover, are some of the most important services we have, they tend to be state only dollars and tend to be the things that get cut first in a community, so we're very concerned about that.
Erney says the proposed cuts come at a time when her agency is seeing increased need for services; people are losing insurance coverage because of unemployment, and veterans with mental health needs are coming home from deployment.
And now, there will be less staff to help them:
Dr. Arthur Evans, director of the Philadelphia department of behavioral health and mental retardation services, says this is a very challenging time for his agency as well. He says his staff is trying to think outside the box and be creative in doing more with less.
More info: Visit the Minds on the Edge main page