Mental Illness and Public Policy

A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

H. Public Policy

I would like to say a few words about some reforms needed in public policy if we are to give people with depression and bipolar disorder, in particular, and people with chronic mental illness in general, a reasonable chance for adequate treatment. I am not a sociologist or a political scientist, so I must leave it to others to devise methods for actually accomplishing these goals.

First, there is an urgent need for some kind of adequate health insurance for both physical and mental illnesses, available to all people at a price they can afford. For mental illness this system should provide all needed services ranging from diagnosis, to talk therapy, to medication, to hospitalization, if necessary. I know that there are those among us who will be quick to utter the dreaded words "socialized medicine", the kiss of death to all policies designed to help the victim instead of enrich the doctor. So be it. I have seen "socialized medicine" at work in Europe, and I learned that mostly it does work, particularly in Scandinavia. So long as mental health services must be purchased by the consumer, the rich will be adequately treated and the poor will live in misery, a gross mockery of their equal inalienable human worth.

Whenever I visit Washington DC, I feel an intense sense of outrage when I see the groups of shabby homeless men (mostly) clustered for survival on sidewalk heat vents from the great white marble palaces our government likes to house itself in. Up close, one sees that they are filthy, their clothes are filthy and ragged, shoes even worse, and that they give every appearance of being depressed and/or unable to connect meaningfully with reality.

Studies show that (roughly) half the group has serious problems with alcohol or street drugs. The bulk of the others people with chronic mental illness who have been dropped by the existing public mental health system. They filter down to the bottom, unable to care for themselves, and struggle with the unrelieved misery of their illness. And I ask myself "Is this what a 'superpower' does for its citizens? Allow them to sink to a level of personal degradation not usually seen outside of the third world? Dooming them to a hell from which they can hope to emerge only by dying? Would anyone knowingly consign his/her fellow human to such a fate?"

The way I see it is that if this country is rich enough to blow away billions of dollars a year in tax breaks to wealthy corporations, then it can easily afford to provide adequate health insurance to all its citizens. Some national priorities need to change, and soon!

A second issue is providing adequate supervision and direction to our public mental health system at local, county, and state levels. It is well to recall historically that when effective medications for mental illness became available, the majority of the patients in large state and federal mental hospitals were released on the theory (i.e. assumption) that they could then be treated effectively on an outpatient basis at the local level.

In theory, a network of well-financed Community Mental Health Centers and half-way houses were to be established to provide this care. Unfortunately there was no follow-through: federal aid was diverted to other ends, and community based services were left the responsibility of local governments, who found themselves swamped by a large influx of people needing care, while having no new source of revenue to pay the costs. In many states existing Community Mental Health Centers tended to focus on the less serious problems (personal adjustment, conflict management and resolution, divorce, etc.) and people with chronic mental illness found they had nowhere to turn: the local centers were unable or unwilling to treat them, and the hospitals were closing down.

Happily this problem has been recognized, and in the past few years a number of states (in response to federal mandate) have given their systems a major reorganization. In some cases, state and local chapters of NAMI have played an important, even decisive, role in representing the interests of people who have chronic mental illness. In those states where this process worked well, much improved access to the system resulted for people with chronic mental illness. The job is not done yet, and everyone interested in conquering mental illness: those who have chronic mental illness, family, friends, all of us, must continue to press for improved services for people who have chronic mental illness at all levels of government.

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