The growing community of people suffering from mental illness needs more money to help expand the network of caring professionals, but it probably needs more innovative thinking to create more effective programs to recognize and diagnose the people who need help as early as possible, as well as treatment protocols for the needy patients.
You just can’t throw more money at a problem. The more money they threw at the VA, the worse it appeared to get.
The pharmaceutical industry has expanded its offerings significantly in the last 10 or 15 years, and this has been very helpful. Pharma will undoubtedly continue to develop and offer new drugs for controlling each different component of the mental illness spectrum.
At the same time, drug costs have to be more controlled in order to be more widely available in or out of insurance and prescription plans.
Cured or Managed – In general, neurological diseases like autism, dementia, bi-polar or Alzheimer’s can be managed with drugs or therapy but not cured. Mental illness, on the other hand, can be treated with drugs and therapy to restore a normal life balance.
The key in either case is early detection, evaluation and finding the right path for optimal results. Often that takes some degree of experimentation through trial and error to find the right formula of either drugs and/or therapists.
Perhaps most of all, it takes a commitment, because the biggest problem in treatment is patients, through frustration and/or over confidence, go off their meds.
Once in treatment, a physician or psychologist rarely mentions the word “cure.” Cure is what doctors do for a broken wrist or the flu. Set the wrist or give the patient a Vitamin-C shot, and voila! Done! Treating mental illness rarely results in a “cure,” per se. What it does result in is a person feeling better and eventually no longer needing treatment. But, even then, rarely will a professional say, “Yes, you’re cured of your depression.”
Professionals have a term for this “non-curing” of mental illness, too. Instead of removing the diagnosis from the chart at the end of treatment, they often place the phrase, “In remission,” onto the end of the diagnosis.
The Macro Approach to Addressing This Crisis – The following is an excerpt from a very comprehensive report from Dr. E. Fuller Terry on reorganizing the way we administer this problem.
“Fifty years ago, we began a grand experiment by transferring to the federal government the fiscal responsibility for individuals with mental illnesses. It has become increasingly clear that, although well intentioned, this experiment has been a costly failure, in terms of human lives as well as well intentioned dollars. The outcome was, clear as early as 1984, when Dr. Robert Felix, who had been the chief architect of the federal program, said, `The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept but…we tried.’”
Federal and State Actions – In order to reverse the continuing deterioration of mental illness services in the United States, the single most important change is to give the responsibility for these services back to the states. Coherent regulations, for example, to cover both Los Angeles County and Montana’s Garfield County, both of equal size geographically but one with a population of 9.8 million and the other with a population of 1,184, should make it clear that an office in Washington would have difficulty in promulgating one set of regulations to cover the whole country.
Currently, the ultimate responsibility for mental health services is vaguely diffused through multiple federal levels of government and multiple agencies. When everyone is responsible, then no one is responsible, and no one can be held accountable.
Responsibility for mental illness services can be returned to the states by block granting to the states all existing federal Medicaid and Medicare funds currently going for mental illness services, with only one condition attached. That condition would require that the funds be assessed and outcomes measured in cooperation with the federal Institute of Medicine and the Government Accountability Office (GAO).
Are There Any New Approaches to Help The Problem?
1. Facing the Problem – An eight-week residential program in Arkansas has shown significant success for vets with PTSD that involves “prolonged exposure,” where patients are encouraged to relive bad experiences on a continuing basis and put it in writing.
2. Short Doses – Research appears to indicate that talk therapy, much like chiropractic as well as physical therapy, is most effective in short doses. Evidence suggests the longer it goes on, the less effective it becomes.
3. Case Worker at Discharge – One example of a cost-effective approach employs a case worker to help mentally ill people leaving a hospital or shelter as they adjust to life in the outside world. Randomized trials have found that this support dramatically reduces subsequent homelessness and hospitalization.
Researchers found that the $6,300 cost per person in the program was offset by $24,000 in savings because of reduced hospitalization. In short, the program more than paid for itself. But we as a society hugely under-invest in mental health services.
4. Co-Response Units Offer Promise – L.A. Times columnist Steve Lopez reports:
“Earlier this year, when a friend of mine made what was perceived as a physical threat to a neighbor, it wasn’t just the police who responded.
“His case managers at Housing Works in Hollywood contacted a special unit that consisted of both LAPD officers and county mental health workers. One of those teams paid a visit to my friend, who suffers from schizophrenia, and evaluated him. The result was that instead of ending up in jail, or left alone at risk to himself or others, he was hospitalized. He’s still undergoing treatment and is much improved, and is still being monitored by the team that responded initially.
5. Different View of Therapists – Just as with physical diseases, the medical community often offers different recommendations. The same is even more true with the therapy community. Their diagnoses and suggested treatment options are wide and diverse. It creates confusion and uncertainty. This is a problem that needs better resolution.
6. Will Obamacare (ACA) Help? – There is some division on the answer to that question; but, in general, the answer is the ACA and a 2010 law called the Mental Health Family and Addiction Equity Act requires mental health and substance abuse services to do so in an equal fashion to medical health services.
Experts say patients will have greater access to treatment, but it will take time for this expansion of coverage to gain true equality. “You can’t just turn it around overnight.” The naysayers say it will put too many treatment decisions in the hands of bureaucrats and insurers.
7. Art Tests – UCLA Medical School is doing some interesting work to educate prospective physicians about what pain is really like by having people who are experiencing pain produce drawings. These drawings are from patients experiencing pain from loneliness, post-traumatic stress, anxiety, and a host of other physical and emotional disturbances.
Can this be the gateway to testing all children in the 6th or 9th grades to uncover the beginnings of mental illness? Asking students to each draw an image of a common subject could be a window to early diagnosis of mental illness.
8. Laura’s Law – Being adopted by L.A. and many counties that allow family members, treatment providers and law enforcement officers to seek a court order to make people take part in the program, under which people can be ordered to undergo treatment but can’t be forced to take medication.
The law has also been hailed by some advocates, who say it will save lives and give another option to over-burdened families. Others argue that forced treatment violates patient’s rights.
9. An Effective Teen Link – The Teen Line is operated by trained teens for any distressed teens. Teens can call anonymously if they feel suicidal, etc. The website is teenlineonline.org, (310) 855-4673. It has been around for many years and has been very successful.
10. Training for Early Detection – Teachers, school staff, religious leaders and counselors in sports and youth activities need to be trained for early identification.
11. Support for Mental Illness Care – Join the National Alliance on Mental Illness at nami.org or call (800) 950-6264.
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Many thanks to Phil Alcabes, Ph.D., and Susane Bacon, M.A., for their invaluable help, review and comments on this series. Could not have done it without them.