The Simplest Mental Health Reform Blueprint

In an unassuming online article published by WDKI television of Kansas, “Mental health reform proposed in Kansas,”there is laid out a summary of the initiative(s) now stirring in Kansas that show the simplest and some of the most needed mental health reform measures needed in this country. The irony is that they are incredibly simple, intuitive and long known as needed by policy wonks in the field and providers of all types in the mental health professions.

They boil down to basically simply and (stupidly enough) restoring some of the most basic lynch pins of our system of mental health care delivery.

Those essential foundations or struts of the superstructures of local or regional mental health care delivery systems of ANY size, consists of two basic things, money (“funding” in the ever dominant bureaucratic talk) and providers. Such a non-complex concept that we are starting to circle around to and rediscover. [Read angry irony in that last sentence please].

The last 20 years have seen state legislatures  cut funding for state and local mental  health services, fight Medicaid expansion to help provide mental health insurance and thereafter access to the ‘new’ privatized’ models of MH services agencies {they used to be called “mental health centers” in each country]. In most states, the new mental health reforms were SUPPOSED to cover the uninsured but somehow they often did not because of limited funding {read “block funding”]. Block funding as a concept originated mostly under the Nixon administration and since then has been largely used by a political party of a certain flavor tp punish frowned upon governmental services, such as Planned Parenthood, National Public Radio, and other entities, you get the idea. The concept was that funding was not cut off to avoid too much blowback, but given in limited and sometimes ever shrinking amounts with the admonition to choose upon what to spend it, leaving the do-gooders in the agencies to make the cuts and make the less than kind decisions and “be the bad guys.” That way legislators could crow to their constituents that they had not increased spending and had not cut funding [the latter often untrue but who’s quibbling here, this is politics…).

The other major pillar of deconstruction of the old county-based mental health system has been the ever shrinking pool of psychiatrists, counsellors, substance abuse counsellors, psychologists, child therapists of all disciplines and especially outreach workers in the old public health system sense, the “outriders,” who visited homes and if nothing else dropped the essential daily antipsychotic doses into patients’ mouths and made sure they swallowed them. It’s called “compliance.” Training programs until the last 10 years have done nothing but stay static in numbers of graduates or shrink dramatically as my one training program did for years. Some few departments of psychiatry closed or merged such as the famous occurrence at Tufts University Dept. of Psychiatry in Boston decades ago which was essentially saved and bought out by Harvard.

Reading the article makes me realize it has taken 30 years to pummel into the heads of the so-called reformers that three simple needed measures: outpatient services including residential systems of living centers for displaced mentally ill out of destroyed or as they would say in the Peron dictatorship years in Argentina, “disappeared,” hospital beds, and increase the funding and programs for providers, in this case, psychiatric residents. Sen. Chris Murphy’s bill and Former Rep. Patrick Kennedy’s now in effect merged national mental health reform bill does the same things largely except on a national basis

Dr Harold Carmel MD of Duke Psychiatry said now over a decade ago, “it will take us 10 years to get back to where we were 10 years ago.” At least we have real starts now.

 

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Author: Frank

I am a older child, adult, geriatric teaching psychiatrist with over 30 years' practice experience in North Carolina, first at Duke as clnical teaching faculty, then in Western NC as a primary child psychiatry specialist. I have taught and supervised child psychiatrists and psychiatrists in training and many other mental health professionals and taught at two medical schools. I have served in many public and private practice settings. My primary interest is in observing and documenting the ongoing mental health reform efforts in the State of North Carolina and documenting its sucessess and failures at all levels. My favorite pastime among many others is spoofing my friends and kids with my deadpan sense of humor.

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