What the New 21st Cure Mental Health Law Brings with It Locally

From the Christian Science Monitor newspaper, comes a good article, New reforms to alleviate pressure on local mental health system that lays out what the newly passed this week 21st Cures Act can bring with it at a local area and gives a hint of the tremendous expectations that will arise around this bill.

In the article, the author outlines some of the major features of the bill, but more importantly, shows how its provisions, especially in the legal arena may be expected to both furnish and require the provision of nonexistent services for the mentally ill in the justice system.

What is heralded is the hope and perhaps requirement of “standard of care,” that may spread nationwide, that could/should be put in place at the time of arrest of an offender of likely a perpetrator or a more mine crime. It is expected that mental health interventions will start to be routine and ready, in place, at the time of arrest and entry into incarceration. What is outlined is evaluations of incoming prisoners, likely those fitting into appropriate criteria, i.e., not offenders charged with murder, or other serious capital crimes such serial rapes, rape, attempted murder, kidnapping etc. What is hoped is the offenders who less serious offenses were at least in part driven by their mental illness or the lack of treatment for it, will be identified and directed under appropriate controls and safeguards to treatment quickly to prevent that current different “revolving door” pattern of the mentally ill offender. That new recidivist pattern, and the term ‘recidivist’ term in this context refers to persons who force with their out of come illnesses, repeat (recidivist) incarcerations and repeat public psychiatric hospital admissions over and over again.

Of course a big part of what drives that is two-fold: little or inadequate or isolated mental health treatment in jails especially in small poorer counties that have no means to coordinate with outpatient agencies to ensure and mandate immediate seamless continuation of care, or just plain inadequate or almost nonexistent local outpatient mental health care, or what exists is most locales of any size and supposed affluence, overwhelmed outpatient mental health care systems. These still exist after a good 15 years of mental health reform started by the states when this national mental health care crisis started and the federal government did nothing at the local levels. The states had to step in, the Great Recession hit and lingered and mental health reform in state after state turned into a business model that emphasized consolidation, mergers of agencies statewide, cost cutting at all levels, and cutting services wholesale, all the while struggling to find new approaches to care delivery with less and less state ability to fund such, which perpetuated and in truth made the state led mental health reform efforts doomed to failure.

So now this article cited above highlights another very important change. The Republicans now are the authors and really the prime moves, with important help from the Democrats as co-sponsors of all the last three years of federal bills. Without the  Republicans finally recognizing that “Houston, we have a problem,” not much would have gotten done at the federal level and the Party of No could have perpetuated its adamant fanatical opposition to anything new that cost money. But now that they control that federal government, they do not have a President they have loathed to deny action on worsening problems such as the inexorably worsening mental health problems have been.

Now the coming years whether this legislation can put into place even a portion sorely needed new services in neglected areas of the mental health care delivery system nationally, especially in my view in the communities. Without constructing a massive system of services this country’s politicos have shied away from such as housing, and rehabilitation efforts of all kinds, then we will see only very partial impartial improvements in elevating and improving the lives of the mentally ill. And by partially, I sadly mean that they could still just receive services when they are in the “systems.”

And finally the recognition has to be accepted by the politicos at all levels, national and state levels, that the care of the mentally ill is lifelong for them and is not a series of brief intense interventions that do accomplish new changes, and then recede because of costs of legislated short term care, and witness the   power of mental illness overcome the new forms of “inadequate services.”



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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