How’s your mental health? How often do we feel comfortable asking this question? Moreover, how prepared are we to respond when the answer is more complex than “okay?”
Recently, I had the honor of participating in the first annual Behavioral Health Summit at Carolinas HealthCare System. It’s amazing to hear speakers discuss the challenges that our nation faces regarding behavioral health, and to be a part of an organization that is leading the way in solving these complex challenges made me proud, and made me think.
The vast majority of Americans don’t spend their days walking around thinking about behavioral health. When they are thinking about behavioral health, they focus on the tragedies they read in headlines and see on cable news at every turn. Perhaps our nation’s focus on a narrative of tragedy exists only because we don’t know the history of treating mental illness in our country. More than three years ago, our president made a declaration that it’s time to bring behavioral health “out of the shadows.” If we look back to recognize the history and challenges in behavioral health, I hope that our nation will see the necessity for optimism in behavioral health.
Mental illness strikes early. According to the National Institute of Mental Health, half of all mental illness presents before the age of 14. People suffering from mental illness have an average unemployment rate of 80 percent in our country. One in four Americans, including our children and our colleagues, are challenged by behavioral health during their lifetime. Previous attempts to create a system designed to support this population did not succeed and we need to find a long-term, effective solution that provides the support and care that these patients so critically need.
If you go back far enough in our history, you would find absolutely no organized system for behavioral health care. Average Americans suffering from mental illness would collect on the street or in jails. Growing populations brought about crisis in this unsustainable model, and in the 1850s we saw our first wave of reform. During this time, people like Dorthea Dix fought for “moral treatment” of people with mental illness. Her actions were a catalyst for the construction of some of our first state psychiatric hospitals. These massive facilities could contain as many as 14,000 beds. In a time without medication, treatment consisted of keeping patients engaged in day-to-day tasks, and engaging in talk therapy. Nonetheless, this primitive system supported the population vastly better than the lack of care preceding this time in history.
As enough time passed, these large hospitals overcrowded. In some of the worst cases the hospitals were filthy, even inhumane to patients. This recognition was at the center of our second wave of urgency to treat the mentally ill. During the 1950s and 1960s, culminating in John F. Kennedy’s Community Mental Health Act, his last piece of legislation before his death, our nation’s leaders made it a priority to provide money and a modernized way to care for people with severe mental illness. This reform was a great stride for many of the patients that languished behind the walls of state institutions. A recharged program brought these patients back to their communities, near their families, and by this time care had evolved enough to provide more medications and some treatments.
Despite JFK’s best intentions for reform, a single piece of legislation was not enough to undue the history of unsuccessfully treating mental illness in our country.
In only a short period of time we went from 500,000 hospital beds for the mentally ill to 50,000 beds. We began to see Americans suffering from mental illness collecting on the streets or in jails. As resources for community treatment dwindled, treatment and support once again began breaking down. And that’s where we are now. Roughly 45,000 beds divided between stand-alone psychiatric hospitals and behavioral health units within acute care hospitals. We have roughly 6,000 community mental health centers, which vary in size, capacity, expertise and standard of care.
As a function of overall health care spending, behavioral health has decreased from over 10 percent in the 1970s to under 5 percent today. Between 2009 and 2011, as the economy struggled, over $4 billion was cut from state budgets across the country. This represents the largest single reduction in funding since the 1970s. What we have left is a long and damaging history of behavioral health that cannot be ignored.
But there is good news. To be transformative within a system so frayed is not a difficult task. Once you know the history, it’s easy to recognize the challenge and urgency for reform. A recurring theme throughout our history of reform is community. It will take focused communities to engage, support, educate, and drive reform for the mentally ill across our country. My challenge to you is to go out and have a conversation about our history of treating the mentally ill. Now that you know our history, you can become part of the change required to pave the future. I’m proud to be leading a System that puts the patient before all else.
The tides have turned and mental illness is surging into national discussions. The brighter future is now ours to create. This is our time to make our case of optimism for the mental health system.