State-led mental health reforms have failed before. But 2022 will be different.


The coronavirus pandemic has revealed a number of overlapping mental health crises that have been simmering beneath the surface for years in America. Drug and alcohol use has skyrocketed since 2020, with suicide rates rising, especially among young people. Therapists have a waiting list and delayed access to services. Even the rollout of a new national emergency number, 988, can be bogged down in some states because they don’t have the resources or trained staff to handle all the calls.

President Biden has advocated for mental health reform, but historically, presidents have struggled to build the political will to pass meaningful legislation.

Yet the political will this time around seems more eager to meet the challenge, despite all the volatility. It’s not just that mental health conversations are breaking out of their silent silos. There also appears to be bipartisan political support to fund local communities. In addition to the strong involvement of activists with lived experience of recovery and families managing mental health challenges, there is a tendency to argue that mental health is fundamental rather than adjacent to overall health. It is rising.

President John F. Kennedy was the first president to push legislation to secure mental health treatment. In the early 1960s, addiction, depression, suicide, and other mental health crises were not openly discussed. About 550,000 American adults and children live in institutions in 279 states, most of which are overcrowded and have fires and health hazards. Many of the patients were “warehoused” and presumed to be lifelong residents who never recovered.

The Kennedy family, despite their wealth and influence, were not excluded from these challenges. There has always been a quiet but pervasive grief in the president’s life over his sister Rosemary, who was institutionalized after a lobotomy. His ambition for the life they could have led him to take this subject seriously.

Influenced by Dr. Robert Felix, former president of the American Psychiatric Association and head of the National Institute of Mental Health, Kennedy addressed both houses of Congress in 1963 to call for action on mental health. He described how state hospitals across the country routinely leave patients “at the mercy of confinement and isolation” where they “weaken.” It was a national stain and shame, he argued, and considered the failure of institutionalization among the nation’s “most urgent problems.”

October 31, 1963, He signed the Community Mental Health Act (CMHA) calling for the construction of 1,600 community-based service centers across the United States. But his assassination three weeks later changed everything. The escalation of the Vietnam War for his successor Lyndon B. Johnson has dried up funding for all of his domestic policy priorities, including the CMHA system. CMHA funding has dwindled and national priorities have shifted. Only one-third of his 1,600 community centers solicited were built.

Jimmy Carter was the president-elect who made mental health reform a priority. His experience in his family also pushed him into action. His cousin Tommy has been in and out of a state hospital in Milledgeville, Georgia for years. However, the interest and influence of Carter’s wife, Rosalyn, led to this accusation. He led congressional hearings to pass laws and played a key role in gathering public and political influence.

The law called for partnerships between the federal government and states to develop models of care and minimize the need for involuntary institutional confinement. At a time when state hospitals seemed unaccountable for the thousands of patients who have already been discharged with little attention to aftercare, the new law will allow the state to fund systems that can improve lives. provided a plan.

The MHSA had nearly unanimous support in both the House (277-15) and the Senate (97-3), but the election of Ronald Reagan as President abruptly ended this window of opportunity. I was. As during his California governorship, Reagan opposed using government funds to help people with disabilities, including mental illness. He extinguished his $500 million budgeted to implement sweeping reforms of his predecessor, pulling the federal government away from direct spending on services.Instead, the Comprehensive Budget Adjustment Act of 1981 Provided block funding to states to integrate mental health and addiction research and services into research and services such as black lung disease, rodent control, blood pressure lowering programs, and lead relief.

But despite these budget cuts, things began to change over the next two decades. As the medical, psychological, and political fields began to change the way we think about mental health, we increasingly recognized the intrinsic and holistic relationship between our mental health and our overall health. This sea change was confirmed in the Surgeon General’s Mental Health Report published in 1999. recovered And such a diagnosis did not have to be life imprisonment. That report was consistent with his 1999 judgment of the Supreme Court. Olmsted vs LC This decision affirms the Americans with Disabilities Act, which states that people diagnosed with “mental illness” or other disabilities should not remain in institutions if they can live in the community.

President George W. Bush Olmsted decision. His commission, the President’s Commission on New Freedoms, in 2002 wanted to lay the groundwork for enabling people with disabilities to live, work, learn and participate fully in their communities. rice field.

Bush’s ideals were ambitious, but never fully realized. Change came gradually only with a Republican president openly acknowledging recovery from alcohol abuse, even though he articulated laudable goals and principles. Disability was built into the system, which remained fragmented, characterized by financial and racial disparities, and irresponsible to the principles of recovery. made it difficult to

Twenty years later, the pandemic has made it clear that essential services are still in short supply. But importantly, the public is more openly discussing the need for mental health treatment. This problem is ubiquitous, as seen, for example, in the nightly television advertisements for new drugs. Elements of the transformation plan so far have been widely accepted, creating political will to fund Biden’s proposal for his 2021 economic stimulus package, the American Rescue Plan (ARP).

ARP is allocating $4 billion to improve mental health treatment and services, expanding access to care, and helping states plan community-based crisis services through the Medicaid Office. The funding package underwrites Substance Abuse and Mental Health Services Agency’s (SAMHSA) new Suicide and Behavioral Health Crisis Line, 988. Health Recovery) Add 277 of these positions. ARP is also funding $300 million for youth mental health services in schools.

No one can yet declare whether this measure was successful, but the implementation of ARP currently underway in various agencies will establish a goal. And even some of the programs that Kennedy, Carter, and Bush had long envisioned. Unlike a few years ago, when mental health was considered as an adjacency rather than integral to general health, mental health belongs to the mainstream of health care, using infrastructure to ensure equitable, accessible and inclusive care. There is a growing recognition that the approach is feasible. delay.

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