Mental Healthcare in a Crisis in US

The US national mental healthcare is in a crisis, says National Alliance for Mental Illness.

Long fragile, fragmented, and inadequate, mental healthcare is now in serious peril. Since 2003 when the presidential New Freedom Commission called for a more effective mental healthcare things do not seem to have progressed much.

Today, even those states that have worked the hardest stand to see their gains wiped out. The NAMI’s new report, grading the States on mental health situation, finds that the national average grade is a D.

Fourteen states improved their grades since NAMI's last report card three years ago. Twelve states fell backwards.

Oklahoma showed the greatest improvement in the nation, rising from a D to a B. South Carolina fell the farthest, from a B to a D. However, the report comes at a time when state budget cuts are threatening mental health care overall.

One in four Americans experience mental illness at some point in their lives. The most serious conditions affect 10.6 million people. Mental illness is the greatest cause of disability in the nation, and twice as many Americans live with schizophrenia than with HIV/AIDS.

America today faces the greatest economic crisis since the Great Depression, NAMI executive director Michael J. Fitzpatrick said. Almost every state, county, and local government is facing large deficits and cutting public services across the board. State Medicaid programs are being squeezed. The budgets of state mental health agencies are being slashed. We know from experience that states often respond to fiscal crises by reducing mental health budgets. As a result, the status of each state system may already be falling below the levels documented in this report Fitzpatrick noted.

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The challenge to our leaders across America today is to find the vision, the political will, and the funding to hold the line; to allow state mental health care systems to continue to move forward and build momentum for change. For NAMI, change means mental health care systems that are accessible, flexible, and promote continuity of care, while paying for only those services that work.

The challenge also is one of generating new ideas—creating innovative financing mechanisms or collaborations, including some described in this report.

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This is the second report NAMI has published to measure progress in transforming what a presidential commission on mental health called "a system in shambles."

NAMI's grades for 2009 include six Bs, 18 Cs, 21 Ds and six Fs, based on 65 specific criteria such as access to medicine, housing, family education, and support for National Guard members.

"Too many people living with mental illness end up hospitalized, on the street, in jail or dead," Fitzpatrick said. "We need governors and legislators willing to make investments in change."

In 2006, the national average was D. Three years later, it has not budged.

NAMI is the nation's largest grassroots organization dedicated to improving the lives of individuals and families affected by mental illness. 

Crisis creates opportunities. Publication of this report coincides with the inauguration of a new President who sees health care reform as part of the nation’s broader economic challenge. Of course, mental health is part of health care. Indeed, this report highlights the need to better integrate mental health care with physical health care and wellness. Health care reform is therefore an important opportunity to strengthen the federal government’s support of state and local mental health care systems, through improvements to the Medicaid program and key policy changes. Together, at every level, we must advance, not retreat, the NAMI urged. 

As we move toward publication, a temporary infusion of greater federal funding for Medicaid seems likely as part of the nation’s economic recovery plan. Federal support for building the mental health care workforce would address this system’s staffing crisis while simultaneously responding to unemployment rates that threaten to reach 10 percent or more. Our hope is that this report will stimulate creative ideas like these that can have a direct impact on multiple fronts, Michael Fitzpatrick hoped.

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