Mental Health Policy and Health Care Reform

By Carter, Rosalynn | National Forum, Winter 1993 | Go to article overview

Mental Health Policy and Health Care Reform

Carter, Rosalynn, National Forum

SUPERMAN IS DEAD...KILLED BY A SUPERLUNATIC, AN ESCAPEE FROM A COSMIC INSANE ASYLUM. This was the headline in papers around the country in September. Here in Georgia, in October, the news was SIX FLAGS OVER GEORGIA TO OPEN NEW HALLOWEEN ATTRACTION: "ASYLUM OF HORRORS."

It seems as though we have been fighting myths, misconceptions, and stereotypes about mental illness for decades; indeed, many of us have! And yet much has changed.

A quick response from mental health advocates clarified the fact that Superman's killer is really a cosmic criminal; the new Halloween attraction at Six Flags became the "House of Horrors."

We are learning a great deal about how to change public attitudes, influence the media, and shape public policy. Our most important challenge of the decade is to ensure that as the debate over national health care reform proceeds we win a victory for mental health in any new plan.

There is much going on in the field that offers great hope to those who suffer from mental illness and to their families. Many of the developments of the last decade have important implications for the debate over including mental health in health care reform.

Progress in understanding the biology of the brain has been nothing short of amazing. We now know more about how messages are sent from one nerve cell to another. We can take pictures of the brain without surgery or injections. We can measure activity related to different emotions and behaviors, and we have learned much more about where medicines act in the brain.

Through careful clinical trials, we have used this knowledge to significantly improve treatment. New medications are helping people suffering from depression and anxiety. Special kinds of psychological therapy are also proving to be effective in treating depressed individuals. And we have new drugs that work for some patients with schizophrenia who have not responded to other kinds of treatments.

One success story involves a thirty-seven-year-old man suffering from schizophrenia who, for almost twenty years, was in and out of psychiatric hospitals. He heard strange voices and preached to other patients that his prayers would save the world. In 1989 he began treatment with one of the new drugs, Clozapine; today he is significantly improved and about to become a college graduate.

The new treatments reduce symptoms and restore personal effectiveness--not for all patients, but for many; not every time, but often; not forever, but for long periods of time. Yet many patients who could benefit from treatment are not receiving it.

Even those with the most severe mental illnesses could significantly improve through treatment with the new medications and rehabilitation. Yet the hope of recovery is denied to hundreds of thousands because of lack of access to care.

Many who could benefit from advances in treatment remain incapacitated because they have no way to pay for care. Hundreds of thousands more and their families face serious economic hardship because of limited coverage under most existing insurance plans. I often receive letters from distraught family members describing their heavy financial burdens and their frustrating efforts at obtaining care for their mentally ill loved one. The stark reality is that our current system of public and private insurance discriminates badly against those in need of a broad array of mental health services.

As most of you know, my greatest disappointment after leaving the White House was the failure to implement the Mental Health Systems Act. A wonderful opportunity to create landmark change in the financing and delivery of mental health services was lost. However, I am proud and pleased that, because of the efforts of many mental health organizations, some of its most significant principles were incorporated into new or existing programs throughout the 1980s.

Small but significant victories were achieved in the use of Social Security Insurance and Medicaid to support people with severe mental illness in the community, and such programs as the Green Door in Washington, D. …

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