U.S. Mental Health Policy: A Study in Elitism

Article excerpt

The United States was founded upon the concepts of equality, liberty, and justice. Yet at the same time, these ideals were not held to apply to the Native American population, to women, to African-Americans, or to white males without property. Two hundred years after its founding, one's access to health care, a quality education, mental health services, and economic opportunity are still affected by race, gender, and income. Despite progress made by various social movements, a two-layer welfare state continues to exist--one serving the rich, one serving the poor. This article will examine a particular piece of the social-welfare system, mental health, and will critique the impact of current mental health policy upon Americans and U.S. society in general.

Mental Health Needs. Before U.S. mental health policy can be explored, current mental health needs must be examined. More than 32 million people, over 18 percent of the U.S. population, are estimated to suffer from a severe psychiatric, emotional, or behavioral disorder. Approximately 30 percent of the homeless population is believed to be mentally ill. Other groups with special needs include adolescents, who have seen a recent 250 to 300 percent increase in suicide, and the elderly, who account for 25 percent of all reported suicides. Many other people experience debilitating emotional reactions to such problems of everyday living as divorce, loss, and victimization.

In addition, untreated problems of mental health disrupt families, decrease one's work productivity, and increase financial expenses to taxpayers. In 1980, for example, such problems cost the United States approximately $64.2 billion. Unaddressed emotional issues can also impair one's physical health, thereby increasing health care costs as well.

U.S. Mental Health Policy. The system of mental health in the United States has several components, including community mental health centers, state hospitals, drug and alcohol counseling centers, outpatient clinics, and private practitioners. Regardless of the service, however, mental health care is affected by several assumptions and trends.

First, the United States has no comprehensive, formally articulated mental health policy. Instead, the mental health system is characterized by both fragmentation and duplication. While agencies and practitioners abound in several fields of practice, services in other areas of mental health are negligible or nonexistent. Drug and alcohol counseling has seen a proliferation of services in recent years, but the chronically mentally ill and the mentally ill homeless remain undeserved. Likewise, rural areas of the country have received less attention with regard to mental health care than have the metropolises.

A second factor impacting the system was that of Reaganomics and fiscal conservatism. As Harold W. Demone and Margaret Gibelman explained in their article "Reaganomics: Its Impact on the Voluntary Not-For-Profit Sector" (which appeared in the September 1984 issue of Social Work), both President Ronald Reagan and George Bush "sought to diminish the role of the public sector in financing, administering, and delivering services and, concurrently, to increase the responsibilities of state governments and the private sector in assisting society's most vulnerable people." With the initiation of Reaganomics, no new major social programs were undertaken by the federal government, and existing programs witnessed drastic cuts in funding and personnel. Consequently, mental health care became increasingly privatized.

Finally, the system of mental health in the United States is dominated by a residual philosophy of social welfare. Such a philosophy supports the belief that social services should provide temporary aid to people only after the normal functioning of the market, the family, and other institutions have broken down. Remediation of individual problems, rather than prevention, is emphasized. …