Op-Ed: Reform of the U.S. Mental Health System

Op-Ed: Reform of the U.S. Mental Health System
By Michael Gottlieb, B. Sc.
How the Mentally Ill Have Been Abandoned by the Ills of a Society Gone Bad
Note: The opinions expressed in this article do not necessarily represent those of City Voices, its writers or its staff.
Reform of the mental health system in the U.S. was well underway when President John F. Kennedy endorsed this new era in mental health in a 1963 speech. He called for a “bold new approach” in which “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.”
One of President Kennedy’s sisters suffered from severe mental illness and back in the 1930s and 1940s they used brain lobotomy. What was Kennedy’s interest or attitude toward the mentally ill and mental health?
Kennedy agreed that locking people away in mental hospitals was inhumane and indecent. He was open to the psychiatrists and activists who wanted local community mental health centers. But Kennedy could not persuade the U.S. Congress to fund that program. So when psychiatric hospitals were closed and the patients discharged, they had to fend for themselves.
Electric shock ‘therapy’ (aka electro convulsive ‘therapy’) was popular for a while. Psychoanalysis seems to have lost out to cognitive behavior therapy and behavior modification therapy. And of course, psychiatric chemical medications. No primal therapy or orthomolecular (nutritional psychiatry) therapy. Those would be the two primary healing tools for mental illness.
President John F. Kennedy tried to introduce compassion into society. However, society seems to operate according to two basic principles: Mindless hedonism (engaging in activities to satisfy personal pleasures and desires, regardless of how it affects or hurts other people, the environment, etc.) and “the ends justify the means.” Helping the severely mentally ill by creating local community support systems (housing, social support, financial support, etc.) did not jive with those values. Hedonism nullified any serious effort to help the weakest and most vulnerable members of society. They were abandoned and left to fend for themselves.
Fountain House is the rare example of a support system for people with severe mental illness. However, they do not focus on therapy or healing. Fountain House is predicated on the concept of having the mentally ill perform useful and meaningful work to give them a sense of dignity, self-worth and demonstrate that the mentally ill can be productive members of society. But they do not focus on healing the terrible wounds afflicting these folks.
These mental ‘wounds’ continue to fester unless they are accessed and healed through primal plus dream therapy, counseling, orthomolecular psychiatry, etc. The mental wounds fester and eventually manifest as serious and severe disease: Multiple sclerosis, arthritis, heart disease, cancers, etc. The premature death rate is directly related to the disunity of mind, heart and body, which eventually breaks down under the ‘weight’ and ‘pressure’ of repressed mental ‘wounds.’
Fountain House is performing a very rare (in our society) and vital service for the mentally ill by providing a support system and a place to work. Founded in 1944 by Michael Obolensky, a former patient, and Elizabeth Schermerhorn, a former volunteer. Fountain House earned the 2014 Conrad N. Hilton Humanitarian Prize, one of a number of awards it has earned since 1996.
Society is also using prisons, jails, the streets, nursing homes, etc. to place the mentally ill. It is a known fact that thousands of mentally ill people are incarcerated in prisons. New York City’s own Rikers Island prison has, over the past decade, housed approximately 4,000 mentally ill men and women at any given time. Harsh jail conditions with their violent culture often cause deterioration in these inmates, which jails are unequipped to handle.
The pharmaceutical companies are making huge profits from selling psychiatric medications. Orthomolecular psychiatry (nutritional psychiatry) is virtually unknown in America. They censored Drs. Hoffer and Osmond.
When President John Fitzgerald Kennedy tried to introduce compassion into our society the U.S. Congress blocked most, if not all, of his legislation. Was that because our federal elected ‘leaders’ (senators and representatives), to a very large degree, mirror and reflect the values and consciousness of the masses of Americans?
The hardened materialism and callous indifference to the pain and suffering of the weakest and most vulnerable members of our society by the masses of our fellow Americans was the primary driving force blocking President Kennedy’s legislative program.
Is making money the primary goal, primary motivating force in our society? 
Making money, greed and callous competitiveness, regardless of how it affects or hurts others, seems to be a major motive of society. But society seems to have descended into the animal world of Darwinian jungle mentality. The idea of bringing healing or providing housing, social support to the mentally ill, or any person for that matter, has been trampled by the mindless stampede of hedonism and selfishness. Society seems to radiate enormous amounts of brutality and cruelty on a daily basis. It is considered ‘normal’ to be uncaring, unfeeling and callous, ignoring those left behind, the mentally disabled, poor, and frail elderly.
What happened? 
Our fellow Americans, with very few exceptions, adopted and believe in the Darwinian jungle values—survival of the fittest. Disabled psychologically and/or physically, this “consciousness” gives way to terrorism, war, theft, crime, hurricanes, droughts, earthquakes, violence, guns, etc. 9/11 could have been a wake-up call. Instead, society ascribed it to “an act of Nature.” 
Any final words?
Keep your eye single on the “I Am” spirit within you. Be more caring, kind and compassionate toward one another, and yourselves. Create solutions that are win-win for all. A little healing goes a long way. “This too shall pass.” Planetary ‘cleansing’ and ‘scourging’ will provide humanity with a fresh start to use free will more wisely. If human nature does not transform to help one another instead of hurt one another, Nature will take its course.

Pullout: “Be more caring, kind and compassionate toward one another, and yourselves. Create solutions that are win-win for all. A little healing goes a long way.” 

Texas’ Mental Health System

Texas’ Mental Health System

By Donald Wayne

A Mixed Bag

Years ago, I was a stringer photographer for the local newspaper in Huntsville, Texas, covering an execution. I was outside the “Walls” unit, and toward that fateful midnight, when the execution took place, I photographed protesters, and advocates, stood beside the TV news videographers pointing their lenses at the lit outside clock. I was at a remove, but it was one of the most brutal events I’ve ever been through.

While Texas seems to be a mecca of law and order, mental health services are often underfunded. While the nation spends per capita about $125, the state of Texas spends $39. In a Dallas Morning News essay online, Clayton McClesky, writing about mental illness and suicide, points out that when a few years ago the West Nile Virus killed seven people in Dallas, the authorities spent $3 million for aerial spraying of mosquitoes. It is a matter of emphasis. Nor is access so good. About 488,520 in the state have serious mental illness, while 156,880 are being served. That’s about 33 percent. I think that may be due to a shortage of mental healthcare workers, as is the case in Texas.

Yet paradoxically, I have had good results. The procedure is something like this: you call the Texas Mental Health number, and participate in a phone interview. If you qualify, you then get an in-person interview, and if qualified after that interview, are assigned mental health services. I was assigned a therapist, and have had three. My most recent, helping me for about five years. She was a godsend, and though it’s been difficult, I have nothing but respect for her. The mental health staff and professionals are caring, highly capable people.

A few years ago, my rural mental health center opened a Peer Support Center, and it is quite nice, with many donors and volunteers. It’s a place to relax. Sometimes we have big meals around the holidays, and there are computers, a television, and meeting rooms. I myself have been a Peer Center Board Advisor and have been on television and in the newspaper doing interviews about the Center. More recently, the Center serves veterans. There is a major military base in central Texas; therefore helping veterans in mental health is especially needed. Pointing veterans to resources have been important, and volunteer colleagues have done a good job in staffing the center for all consumers.

Some years ago, the Texas legislature passed a bill that makes claims on Medicaid beneficiaries, like me, if one is 55 or older. Once a recipient dies, the State makes a claim on the person's estate, unless there is less than $10,000, or a spouse is still living, to make up for repeated expense to the State. I know, I know, there is no free lunch, but as I have never married and as my home is about the only thing of value I own, and it was inherited, I wanted to give it to whom I chose in my will. So, in this respect, I feel a little brutalized.

Self-Direction in Medicaid for Well-being and Empowerment

Self-Direction in Medicaid for Well-being and Empowerment
By Briana Gilmore, Public Policy and Advocacy Director, NYAPRS
Self-direction is a strategy in organizing and delivering Medicaid-funded services and community supports that can dramatically enhance opportunities for people living with disabilities. The process transfers some of the funds typically afforded through Medicaid payments directly to the consumer, who develops a plan to utilize the money for services and supports for increased engagement and well-being. Hundreds of thousands of people experiencing developmental disabilities already utilize the approach, and many states have implemented or are seeking pilots to bridge the method to the behavioral health recovery community.
In New York, the Office of Mental Health (OMH) selected self-direction as a new service to implement through a Health and Recovery Plan (HARP) for Medicaid recipients with enhanced BH (behavioral health) needs. Implementing the program thoughtfully will take some careful planning; therefore the program will be piloted for a few years before being brought to scale statewide as a benefit for eligible recipients.
Any self-direction model must take into consideration the particular recovery needs of the community for whom it’s modeled. For people with physical needs, funds are often self-directed to health aides, house modifications, or other consistent supports. A model to support the behavioral health needs of a community must take into account social needs that span employment, education, community inclusion, well-being, and traditional rehab supports. New York is looking at an approach that would allow recipients to buy services like habilitation (services that help a person learn, keep, or improve skills and functional abilities that they may not be developing normally) and supported employment, but also direct funds to community wellness supports like gym memberships and yoga classes, college classes and bus passes.
The implications of self-direction are vast; it is the most flexible way for consumers to take ownership over their recovery and invest in chosen supports. The success of a self-directed recovery plan is largely dependent on the relationship between each recipient and a support broker, who is a chosen navigator that helps to maximize an individual budget. A recovery plan is based on current capacities and supports, and incorporates wellness goals for overall health. A recipient uses the plan as a tool to guide their spending. Purchases of traditional services and community supports are now typically made with smart debit cards that can track allowable services and be refilled directly by the payer.
There are many considerations that go into creating a self-directed design that benefits people with BH needs. The plan must take into account accessibility and enrollment processes, ensure culturally competent approaches, and allow for creative community-based solutions for enhanced well-being. The design must also plan for a relationship between a recipient-driven recovery plan, and a treatment plan that is supported by a Medicaid Managed Care Organization. Support brokers—who in most models are peer specialists or recovery-trained life coaches—should be supported by an infrastructure that can foster innovation and adaptiveness within the model. And ultimately, the financial process has to offer an efficient transfer of funds from the state Medicaid program.
I’ve been involved in a planning process with NYAPRS and the Columbia Center for Practice Innovations to help OMH develop a draft model for BH self-direction. The team has worked for eight months to review research, meet with experts in the field from around the country, and engage Medicaid recipients, DOHMH (dept. health mental hygiene), and other stakeholders to develop a strategy for implementation. The process will continue in the coming months as OMH explores the best framework and negotiates the process with other state agencies, Managed Care Organizations, and recipients.
NYAPRS (New York Association for Psych Rehab Services) has been advocating for a self-directed model in New York for nearly a decade. It’s exciting to know that the model could be offered to tens of thousands of Medicaid recipients with BH needs in the coming years. The state agencies, particularly through the Medicaid Redesign process, recognize that innovative approaches like self-direction can contribute to long-term savings and system benefits. These gains will be as a result of quality of life improvements like reduced hospitalizations and increased community engagement, as well as better overall satisfaction with the Medicaid program. A New York State pilot will include a strong research component to look at how recipients of different ages, backgrounds, and with different geographic living settings use and benefit from self-direction.
Barriers do remain, particularly in the appropriate financing of the approach. It’s also essential that appropriate protections be in place for both consumers and insurance companies before the design is implemented as a standard benefit. The design may provide a truly fundamental shift in Medicaid programming and consumer rights, if stakeholders on both sides continue to work together to actively improve the design through emerging best practices.
Look for opportunities in your area to participate in a self-direction pilot in 2015, as well as information about how you can get involved in the state’s planning process.