America's Mental Health Care System 'Beyond Repair'

By Ed Edelson
HealthDay Reporter 


TUESDAY, July 22 (HealthDayNews) -- America's mental health care system is "beyond simple repair," says a presidential commission report that calls for a series of basic changes in the way mental illness is diagnosed and treated.

"Traditional reform measures are not enough," says the President's New Freedom Commission on Mental Health's final report, which was issued after a year-long study. It describes a corrective effort that would involve every level of government and citizens as well.

No extra money for mental health care is mentioned in the report, because of the rules set up for the commission. The board called for "policies that maximize the utilization of existing resources," says Mark Weber, director of communications for the federal Substance Abuse and Mental Health Services Administration.

About $71 billion of the nation's $1 trillion annual health care spending goes for mental illness, the commission estimates.

"But here's the rub," says Michael F. Hogan, chairman of the commission and director of the Ohio Department of Mental Health. "Mental health is the only category where we spend more money not to treat it than to treat it."

He means that the bulk of the money is in the form of disability payments to people, "most of whom could work if they had a modicum of support. We spend too much on the consequences of the illness and not enough on treating it.

Even the basic structure of the mental health care system differs from that of other medical conditions, Hogan says. 

"It is the only category where we have assigned much of the treatment to state and county agencies," he adds. "We don't do that for heart disease or cancer, but we do it for disease of the brain."

And while the responsibility for mental health care mostly rests with state and county agencies, "most of the money is federal money, not in dedicated health programs but in Social Security (news - web sites), Medicare, and Medicaid," Hogan says.

At the root of the problem is an ingrained attitude toward mental illnesses, he says.

"Prejudices persist that these are not real illnesses," Hogan adds.

Yet 5 to 7 percent of American adults will experience a mental illness in any given year, the report says. And "these illnesses rank far ahead of cancer and heart disease in the amount of disease in the world," Hogan says. "Globally, suicide takes more lives than murder or war."

But current attitudes toward the mentally ill mean that there is "a chasm between interventions that are known to be effective and those that are used and paid for," Hogan says. The report asks for more "evidence-based treatment" of the kind routinely used for other diseases.

Achieving the report's goals will be difficult because "the mental health system is so complicated and so dispersed," Hogan says. "It is as much an issue in state capitals and local governments as it is at the level of the federal government. If we all come together over time, we can make a significant difference. But that is a tall order."

Reaction to the much-anticipated report was quick to come from private mental health organizations. More than a dozen of them were ready with prepared statements, many hinting at the need for more money.

For example, a statement by Dr. Marcia K. Goin, president of the American Psychiatric Association, commends the commission and asks Congress and the President "to provide real solutions to fix the current fragmented mental health delivery system, pass mental health parity legislation and provide adequate funding in the public health system."

And Dr. Norman Anderson, president of the American Psychological Association, says, "The challenge now before us is to develop and finance a continuum of culturally appropriate mental health and family support services, ranging from prevention to acute and chronic care, across the lifespan."