Panel Finds US Mental Health System 'Dysfunctional'
by Todd Zwillich
WASHINGTON, (Reuters Health) Nov 01 - America's system for
treating and rehabilitating persons with mental illness is
in financial and bureaucratic disarray and is plagued by
complexities that make it nearly impossible for many
patients to receive needed care, according to a report
issued Friday by a presidential mental health commission.
The commission's chairman, who called the report an
"indictment" of the nation's mental health care
system, said that a massive shift in priorities was needed
to improve care for mentally ill adults and children. The
report paints a picture of a system plagued by fragmented
services and inadequate funding, often losing patients in a
maze of complexity.
Between 5% and 7% of Americans are believed to suffer from a
serious mental illness in any given year, according to
federal figures. While some patients have private insurance
coverage, most receive care through a patchwork of federal
and state programs.
The report is an interim step for the New Freedom
Initiative, a comprehensive review of the nation's mental
health system ordered by President Bush last April. It was
written by a panel of policy experts from the government and
the private sector, who are later expected to recommend ways
to repair the system.
Michael Hogan, Ph.D., the commission's chair, said that the
panel's deliberations led it to conclude that the nations'
mental health delivery system is "maddeningly complex
The report criticizes child mental health systems that often
cut adolescents' benefits as soon as they turn 18, forcing
them to navigate a new system of care geared toward adults.
Adults with a combination of mental illness and drug or
alcohol abuse--who, according to the government number 3
million--often cannot get care for both problems in the same
clinic or using the same government benefits. "Because
mental illness and substance abuse disorders are often
long-term in nature, the inconsistencies of the system play
out day-to-day, week-to-week, and year-to-year," the
The commission also pointed to studies showing that mental
illnesses and substance abuse are the two leading causes of
disability in North America and Europe, together accounting
for more than a third of all claims. But disabled, and
usually unemployed, persons who seek care in the US often
risk their Medicaid health care benefits if they get well
enough to rejoin the work force.
"They can't afford to get back to work because they
lose their health insurance. We have trapped people in a
system that is at least as dysfunctional as the old welfare
system," said Dr. Hogan, who is the director of the
Ohio Department of Mental Health.
The commission is due to release a final report within 6
months recommending to the president ways to repair the
mental health system.
The American Psychiatric Association released a statement
criticizing the effort, saying that the commission has
"unreasonably limited" its evaluation of the
mental health delivery system to budget-neutral solutions
and did not look at disparities in privately-funded
"The public at large, the media, opinion makers, and
political leaders must be made aware of the perilous state
of financing for mental health care today," read a
statement from Paul Appelbaum, MD, the organization's
Reuters Health Information 2002. © 2002
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