In the 50 years since the implementation of the Community Mental Health Act, we have learned a great deal about how to improve the mental health of the nation, particularly for those of us with serious mental illnesses. The solutions to improving mental health care in America are clear and have been demonstrated repeatedly by presidential commissions, federal agencies, states, providers, the Surgeon General, the Institute of Medicine, foundations, nonprofit organizations, and others over the last several decades. However, as a nation we continue to lack the economic and political will to put these solutions into place, despite the fact that they would greatly reduce the economic burden of mental illness; increase productivity, achievement, and independence; and improve the lives of millions of Americans and their families.
The following are 5 steps America could take that would immediately and greatly improve the existing overburdened mental health system and would help ensure delivery of effective, high quality, coordinated, and evidence-based care for Americans with mental illnesses.
1: Increase Prevention, Treatment, and Recovery Services
Despite the ongoing knowledge that 1 in 5 Americans experience a mental illness each year, and that many Americans with serious mental illness die years earlier than other Americans from treatable medical conditions, our nation is often reluctant to make the investments necessary to provide effective prevention, treatment, and recovery services for mental illness as it does for other health conditions. These investments – personal and public – would improve care coordination and save money by preventing the use of costly crisis care and hospitalizations, and preserve these resources for when they are truly needed. America should invest in increased 1) prevention – that includes reducing the tragedy of suicide; 2) integrated treatment and early intervention; and 3) recovery services – such as supported employment, supportive housing, and peer-operated services – and target much of these efforts for people with serious mental illnesses and their families.
Similar to the disparities in the overall healthcare system, disparities based on culture, race and ethnicity, gender and gender identity, disability, and sexual orientation have an impact on the delivery and quality of care and outcomes in mental health. We need to target outreach and engagement strategies and treatment and services that are tailored to the backgrounds of individuals, families, and communities. In so doing, individuals and families should have access to and choice of both evidence-based medical supports as well as efficacious complementary and alternative services.
While the implementation of the Affordable Care Act and the Mental Health Parity and Addiction Equity Act will help, more resources are required at both the state and federal levels to adequately provide needed quality mental health services.
2: Expand the Mental Health Workforce
Workforce shortages continue to burden an already underfunded and fragmented mental health system. A trauma-informed, recovery-oriented and culturally competent workforce in numbers and locations adequate to meet the need is essential for increased service delivery capacity and system improvement. The delivery of safe, effective, and high-quality coordinated care is dependent on workforce competencies. America should invest in training and education of the mental health workforce including evidence-based and effective clinical and psychosocial innovations that incorporate medications, counseling, crisis prevention and intervention strategies, engagement techniques, community support services, and use of peer and family providers.
3: Widen the Use of Health Information Technology
New information technologies are revolutionizing health and behavioral healthcare and exponentially expand the outreach and engagement of populations into mental health treatment and services via electronic health records, telepsychiatry, self-care applications, on-line psychotherapies, and many other approaches. Such technologies can help to achieve needed efficiencies to address gaps in care availability and accessibility that will enable individuals to attain help in a confidential, easy-to-access manner. Use of these technologies can also help to support the workforce stay abreast of the most recent developments and training opportunities in the behavioral health field.
4: Educate the Public
Negative attitudes, beliefs, and behavior about mental illness and prejudice and discrimination toward individuals with mental illnesses and their families continues to be one of the greatest barriers to improving mental health care and helping those in need. Negative beliefs deter the public from wanting to pay for care, despite the prevalence and impact of mental illness on the lives of Americans. Public rejection often prevents individuals from seeking care. America should invest in multiple, evidence-based public education and awareness strategies, campaigns, and engagement activities to reduce prejudice and discrimination. Such efforts should be done in schools, workplaces, faith communities, and other settings until mental disorders are understood and treated the same as any other set of health conditions, and emotional health development is considered just as important as exercising and resting to take care of our bodies, and preventing death by suicide is just as important as preventing death from cancer.
5: Invest in Research
Despite the gains in our knowledge about mental illness and what works best to ameliorate symptoms, restore and improve functioning, and assist persons with mental illness to live successfully in the community, we still have much to learn. We are just beginning to understand how the brain functions and how our genes and the environment – including trauma – impact our emotional well-being. Bio-markers for mental illnesses are not yet available, making the assessment and treatment of mental illnesses often less precise than other health conditions. Our ability to identify and practice early intervention to prevent long term disability or death from these conditions needs to be further developed. The research about which services and supports work best for different kinds of people and in a variety of circumstances deserves more attention in and from the research community. We also need to understand more about moving what we do know into practice more quickly with a much wider reach. Evidence-based care is possible and more evidence is needed.
Future blogs will explore each of these points in more detail. Let us know what you think it will take to improve the mental health of the nation.
Visit http://www.samhsa.gov/priorities for more information on the priorities established by SAMHSA to improve the behavioral health system.