And then I try to coalesce in my simple brain all of these really good ideas with a tremendous concern that they will lead to targeting and profiling high risk youth with the unfortunately convenient and easy answer of increasing residential and psychiatric hospital bed space without an equal or greater focus on providing effective community-based services.

Consider this recent plea from Cheryl Des Montaignes, MSW, LCSW, LMSW, one of many Network faithful who have sent emails to us, and try to juxtapose her concerns with the wonderful plans outlined above:

•  There has been much talk of restricting availability of assault style weapons, some talk of changing mental health services reporting requirements but I have not heard any discussion of the challenges in the field of mental health services and diminishment of mental health services. In the state of Michigan funding and services have been drastically cut, many psychiatric facilities closed to the point that only very limited services are available in some areas. And the services available continue to be diminished by increased pressure to provide services to more people with less cost. Individual practitioners are under increased pressure to fill more and more roles and to complete more and more documentation or paperwork much of which seems to be orientated towards covering possible liability of agencies or funders such as community mental health rather than quality of services. Therapists’ time and energy is increasingly distracted by case management and administrative and other functions outside of their area of training. The pressures are increasing in the mental health field to complete more documentation with less time, focus, and energy to provide therapeutic services. The concern of supervisors and agencies is orientated around documentation and paperwork and timing of reports not the quality of therapy or services, the competency of the therapist. The priority too often is the appearance of the documentation and filling requirements of the state or funder and not providing good mental health services, not providing services that assist and heal people, services that keep people safe. This too must be addressed if we are to address the issue of violence in this country.
  

Or the comments by Patricia Rehmer, Commissioner of the Department of Mental Health and Addiction Services in Connecticut, in a recent interview with the Washington Post, who lamented that there are limits on the number of services that can be used annually, which can create a problem for a family, and said:

• “I am often called, especially by parents of young adults who are now keeping their children — young adults — on their insurance until they’re 26, who need the services that we provide,” Rehmer said of her agency, which serves only people without private insurance. “They need case management. They need supportive housing. They need interactions with their peers,” she said. “Those are things that private insurance companies do not pay for.”

Or the comments of another Network follower, reacting to a recent episode of Dr. Phil:

• I am delighted to see the increased attention to mental health in general and children’s mental health in particular, although I am certainly not happy about the reasons for it. I am concerned now that it might lead to more kids rather than less being shipped away to residential programs, and money being spent to try to identify high-risk kids rather than to provide effective services. It just seems to me that the timing is good for a major public education program, and part of that perhaps could be a TV series, maybe on PBS, that talks about positive developments in supporting children, youth, and families. We hear so much about the failures and yet there have been great gains that the public is unaware of (and that many professionals are unaware of as well).
   
  As you may know, earlier this week Dr. Phil had a show with young adults who had been in abusive residential programs as teens. There was absolutely no mention of non-residential alternatives. Dr. Phil acknowledged that the programs the youth had been in were in fact abusive (which is progress) but left the audience with the impression (at least I believe he did) that the alternative is to find better residential programs. And of course he reached an enormous audience. How can we get a more positive message out there to a large audience?

Or these shocking statistics regarding mental health funding from our friends at NAMI:

• About 30 states have reduced mental health spending since 2008, when revenues were in steep decline, according to the National Alliance on Mental Illness. 
• The steepest drop by percentage was in South Carolina, where spending fell by nearly 40 percent over four years — an amount that Republican Gov. Nikki Haley has called “absolutely immoral.” South Carolina eliminated 600 full0time caseworkers and closed five treatment centers. That led to an increase in the number of people with mental illness in jail in Columbia — so much that it now exceeds the patient total at the city’s public psychiatric hospital.

If there is good news in the wake of this tragedy, it is that many states are rethinking planned mental health cuts. In an AP article, Shelley Chandler, executive director of the Iowa Alliance of Community Providers notes that that in many states, lawmakers have begun to recognize that their cuts “may have gone too deep. People start talking when there’s a crisis.” Read the full article here.

And in an ironic twist, quite possibly the easiest path to funding appropriate mental health services may lie with Medicaid Expansion – the very thing that many governors are fighting. In an article in Stateline it is noted that if states opt in, “For the first three years that additional coverage would cost the states nothing: Under terms of the Affordable Care Act, the federal government will cover 100 percent of the costs of new Medicaid enrollees for the first three years and 90 percent after 2020… If all states opted into the expansion, an estimated 13 million more Americans would receive mental health benefits through Medicaid next year, according to a report by the Congressional Budget Office. The number would rise to 17 million in 2022.

• “This is a golden opportunity to shore up the state public mental health systems where they have seen these major cuts in the last ten years,” says Joel Miller, senior director of policy and health care reform at the National Association of State Mental Health Program Directors (NASMHPD)… And from Mike Fitzpatrick, Executive Director, NAMI, “As states take up this legislation, mental health advocates and some state officials express wariness about aggravating the uneasiness many people already feel toward those with mental illness. “People begin to equate mental illness with violence or evil,” says NAMI’s Fitzpatrick, “but there are very few people with mental illness who become violent.” Read the full article here.

So what’s the moral of this particular story?
Go slow, beware the stereotype, and do your homework. Learn about what works and what doesn’t. And finally, recognize that we as mental health professionals need to take some responsibility for the holes in the mental health safety net. This is a challenge that we all must assume responsibility for and address. No bystanders on this one.

Next week we will be reviewing an article by Garland, et al that shines a very bright light on the effectiveness (or lack thereof) of traditional mental health care. What would be most egregious would be to throw money at programs and initiatives to just to say we did it. Over the next few months we will be working on appropriate education vehicles to educate and inform about mental health services that work – both for those with the most serious issues all the way down to those who are just beginning this amazing journey known as life. If you would like to be a part of the discussion and action, please let us know. All are welcome. Click here to get involved.

Scott Bryant-Comstock, President & CEO
Children’s Mental Health Network