The Massachusetts ' Mental Health System

In an effort to transform the public mental health system, in 1963, President Kennedy proposed the Community Mental Health Act. It was the first among several federal initiatives to create a community mental health care system. Once the act was ratified, there was an intense deterioration in institutionalization, otherwise known as “deinstitutionalization”, and by 1980 there was a 75% declined of the inpatient population at many public psychiatric hospitals. In 2000, there was less than 10% of the public institutionalized just fifty years earlier. In 2009, there was even a more dramatic shift among children and adolescence whereby there was a 98% decline in

As a whole, literature on the topic of mental illness in our country and specifically in our criminal justice system had a reoccurring theme. There are millions of individuals who suffer from mental illness but are improperly being handled through the criminal justice system. These individuals are deemed criminal just by their acts and their mental health state is not overly examine. Jails and prisons are being overcrowded. State prisons and jails are overpopulated anywhere from 15 to 32% (Spending Money in All the Wrong Places: Jails & Prisons).

Given the number of incarcerated inmates who suffer from some form of mental illness, there are growing concerns and questions in the medical field about treatment of the mentally ill in the prison system. When a person with a mental illness commits a crime or break the law, they are immediately taken to jail or sent off to prison instead of being evaluated and placed in a hospital or other mental health facility. “I have always wondered if the number of mentally ill inmates increased since deinstitutionalization” Since prison main focus is on the crimes inmates are incarcerated; the actual treatment needed for the mentally ill is secondary. Mentally ill prisoners on the surface may appear to be just difficult inmates depending on the

The Mental Health Services Act is a monumental proposition that has helped many people for more than a decade. In California alone, close to 1.2 million adults and around 422,000 children live with a serious mental illness (State 2010). Without the proper treatment, suicide is the leading cause of death for a person battling an untreated mental illness (State 2010). With over thirteen billion dollars raised so far, MHSA has been the root of funding for mental health in California (Williams 2015). MHSA is still a work in progress. The act is nowhere near perfect, as a recent audit has shown, but it is certainly a step in the right direction.

Many years ago, mental illness was viewed as a demonic possession or a religious punishment. In the 18th century, the attitudes towards mental illness were negative and persistent. This negativity leads to the stigmatization and confinement of those who were mentally ill. The mentally ill were sent to mental hospitals that were unhealthy and dangerous. A push in the mid 1950s for deinstitutionalization began because of activists lobbying for change. Dorothea Dix was one of these activists that helped push for change. The change called for more community oriented care rather than asylum based care. The Community Mental Health Centers Act of 1963 closed state psychiatric hospitals throughout the United States. "Only individuals who posed an imminent danger to themselves or someone else could be committed to state psychiatric hospitals" (A Brief History of Mental Illness and the U.S. Mental Health Care System). Deinstitutionalization meant to improve quality of life and treatment for those who are mentally ill. This would hopefully result in the mentally ill receiving treatment so they could live more independently. The hope was that community mental health programs would provide this treatment but sadly there was not sufficient or ongoing funding to meet the growing demand for these programs. Budgets for mental hospitals were reduced but there was no increase for the community based programs. Many mentally ill individuals have been moved to nursing homes or other residential

The community-based mental health programs are not only inadequate in relation to numbers, but also underfunded (Unite for Sight.org, 2013). According to Martin (1995), we live in a society that is increasingly becoming conscious of an excessive tax burden. Tax burden, on the other hand, provides for the realization of just how deinstitutionalization is directly related to politics and public policy. The pubic in America who account for the electorate, have a significant say in how policy is affected. To this extent the assumption in relation to deinstitutionalization is that due to increased public outcry in regards to taxation, the both federal and state governments have over the years been forced to cut down spending on some items in the recurring budget in order to free up additional funds. According to Treatment Advocacy Center (2011), the federal government in 1965 surgically excluded the payment of Medicaid for patients institutionalized in state psychiatric and other mental disorders institutions. The goals of this action, according to Treatment Advocacy Center (2011) was to foster deinstitutionalization, and the wading of care costs to sates, viewing them as largely responsible for mental care.

The United States criminal justice system has been continuously increasing incarceration among individuals who suffer from a sever mental illness. As of 2007 individuals with severe mental illness were over twice as likely to be found in prisons than in society (National Commission of Correctional Health Care, 2002, as cited in Litschge &Vaughn, 2009). The offenses that lead to their commitment in a criminal facility, in the majority of cases, derive from symptoms of their mental illness instead of deviant behavior. Our criminal justice system is failing those who would benefit more from the care of a psychiatric rehabilitation facility or psychiatric hospital by placing them in correctional facilities or prisons.

Problem Statement: The World Health Association defines ‘good’ health as: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” However, in the United States, access to care and funding for mental health care are grossly neglected and underfunded in comparison to other aspects of health care.

In the book, Crazy, by Pete Earley, provides a detailed overview of the mental health system in the United States, as it presents a first hand narrative of Earley’s family journey through the system. The author’s major premise and arguments, in the book, is to highlight the history of mental health, navigation through the judicial system with mental illness, the bureaucracy and policies of hospitals, society views on human rights and client safety, and the impact on the individual, family, and community. The content suggests that human service workers and public health workers should extend their professional lens to advocate for change in the mental health system in the United States.

In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the

Senate (S.) 689 is the Mental Health Awareness and Improvement Act of 2013, which resanctions and increases critical behavioral health programs through superior federal education and healthcare programs related to awareness, early identification, and prevention of mental illness (The Library of Congress, 2013). United States Senators Tom Harkin (D-IA) and Lamar Alexander (R-TN) pioneered S. 689 on April 9, 2013 (The Library of Congress, 2013). There are 23 co-sponsors of the Mental Health Awareness and Improvement Act of 2013, including 14

The United States has never had an official federal-centered approach for mental health care facilities, entrusting its responsibility to the states throughout the history. The earliest initiatives in this field took place in the 18th century, when Virginia built its first asylum and Pennsylvania Hospital reserved its basement to house individuals with mental disorders (Sundararaman, 2009). During the 19th century, other services were built, but their overall lack of quality was alarming. Even then, researchers and professionals in the mental health field attempted to implement the principles of the so-called public health, focusing on prevention and early intervention, but the funds were in the hands of the local governments, which prevented significant advances in this direction.

In the current system far too often have mentally ill patients and the victims of their crimes fallen through the cracks. It is my belief that with this combination of disciplines I could constitute reform to fix these holes. Mentally ill patients need to receive the necessary treatments to help them recover, stabilize, or cope with life. While on the other hand, their victims need someone who believes that just because their attacker was sick that they mean no less than any other victim that goes through the court

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

The National Alliance of Mental Illness (NAMI, 2015) estimates 1 in 5- 48.8- million adults in the United States are diagnosed with a mental illness each year. Amongst adolescents and children, it is estimated 1 in 5 youth ages 13-18-(21.4%) have, or will have a serious mental illness every year (NAMI, 2015). For children ages 8-15 the prevalence of experiencing a serious mental illness at one point in their life is 13% (NAMI, 2015). Although, children and adolescents are most commonly diagnosed with mood, conduct and anxiety disorders, there are those who occasionally experience psychotic disorders such as early onset schizophrenia.