February 26, 2013

Maine Voices: Bill takes step toward effective mental health services in Maine

Consumers would be able to receive care at home, an option that's both less costly and more humane.

By TARA KARCZEWSKI-MITCHELL

In the United States, we have struggled to care for our most vulnerable citizens. Over the last 200 years, we have warehoused mentally ill persons in insane asylums, madhouses, poorhouses and currently inside jails and prisons.

ABOUT THE AUTHOR

Tara Karczewski-Mitchell is a resident of Vassalboro.

The Community Mental Health Centers Act of 1963 established an effort to develop a nationwide mental health infrastructure. Signed into law just one month before John F. Kennedy was assassinated, this measure was supposed to provide federal funding for community mental health centers throughout the United States.

The goal was to have mental health centers providing community-based care to people with mental health needs within the community rather than in traditional institutional settings. President Kennedy's goal was to "get people out of state custodial institutions and back into their communities and homes."

This legislation strived to de-institutionalize mental health consumers. However, community mental health agencies were never given the amount of money they truly needed in order to meet the needs of their consumers adequately.

Unfortunately, there were significant miscalculations related to the unforeseen demand for mental health services and the financial consequences of addressing our country's mental health needs.

Sixty years after the passage of the Mental Health Act of 1963, we are facing significant homelessness and the incarceration of persons with severe and persistent mental illness. It is not hard to assume that some of these issues are related to the unfulfilled promises of the Community Mental Health Centers Act and the lack of community resources that still exists today.

The current economic situation and the more socially conservative political environment have left services to this marginalized population dying a death of a thousand cuts.

Aggressive legislation is needed, not only to address the needs of this population but also to undo the ravages that have been exacted over the last 10 years. An example of this legislation has been offered in the form of L.D. 87.

L.D. 87, "An Act To Improve Community Mental Health Treatment," would assist in re-establishing community-based mental health services, services that have been previously cut by the Department of Health and Human Services.

One treatment option that would be restored is the ability to provide and receive support services in a consumer's own home. These "scattered-site" homes provide an opportunity for people with mental illness to live in the community with minimal supports, in contrast to the more costly psychiatric institutions they replaced.

Let's not forget the days when thousands of Maine citizens sat for decades in large psychiatric hospitals, experiencing their surrounding community either through security glass or the occasional outing.

Home-based, non-institutionalized support, however, offered thousands of people the opportunity for richer and more productive lives that the isolation and warehousing of the past could not provide.

Additionally, the naive assumption that eliminating this level of care would somehow magically be addressed by the already overburdened community resources only further added to an avalanche of demands on our legal and emergency response systems. Reducing adequate levels of community-based care leaves these individuals with few treatment options and often necessitates more costly interventions.

I work in the mental health system, managing emergency response services for people in crisis. Since 2009, when scattered-site private nonmedical institutes, or home-based support services, were eliminated, consumers entering the crisis system have presented with drastically more severe and complex symptoms.

Law enforcement, rescue involvement, prolonged stays in emergency rooms, extended psychiatric inpatient admissions and increases in incarcerations are only the obvious consequences of these decisions.

In 1963, the Mental Health Act launched the United States into a new progressive era of community-based mental health that was long overdue. We again find ourselves at a similar turning point.

We can continue to mature as a community or return to simple solutions to complex problems. We must keep moving forward! All of us are needed to voice the outrage at any policies that would dismiss the needs of any of us who may struggle with mental health.

L.D. 87 would restore a much-needed level of care for many of our most vulnerable citizens, allowing for community integration and individualized support.

We know the sins of our past, and we are beginning to realize the sins of our present. This legislation gives us the chance to compassionately restore what is right and effective.

– Special to the Press Herald

 

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