Nearly 16 million Americans have serious, disabling mental illnesses or emotional disturbances. In fact, mental illness is the country's leading cause of disability -- not heart disease, cancer, or diabetes. But even though new medicines and treatments are being developed all the time, the archaic, maze-like U.S. mental health system blocks most people from getting access to them. More than 60 percent of people with mental illnesses do not receive stable, ongoing treatment; 25 percent of homeless people have serious mental disorders but generally do not receive any treatment at all.
This is a tragedy with far-reaching consequences: Untreated mental illness contributes heavily to the 30,000 suicides in the United States each year, and to the 650,000 suicide
attempts serious enough to involve emergency medical care. It also contributes to crime and incarceration rates, and to homelessness. Aside from the human costs, mental illnesses cost the country an estimated $150 billion per year.
Lawmakers in Washington have offered little help. The policy debate on mental health reform has been stalemated for years over the concept of "parity" -- the idea that public and private health insurance plans should provide the same coverage for mental illnesses as for any other health conditions -- which many conservative and business groups oppose as too expensive. Meanwhile, state and local governments, which are responsible for more than one-half of the nation's spending on mental health, have in many cases passed their own parity laws. But they continue to struggle with a chaotic and often
ineffective system of care that covers too few people and achieves too few positive results at too high a cost.
The mental health system needs more than just parity; it needs fundamental reform. Fortunately, though, best practices that hold the potential to strengthen the system where it is weakest are emerging in some states. For example, states are cutting through bureaucratic barriers that keep scientifically proven treatment programs from being made widely available, and they are developing innovative ways to tailor mental health services to the needs of individuals.
Here are just three examples of state and local reforms that are producing important improvements in the system:
A single delivery system for all mental health services. In New Mexico, Gov. Bill Richardson discovered that 17 different state agencies were providing services related to mental or behavioral health, including substance abuse. To eliminate redundancy and maximize efficiency, Richardson's administration drew all these services together into a "behavioral health purchasing collaborative" designed to oversee service delivery and spending, and to measure and evaluate overall performance outcomes. The initiative, which streamlines services without the cumbersome process of completely
reorganizing or combining agencies, is being implemented this year.
Offering comprehensive mental health services, no matter where people enter the system. Even without consolidating the management or financing of mental health services, it's important to ensure that people needing help don't fall through the cracks of complicated eligibility requirements or regulations. Similarly, it is important to ensure that people with no idea of how the mental health system is structured don't approach the wrong agency, get confused or frustrated, and then give up on finding the help they need. To solve those problems, the state of Washington and the city of Milwaukee have both implemented "No Wrong Door" policies that direct people to the right services and the right service providers, regardless of their first point of contact. A program called "Wraparound Milwaukee" offers special help to the city's seriously disturbed children and their families, using a "crisis team" and a provider network that links them to 80 different services through a single public agency.
Funding that follows patients, not programs. One approach, called "cash and counseling," is common in programs serving the developmentally disabled. It gives consumers the power to choose among approved providers, and supplies counselors to help them evaluate services and manage their funds. A pilot program adapting the cash-and-counseling approach to mental health services has had some good initial results, including decreased hospitalizations.
None of these reforms will be a cure-all for the problems with our mental health system. But they all illustrate an important general principle: the need to focus on delivering results to consumers of mental health services -- and treating them as citizens, not patients for life. Indeed, this principle needs to guide a national reform effort.
Drawing on that idea and many field-tested state and local innovations, the Progressive Policy Institute recently unveiled "Parity-Plus," a plan to overhaul the national mental health system. But until Washington can bring itself to take on the challenge, it will continue to be up to states and localities to adopt the best practices that can provide more
Americans access to affordable, high-quality mental health services.
