The US mental health crisis: profound and persistent

PHOTO: George Hodan
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As both a practitioner and consumer of mental health services in the U.S., I have seen a lot over my lifetime. And while the Covid pandemic commonly gets blamed for the current mental health crisis, it merely revealed a situation that has been building for decades.

In 1985 I had a mental breakdown and was hospitalized for six weeks. I was diagnosed with bipolar disorder and placed on medication. A few years of shorter hospital stays followed while I fought to regain my equilibrium. With the help of intensive psychotherapy, I was able to return to work.

The thing is, I had “Cadillac” health insurance. I never had to wait for a hospital bed. I never had to fight over a bill, although psychotherapy was not covered.

Things are different today. Patients with psychosis often languish in emergency rooms for days and even weeks, waiting for a hospital bed. People trying to access individual therapy or substance abuse treatment face months-long waiting lists. Right-wing state legislatures deny trans kids medical treatment. Meanwhile, the suicide rate is up and teenagers report greater feelings of depression and anxiety. Social media tells girls they are fat and sells nihilism to boys.

A major contributor to the current crisis is the closing of psychiatric hospitals across the country in the 1970s. The advent of powerful antipsychotic drugs made it feasible to treat more patients on an outpatient basis. Unfortunately, the community mental health model that was supposed to take over was never adequately funded. As a result, openly psychotic individuals are left to wander the streets, unmedicated and uncared for.

Insurance companies introduced “managed care” in the 1990s to cut costs and increase profits. They reduced benefits and set time limits for treatment. And they refuse to cover psychological well-being at the same rate as other medical issues.

Jails have become the new psychiatric hospitals as many mentally ill folks without resources are arrested for things like “disturbing the peace.” With mental illness increasingly criminalized, the stigma worsens for a population that has few advocates.

Society can do better. People need to demand that our taxes be used to rebuild the social safety net that has been relentlessly shredded since Ronald Reagan’s time. We need funds for affordable housing. We need social workers and case managers and addiction counselors to support the ability of chronically mentally ill folks to function in the community.

As capitalism continues to decline, the pressure increases on each of us. The demand for therapy and substance abuse treatment is off the charts, along with the need for more psychotherapists, counselors, drug and alcohol rehabilitation programs, and school psychologists. But it’s important to remember that the trick is not to adapt to a crumbling system, but to change it.

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